Article: Credentials for in-home caregiver aides? | ProHealth Fibromyalgia, ME/CFS and Lyme Disease Forums

Article: Credentials for in-home caregiver aides?

ProHealth CBD Store


New Member
Ensuring safe, quality home care
Caregiving firms provide crucial aid to elderly but are unregulated by state
by Ginger Rough - May. 24, 2009 12:00 AM
The Arizona Republic

Every day, tens of thousands of Arizona's most vulnerable seniors rely on in-home caregivers to look after them in their declining years.

These tireless aides spend hours helping with tasks the elderly can no longer do by themselves, from light housekeeping to dressing and bathing, and are often their only regular contact with the outside world.

But this burgeoning sector of the health industry remains virtually unregulated.

And as it grows rapidly in tandem with an aging population, there are concerns that it's employing too many unqualified workers and attracting a few unscrupulous ones who prey on the infirm by defrauding and abusing the very people they are paid to take care of.

Arizona is one of more than 20 states that don't license or monitor businesses that provide non-medical home care for seniors.

There are no rules that require the men and women who spend hours each week alone with elderly residents to know basic first aid or CPR. Nor are there any laws on the books that compel home-care companies to carry out criminal background checks on applicants, meaning ex-convicts can end up as caregivers.

"Anyone in the state can hang up their sign and get business cards and say, 'I have a home-care agency,' and the consumer doesn't know who is going to be going into the house or what background they have," said Gail Silverstein, president of Care Corner Personal Services, who is pushing for licensing laws.

"These are people who are going into the homes of vulnerable adults. There's a lot to be concerned about," she said.

About 1,700 complaints of elder abuse, neglect and exploitation were logged in 2008 by the Arizona Adult Protective Services office involving paid caregivers.

The category includes both in-home health workers and those at assisted-living facilities.

Silverstein, who is part of a grass-roots operation that plans to push for a bill during the 2010 state legislative session to regulate in-home caregivers, believes increased oversight could help cut down on some of the problems.

Previous attempts to pass a law have failed because of costs and other issues.

Caring hands

For many, unlicensed "private duty" caregivers are a godsend.

These aides cook, run errands, provide companionship and perform personal-care tasks such as dressing, showering and grooming - all things that allow seniors to stay in their homes.

They also take much of the burden of care off the adult children.

"My brother and I, we cover about 60 hours a week between the two of us," said Kim Schofield, who hired Silverstein's company to help care for his elderly parents, Kenneth and Gladys. "But we need someone there around the clock. When I am not there, I don't worry. I feel really confident that these people are capable of doing the job."

Gladys died earlier this year, but caregivers, including Martha Bosquez, continue to provide companionship for Kenneth, who is bedridden.

Bosquez spends her weekends with him, arriving at 6 a.m. for two 12-hour shifts.

"She's among the best," the 92-year-old Kenneth said. "She always has a big smile. . . . She comes in, feeds me, bathes me.

"Without the help, there's no way we could have stayed here."

But even as the industry continues to expand to meet a growing demand for home care, finding the right person remains difficult.

Gay Boise learned the hard way that it can be a struggle to find a reliable caregiver.

It never occurred to her to inquire about background checks when interviewing companies to look after her 85-year-old mother, Mae.

"I didn't know to ask for that," she said. "I just sort of assumed they did it. To me, this is a medical field."

Mae is frail and relies on a walker. She needs round-the-clock assistance and help with basic tasks.

Boise hired and dismissed three caregivers for her before finding one she liked and trusted.

"The other companies . . . their workers . . . they just didn't treat my mom right," she said. "They didn't want to do much, and there were other problems. I'd notice medications missing - that kind of thing."

Now, Gay has grown to think of her mother's current caregiver, Gracie Bassett, as a member of the family.

Bassett, who works for Comfort Keepers, comes five days a week. Some mornings she helps Mae with her exercises. She also may help her bathe and put on makeup. The two do crafts together, read, work puzzles and play cards.

They giggle and tease each other a lot.

"We're busy all day long," Bassett said. "We find lots of things to do."

Industry growth

Aides like Bosquez and Bassett aren't regulated by any state licensing board or agency, the way that physicians, nurses and other practitioners who work directly with patients are.

Many in the business want that to change - before a tidal wave of Boomers starts needing care.

Currently, 13 percent of the U.S. population - or 37.9 million people - are seniors, according to census data released earlier this month. But agency projections show that nearly one in five U.S. residents will be 65 or older by 2030.

And recent U.S. Labor Department projections suggested the number of personal and home-care aides would jump by 50 percent between 2006 and 2016, which makes the need for state oversight even more important, said Debbie Seplow, president of Home Instead Senior Care of Greater Phoenix.

"This is really about protecting these seniors," said Seplow.

In Arizona, it's hard to tell how many people work in the field because no one keeps track of such individuals or even the companies they work for.

But Seplow and others think there are about 400 such firms operating in the state, up from about 70 a decade ago.

"That's the guesstimate, and there could be an untold number of individuals doing this that would be even harder to uncover," she said.

Seplow, who has been in the non-medical care business for 13 years, also serves as legislative chairwoman for the Arizona Chapter of the National Private Duty Association.

The organization is working to pass laws regulating home-care workers in all 50 states; currently only 27, including Nevada, Florida, Illinois and Texas, license such agencies, she said.

Colorado recently passed legislation that takes effect Jan. 1.

Abuse and neglect

Although the majority of caregivers provide critical help and often much-needed companionship to the elderly, a few exploit their position of trust.

In February, the state Attorney General's Office reached a plea agreement with a 22-year-old in-home caregiver in Tucson who defrauded an elderly couple out of thousands of dollars.

The woman looked after a 90-year-old man suffering from Alzheimer's and his 87-year-old wife who was blind and used a walker. She stole, with the help of an accomplice, the man's checks and drained more than $48,000 from the couple's bank account.

She was sentenced to seven years of probation for fraud and conspiracy and ordered to pay back the money she took.

Anne Hilby, a spokeswoman for Attorney General Terry Goddard, said that while the Attorney General's Office believes the absence of state laws regulating in-home caregiving is a problem, new regulations aren't a cure-all.

"We do feel the lack of licensing contributes to the incidents of abuse and neglect we've seen," Hilby said, "But it won't solve the problem on its own."

Many caregivers aren't employed by any agency or hire themselves out as a housekeeper, she said, making them especially difficult to track and regulate.

Last year, the Centers for Medicare & Medicaid Services, part of the U.S. Department of Health and Human Services, released the results of a three-year pilot program to determine the best way to screen health-care workers.

Of the more than 204,000 individuals vetted across seven states, nearly 7,500, or about 3.6 percent, were disqualified because of a criminal history. Another 38,000 applicants voluntarily withdrew from the process, and the experts evaluating the program said they believe some were deterred by the existence of a background check.

In March, the Patient Safety and Abuse Prevention Act was introduced in the U.S. Senate, with the goal of expanding the pilot program to create a comprehensive nationwide system of background checks for anyone working with seniors in a long-term care capacity.

What's next

For now, in the absence of state and federal regulation, many Arizona-based companies are opting for self-licensing.

Silverstein's Care Corner and Seplow's Home Instead fingerprint their workers, perform background checks and require CPR and first-aid competency. They both also run specialized employee training programs.

Phil Senff, who owns five Comfort Keepers offices in the Valley, including the one that employs Bassett, also carefully screens his caregivers and puts them through a rigorous training program.

"My dad is 84 years old," Senff said. "I am not going to put someone in your mom's home or your dad's home that I wouldn't put in my own dad's home."

In addition, Care Corner, Home Instead and Comfort Keepers are among the companies that have contracts with the Arizona Long Term Care System, which means their workers are also monitored by the state.

ALTCS, a Medicaid-funded program, provides in-home care to more than 16,000 area seniors, and the agency keeps tabs on caregivers by watching them at work and interviewing seniors about the service every 90 days.

To qualify, seniors must earn less than $2,022 per month and require a "nursing home level of care," said Alan Schafer, a manager in ALTCS Division of Health Care Management.

But long-standing caregiving companies say a state statute is necessary to protect the seniors who are paying out-of-pocket or through private insurance.

They would like to see that law, at a minimum, require fingerprinting and other criminal background checks.

Previous legislative efforts have failed for a variety of reasons, Seplow said.

These include disagreements over whether the individual caregiver or just the private-duty care company should be licensed, and concerns about the cost of running such a program. Any monitoring or oversight would likely be performed by the Department of Economic Security or the Department of Health Services.

"The last time, it sort of fell apart at the 11th hour," Seplow said. "Moving forward, we're trying to seek out all the stakeholders, get them involved. There are a lot of states that are looking at introducing legislation this year or next.

"We want to be one of them."