Homecare nurses - they come to care for your medical needs at home so you don't have to leave home to get care. Home nursing care has kept many an older person out of the hospital or a nursing home.

Home care nurses travel from patient to patient, ministering to people with an enormous variety of medical needs. Some of the homes they visit are immaculate, eat-off-the-floor clean. Others are awesomely dirty. Talk to a visiting nurse and you'll hear some hair-raising stories.

We don't often think about where the nurse (or the aide, or the therapist) has been before visiting our home, and what may be coming in the front door along with him or her. The best visiting health professionals give thought to where they've been, and take proper precautions. Others bear a strong resemblance to Typhoid Mary. They contaminate without being aware.

Typhoid Mary, as most people know, wasn't sick herself. She was a typhoid "carrier," who worked as a cook and kitchen worker back in the 1800s. Wherever Mary went, typhoid soon followed. Eventually she was corralled and the Mary-induced epidemic ended, but not before many people became ill. Some died.

An oblivious home care nurse and her medical bag could be the "Typhoid Mary" in your home.

Home care professionals are well aware of proper hand washing techniques, and most observe the proper protocols before touching a patient: They wash their hands thoroughly, and dry them on a clean paper towel.

The bag they carry their paperwork and equipment is another matter. That bag has been in tens to hundreds of clean to not-so-clean homes. In a recent study of the outside of these bags, most were found to be positive for Gram Negative Bacteria, E-coli, Pseudomonas, Methicillin Resistant Staphylococcus aureus (MRSA), and a long list of other, less familiar nasties.

While you wouldn't expect your home care nurse to put her shoes on your furniture, your counters or on your loved-one's bed, without thinking and for convenience that's exactly where many nurses will place their bags. So medical equipment bags are even more likely than shoes to be contaminated with "bugs" from other homes.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommends that traveling healthcare professionals carry newspaper with them. They are instructed to place a clean piece of newspaper under their bag before placing it on the floor (always on the floor, never on any other surface). They should discard this newspaper in the home as they leave. In this way, they will be less likely to transfer organisms from their bags to the homes of other patients.

This is excellent advice. However, being human, some home care nurses may still put their bags where they shouldn't, and clean newspaper is one more thing nurses have to remember to carry with them.

The easiest way to be sure your visiting nurse observes the recommended medical equipment bag rules is to keep a supply of clean newspaper in the room where your "patient" will most often be seen. On the first visit by every nurse, therapist or aide, simply say cheerfully, "I've put a pile of clean newspapers over there for your bag." It's non-confrontational, and right away the home caregiver will know, a) that you are very aware of what they are supposed to be doing; and, b) that you know a little something about homecare and the dangers of cross-contamination.

Advocating for an older person with health problems doesn't have to be an obvious effort on your part. Little things, like offering newspaper for medical bags, positions you as both an ally and a knowledgeable caregiver yourself. You won't have to say another word.