Important Article on Hiring a Caregiver Privately

This article is so important, I copied it to paste here instead of just giving you the link. If you are considering private employment of a caregiver – PLEASE ask the questions at the end of the article. There is not much control over private industry home health.

Dangerous Caregivers for Elderly: Agencies Place Unqualified, Possibly Criminal Caregivers in Homes of Vulnerable Seniors, Study Suggests
ScienceDaily (July 10, 2012) — If you hire a caregiver from an agency for an elderly family member, you might assume the person had undergone a thorough criminal background check and drug testing, was experienced and trained for caregiving. You’d be wrong in many cases, according to new Northwestern Medicine research.

A troubling new national study finds many agencies recruit random strangers off Craigslist and place them in the homes of vulnerable elderly people with dementia, don’t do national criminal background checks or drug testing, lie about testing the qualifications of caregivers and don’t require any experience or provide real training.

“People have a false sense of security when they hire a caregiver from an agency,” said lead study author Lee Lindquist, M.D., an associate professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital. “There are good agencies out there, but there are plenty of bad ones and consumers need to be aware that they may not be getting the safe, qualified caregiver they expect. It’s dangerous for the elderly patient who may be cognitively impaired.”

The study will be published in the July 13 issue of the Journal of American Geriatrics Society.
Lindquist, a geriatrician, personally has seen a number of bad caregivers accompanying patients in her clinic. “Some of the paid caregivers are so unqualified it’s scary and really puts the senior at risk,” she said.

Lindquist had a 103-year-old patient whose illiterate caregiver was mixing up her own medications and the patient’s medications. The caregiver was giving her own medicines to the elderly patient by mistake. Another patient had dropped 10 percent of her weight and developed pressure ulcers because her caregiver was not properly feeding her or getting her out of bed.
“It was easier for the caregiver to sit and watch TV and not to try to feed the patient or move her,” Lindquist said. Several agencies surveyed in the study actually made up names of screening tests they claimed to give their job applicants.

“We had agencies say they used a ‘National Scantron Test for Inappropriate Behavior’ and an ‘Assessment of Christian Morality Test’,” Lindquist said. “To our knowledge, these tests don’t exist. If you’re not a smart consumer, you won’t recognize which agencies are being deceitful.”

Identifying the good agencies from the bad is difficult because many agencies have slick websites and marketing campaigns, she added. “It’s a cauldron of potentially serious problems that could really hurt the senior,” Lindquist said. “These agencies are a largely unregulated industry that is growing rapidly with high need as our population ages. This is big business with potentially large profit margins and lots of people are jumping into it.”

For the study, researchers posed as consumers and surveyed 180 agencies around the country about their hiring methods, screening measures, training practices, skill competencies assessments and supervision. They found:

Only 55 percent of the agencies did a federal background check.
“A number of agencies don’t do a federal background check or look at other states besides their own,” Lindquist said. “Someone could move from Wisconsin to Illinois and could have been convicted of abusing an elder adult or theft or rape and the agency would never know.”

Only one-third of agencies interviewed said they did drug testing.
“Considering that seniors often take pain medications, including narcotics, this is risky,” Lindquist said. “Some of the paid caregivers may be illicit drug users and could easily use or steal the seniors’ drugs to support their own habits.”

Few agencies (only one-third) test for caregiver skill competency. A common method of assessing skill competencies was “client feedback,” which was explained as expecting the senior or family member to alert the agency that their caregiver was doing a skill incorrectly.
“How do you expect a senior with dementia to identify what the caregiver is doing wrong?” Lindquist asked.

Many agencies (58.5 percent) use self-reports in which they ask the caregiver to describe their own skills. “In the hunt for a job, some people may report they can do tasks that in reality they have no idea how to do,” Lindquist said. “We found agencies sending caregivers out into the seniors’ home without checking.”

Inconsistent supervision of the caregiver.
Agencies should send a supervisor to do a home visit to check on the caregivers more frequently initially and then at least once a month. But this only occurred with 30 percent of the agencies.
“Amazingly, some agencies considered supervision to be asking the caregiver how things were going over the phone or when the employee stopped in to get their paycheck,” Lindquist said.
With seniors wishing to remain in their own homes, paid caregivers fill an important role.
“The public should demand higher standards, but in the short term, seniors need to be aware what explicitly to look for when hiring a paid caregiver through an agency,” Lindquist said.

Below are Lindquist’s 10 questions to ask an agency prior to hiring a paid caregiver:

1. How do you recruit caregivers, and what are your hiring requirements?
2. What types of screenings are performed on caregivers before you hire them? Criminal background check — federal or state? Drug screening? Other?
3. Are they certified in CPR or do they have any health-related training?
4. Are the caregivers insured and bonded through your agency?
5. What competencies are expected of the caregiver you send to the home? (These could include lifting and transfers, homemaking skills, personal care skills such as bathing, dressing, toileting, training in behavioral management and cognitive support.)
6. How do you assess what the caregiver is capable of doing?
7. What is your policy on providing a substitute caregiver if a regular caregiver cannot provide the contracted services?
8. If there is dissatisfaction with a particular caregiver, will a substitute be provided?
9. Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?


4 responses to this post.

  1. As a nurse who has owned a home care agency providing personal care and light homemaking to clients as well as having worked for home health companies providing skilled care let me add a few ways to be sure the questions you ask will yield results.

    If a home care agency is providing HCBS or personal care services and receiving any form of federal or state reimbursement (Medicaid) they are required by the state to have certain checklists completed for their employees. Each state varies in their competency lists and requirements, but you can find out through the state Attorney General’s office or sometimes the licensure governing board. In MT that is the Board of Nursing.

    If an agency is providing skilled services (nursing etc.) the best way to know your caregivers are qualified on any level (nursing, PT, OT, ST or care aides) is to check again with the licensing board. In Montana those who work for a Medicare or Medicaid certified home health agency (meaning they accept those payors for payment of services on qualifying clients) personal care aides must be certified and have taken training courses as a Certified Nursing Assistant as well as further training and competency testing as a Home Health Aide. Other states have similar guidelines.

    Your best bet is to deal with agencies certified and licensed by the state and federal guidelines. In those agencies a review of the care plan must be done on a regular basis and there is mandatory supervisory oversight by a licensed nurse or social worker (depending on the state).

    As a family member, neighbor, friend, or associate with a senior citizen in any capacity and you feel the individual is not getting proper care report it immediately. Every state has a hotline for reporting abuse, suspected abuse, or any concern regarding quality of care. Once you make a report (which can be anonymous) the agency will receive an unannounced visit from state surveyors who will assess employment records, client care records, licenses, and compliance with safety standards.

    Let’s protect our vulnerable populations and keep the agencies honest and in the business of providing quality care.

    Thanks for a great post on such an important issue.


  2. When reading this article and the response from “startingthedialogue” please recognize that what this RN and former HHA owner states is true………..for Montana. However, very little of the comment applies to the state in which I live. I believe the intent of the article was to be general in nature, giving you guidelines by which to make serious decisions that only you and your family can.

    Oftentimes, I hear from family members who have read a comment much like the one above, thinking that every state functions the same. They do not. When an unannounced audit/visit does not happen as requested, they are sorely disappointed and I get this misinformed person on my phone wanting to know why.

    The reason why is that most all rules, regulations, policy and auditing must go through a process by which your state legislature will approve or deny and then be signed by the Governor of your state. If that does not happen, then it is not a part of your state’s cadre’ of services, stop-gaps, or policing.

    Your best bet is to find out what is allowable in YOUR state.


  3. Reblogged this on Mom & Dad Care and commented:
    Thanks kellidd for posting. Very important piece.


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