Roselle Tena-Trello was a young lawyer 12 years ago wondering whatever happened to all of the frail people who came out of hospitals and returned home, possibly lacking the support they needed to fully care for themselves.

	Darrell Sapp, Post-Gazette
	Roselle Tena-Trello: "I think people work in home care because they want to make their own schedules and it's a one-on-one situation."

That question led the Mt. Lebanon resident, now 39, to start Renaissance Home Care, one of dozens of services in Allegheny County, hundreds in Pennsylvania and thousands across the country to assist elderly individuals in their homes. With sharp growth in the number of people in their 80s and older, which is the population most likely to need services to avoid institutionalization, the number of home care agencies has also proliferated.

Referrals from hospitals, doctors and others give Ms. Tena-Trello's staff of 13 nurses, 10 home health aides and 10 therapists about 150 people to visit during the week. Their care includes assistance with dressing, bathing and other personal needs; help in regaining the ability to perform basic tasks; and medical checkups needed to monitor ongoing health or provide treatment after illnesses and injuries.

Medicare, the Allegheny County Area Agency on Aging and private insurers provide the bulk of the funding for the various clients from Allegheny County, and some adjacent ones, who are served by Renaissance. Its office is on Bower Hill Road in Mt. Lebanon, but the nurses and aides travel by car or public transportation wherever the clients are.

As the daughter of two physicians, Ms. Tena-Trello figures it's appropriate for her to be doing health-related work instead of her original profession of law. Among her challenges is finding and retaining the staff needed to do all the work in a field not known for high rewards.

Nurses earn about $28 to $45 per home visit, and aides, who have more turnover, start at about $8 an hour.

"I think people work in home care because they want to make their own schedules and it's a one-on-one situation," Ms. Tena-Trello said. "A nurse is not having to take care of 10 patients at once. You're not over-inundated by patients."

The burgeoning home care field has a wide range of operators. Those like Renaissance, which include skilled nursing care and have contracts with the Area Agency on Aging, have regulations and oversight at the county, state and federal levels.

Other operators that offer nonmedical home assistance on a private-pay basis -- such as housekeeping, shopping and meal preparation -- are largely unregulated. Consumers often find those through word of mouth and hope their instincts lead them to someone trustworthy.

Darlene Burlazzi, deputy administrator of the Allegheny County AAA, said the agency provides consumers with a choice of home care providers for both its Options program of lottery-subsidized home services, and the more comprehensive Waiver program of Medicaid-funded home services.

Renaissance is on both of those lists, and thus is among the couple dozen of providers receiving county evaluations of their work. It must perform criminal background checks on employees and provide them training before they're left on their own with clients.

The county develops a "compliance rate" for the home services by evaluating such factors as whether its workers show up on time to do the job they're supposed to do, and Renaissance has had a 97 to 99 percent compliance rate, Ms. Burlazzi said.

At www.medicare.gov, the Centers for Medicare & Medicaid Services provides comparisons of the performance of Medicare-certified home health agencies.

The federal Web site's data, for instance, suggested Renaissance's patients do better than state and national averages at improving bladder control, are about average at becoming better at getting in and out of bed, and are worse than the norm at regaining walking ability.

Renaissance works only with patients funded by government programs or insurance, as opposed to clients looking to pay someone privately for home assistance with basic tasks. But for both basic and more skilled care, the number of operators has been increasing.

The Pennsylvania Health Department lists 367 certified home health agencies, or 53 more than was the case five years ago.

"Most patients go with those they know, like if they've dealt with a certain nurse before," Ms. Tena-Trello said. "Ultimately, it's the patient's decision -- that's what the patient should know."