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Home Health Aides: We Need to Raise the Bar

While this survey uncovered far too many "bad apples," home health aides like Zena give us a benchmark to strive for as we seek to fill a ballooning and all-important need: caring for our loved ones as they age.
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A Troubling Study on Eldercare

Finding qualified, compassionate people to care for our aging parents, spouses and ourselves as we grow old is an undeniable challenge of our era. Americans are living longer, and those with chronic, debilitating conditions are increasingly likely to remain at home -- which translates into a soaring need for home- and community-based long-term care in the coming decades.

While most of this care is expected to be provided by unpaid family members, a recent National Health Statistics Report (NHSR) from the Centers for Disease Control and Prevention (CDC) cites projections that employment of home health aides will rise by 50 percent between 2008 and 2018 -- from 921,000 to 1,382,000.

This raises the vital question: Who are these caregivers we bring into our homes, and how do we know we can trust them?

A disturbing new study in the Journal of the American Geriatrics Society reveals that we as a nation -- and those of us in the health care industry -- have to do better. The study, led by Lee Lindquist, M.D., of Northwestern University Feinberg School of Medicine, finds that many agencies recruit random strangers off Craigslist and place them in the homes of elderly people with dementia, do not perform national criminal background checks or drug testing, lie about testing the qualifications of caregivers, require no experience and provide no real training. We agree with the researchers that this is unacceptable.

Separating the Good from the Bad

"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," said Dr. Lindquist.

As I've argued before, the job of a home health aide cannot and should not be done by just anybody. Home health aides perform a vital job on the front lines of health care for vulnerable seniors and others who want to live at home but are not stable enough to be on their own. Talented, well-trained aides are the best offense for keeping at-risk individuals out of the hospital and living safely and as comfortably as possible in their own homes.

When you hire a home health aide, you should expect a person who is compassionate, trustworthy and knowledgeable -- which is why I recommend hiring an aide who is insured, certified and properly trained. My agency, Partners in Care, for example, requires aides to pass comprehensive background checks as well as random drug testing. It also gets references and runs fingerprint checks through the FBI database.

Of the 180 agencies researchers surveyed in the Northwestern study, 55 percent conducted a federal criminal background check and only one-third of agencies interviewed had administered drug tests. If you don't have time to check on the aide, make sure the agency is reputable and has done its checking. Don't assume -- ask. And be specific.

Dr. Lindquist provides an excellent list of 10 questions to ask an agency before hiring a caregiver. They include:

  • What types of screenings are performed on caregivers before you hire them? Criminal background check -- federal or state? Drug screening?

  • Are the caregivers insured and bonded through your agency?
  • Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How, where, and how frequently?
  • Partners in Care, too, offers a library of home care tips, including questions to ask to give you peace of mind when hiring an aide.

    Training Is Critical

    A well-trained home health aide is much more likely to notice changes in a patient's behavior or well-being and act immediately and appropriately. I am a strong advocate for rigorous screening and training of home health aides, and I find it unconscionable that regulations for this life-or-death industry vary state by state (including, woefully, none in some states). New York has relatively strict requirements for certification -- a minimum of 75 hours of training -- and Partners in Care requires even more, at 114 hours.

    Training helps the aide perform the job, of course, but it also helps agencies identify candidates who are truly committed, reliable and well-suited to home care. Like Frankie Fisk, who was so worried about the man that he cared for during New York City's massive subway strike a few years ago that Frankie woke up at 5 a.m. the morning of his shift, took a cab as far as the strike limits would allow, walked the rest of the way, and arrived for work one hour early.

    Regulating a Growing Industry

    This study serves as an important wake-up call, both to individuals seeking home care and to the home care industry. As experts in the field, we must recognize that people searching for home care are often overwhelmed by need and emotion and frustrated by lack of consistent information, regulation and benchmarking.

    Our lawmakers need to make this a priority, and laws should be changed to regulate home care services on a national level. Training, screening and supervision of aides aren't optional; they need to be non-negotiable table stakes.

    The survey uncovered some truly frightening incidents, such as 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.

    But there are countless examples of good caregivers -- compassionate, well-trained and well-suited -- who work hard to help aging seniors live as full a life as they can. Take Zena Foster, whose care for 104-year-old Shirley Herskowitz goes above and beyond attentive physical care. "Zena doesn't allow my mother to be any less than she is, the best that she is," says Mrs. Herskowitz's daughter, Eleanor Brown. "She keeps her in touch with the world and helps her achieve as much as she can at this age. If my mother forgets something, Zena will say, 'Come on now, you know that.'"

    While this survey uncovered far too many "bad apples," home health aides like Zena give us a benchmark to strive for as we seek to fill a ballooning and all-important need: caring for our loved ones as they age.

    For more by Marki Flannery, click here.

    For more on caregiving, click here.