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Home Elder Care: Buyer, Beware

By Randy Dotinga
HealthDay Reporter

THURSDAY, July 12 (HealthDay News) -- Many home aides who care for the elderly in the United States have no training and don't undergo stringent background checks or drug tests, a new study finds.

In some cases, the caregivers get no supervision from the agencies that hire and place them. Most agencies questioned said they recruit aides from advertisements, including Internet sites such as Craigslist, and some agencies appear to lie about their employees' screening or education, the researchers found.

"There are good caregivers and good agencies, but consumers need to understand that there are questions that you need to ask," said study lead author Dr. Lee Lindquist, an associate professor at Northwestern University's Feinberg School of Medicine. "You need to be discerning about whom you hire."

Her study looked at the qualifications of caregivers who visit the homes of the elderly to assist with daily activities such as dressing and meal preparation. "These are not nurses," Lindquist said. "These are caregivers, private duty attendants. They don't need any medical training."

They may be expected to help with nutrition assistance, housekeeping, and scheduling medical appointments. But legally, these often low-paid workers can't administer medicine, although they can remind their clients to take their pills, she said.

Without adequate quality control measures, the frail elderly may be vulnerable to abuse, fraud or neglect, experts say.

For the study, researchers posing as consumers hiring caregivers questioned 180 caregiver agencies in Illinois, California, Florida, Colorado, Arizona, Wisconsin and Indiana -- states with large populations of elderly residents.

The study is published in the July 13 issue of the Journal of American Geriatrics Society.

Slightly more than half -- 56 percent -- of the agencies said they performed federal background checks and about one-third tested workers for drugs. Training ranged from nothing to seven days; in some cases, there was no supervision by the agency.

Two-thirds of the agencies said caregivers could assist in financial transactions, such as bill-paying.

Some agencies appeared to lie about their screening system. One agency said it relied on an assessment called the "National Scantron Test for Inappropriate Behaviors," while another mentioned "Assessment of Certification of Christian Morality." Those don't seem to exist, the researchers said.

Although laws vary by state, the caregiver agencies don't tend to be regulated, Lindquist said, whereas nursing homes, whose services can be funded by Medicare, are regulated.

According to background information in the study, the typical aide is a recent female immigrant, earning $7.25 an hour on average or, for live-in help, $5.44 an hour.

Beth Kallmyer, vice president of constituent services at the Alzheimer's Association, agreed with Lindquist that consumers need to ask plenty of questions when seeking elder care.

It's also a good idea to pay surprise visits when the caregivers are working. "Drop in and see how it's going," she said. "These unannounced visits are a really good way to help people feel comfortable about what's going on."

The study authors also recommend asking caregiver agencies the following questions:

  • How do you recruit caregivers, and what are your hiring requirements?
  • What screenings are performed before you hire a caregiver? Criminal background check? Federal or state? Drugs?
  • Do the aides have CPR (cardiopulmonary resuscitation) certification or any health-related training?
  • Are the caregivers insured and bonded through your agency?
  • What skills are expected of the caregiver you send to the home? Examples: lifting and transfers, homemaking skills, personal care skills (bathing, dressing, toileting), and training in behavioral management.
  • How do you assess the caregiver's capabilities?
  • What is your policy regarding substitute caregivers if a regular caregiver cannot provide the contracted services?
  • If you're dissatisfied with a particular caregiver, can he or she be replaced "without cause"?
  • Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How often?
  • Does supervision occur over the telephone, through progress reports, or in person at the home of the older adult?

More information

For more about caregivers, see the U.S. National Library of Medicine.

SOURCES: Lee A. Lindquist, M.D., M.P.H., associate professor of medicine, Feinberg School of Medicine, Northwestern University, Evanston, Ill.; Beth Kallmyer, M.S.W., vice president of Constituent Services, Alzheimer's Association, Chicago; July 13, 2012, Journal of American Geriatrics Society

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