Just after 7 a.m., Barbara Bedillion begins her work shift with a smile, busy hands and friendly, purposeful inquiries of the anxious female in room 4317 and the blind woman just awakening in 4319.

	John Beale, Post-Gazette
	Nurse's aide Barbara Bedillion helps patient Edward Dunlay with personal items at The Willows Presbyterian SeniorCare in Oakmont. Ms. Bedillion is one of about 2.4 million Americans working in the direct-care field, most of them in long-term care.

"Did you sleep well? ... Are you hungry?" the nurse's aide asks in the course of greeting, washing and dressing her patients at Presbyterian SeniorCare's Oakmont nursing home, The Willows. Other residents continue sleeping soundly in rooms nearby.

Television news chatter from behind doors of a few early risers drifts into the fourth-floor hallway.

Ms. Bedillion, who arose at 5:30 a.m. in her Penn Hills home, is doing what she most enjoys: taking care of people. A lot of family members do that personal, sometimes dirty or exhausting work for the relatives they've known all their lives, but would never imagine doing it for strangers.

Some 2.4 million Americans, however, are direct-care workers similar to Ms. Bedillion. Most of them are in the long-term care field, and it's hard to imagine many doing it with the dedication she has for the past 15 years. Five days a week, the 58-year-old mother of two grown children gets eight to 12 residents out of bed, offering sturdy support as well as a gentle voice and reassuring stroke of their hair or arm when needed.

Presbyterian SeniorCare treats its nursing home aides better than many facilities, starting their pay at $10.25 an hour and providing full health care benefits and four weeks of vacation to experienced staff members such as Ms. Bedillion. But it is still one of those high-turnover jobs deemed unattractive to many people in the labor market.

Not Ms. Bedillion, who worked five years previously as a housekeeper in the nursing home, and before that as a retail clerk.

"I pretty much knew what was required of an aide, and knew it would be hard at times," she said. "I went into it with my eyes open, and I've never been sorry I made that change."

Ms. Bedillion credits Presbyterian SeniorCare for embracing an industry concept called "culture change," trying to provide a more homelike setting and autonomy for both residents and staff. She is assigned to the same group of residents each day, learning their needs well. They have more flexibility in when to wake, what to eat and how often to shower than is common in many institutions.

When a woman complains that her breakfast lacks the sausage she ordered, Ms. Bedillion declines to bring up that the resident always leaves sausage untouched, even though it's the reason another aide who took the patient's menu order the day before scratched out the meat request. Ms. Bedillion says outside the patient's earshot that it's best to put the food she asked for in front of her, and if she doesn't eat it, so be it.

"To me, the bottom line is the residents," said Ms. Bedillion, a thin, wavy-haired woman in Nike sneakers, who resembles the actress Blythe Danner. "I've always been a little sentimental about seeing my residents as individuals, always trying to do for them what I would want them to do for me, if our places were reversed."

It means she tries to converse with them as though they're mentally alert, even if they might not understand. If they're unable to respond, as was the case with one nonverbal, 97-year-old woman undergoing hospice care, she still speaks to them, pats them, compliments them on some aspect.

Her skill and demeanor led the nursing home's administration to have her mentor new aides. She also wins praise from relatives of patients who feel secure leaving them in her care.

"She's kind, she's empathetic, she's safe, and those are the attributes we look for," said Christie Overmyer, a registered nurse who oversees training of new aides. "She can visualize where the resident is, and meet the resident's needs at his level. She's not task-oriented -- when she's with you, you are her need. Nobody else is on her mind."

Ms. Bedillion moves throughout the day from helping people dress, to assisting them with toileting, to adjusting their bed and television or radio to suit them, to alerting the nurses on duty of problems they need to be aware of, such as one woman with above-average temperature who has vomited.

Among the eight patients she tends to most frequently, two are known as "completes," meaning they can do nothing for themselves.

Ms. Bedillion draws little reaction from them as she works.

Just down the hall, however, former construction worker Floyd Beltrame and onetime steel salesman Edward Dunlay chat animatedly with her from adjoining rooms.

"I've got Sweet Pea here taking care of me -- I'm in paradise," says Mr. Dunlay, a 76-year-old amputee who sits up to shave himself in his bed, using a wash basin, after reading the morning sports section that Ms. Bedillion passed along.

She plans to work several more years, but perhaps no more. The problem for the industry, and all the people who will need nursing homes in the future, is the already precious supply of Barbara Bedillions is declining. An AARP report said that while the U.S. population age 85 and older is projected to more than double between 2000 and 2030, the traditional caregiving population of women ages 20-54 is supposed to go up just 9 percent.

Ms. Bedillion suggests the increasing need for her occupation might be draw in good people to replace her and others.

"It's probably not something that's going to make you rich, but you're always going to be employed," she said. "It's going to be one of the more secure jobs you can have ... and sometimes the things you do for a resident means the world to them."