Tuesday, July 24, 2012

Who's taking care of Mom?

The July Journal of the American Geriatric Society has a disturbing article - "Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults."

Researchers at Northwestern School of Medicine posing as prospective clients seeking a caregiver for an elderly adult relative, contacted 180 agencies and asked about hiring, screening, and supervisory practices. Their findings aren't pretty!

67% of the agencies required experience, but this was often assessed by self-report. 62% checked references. 92% checked criminal background within the state, but no agencies checked other states, meaning that someone who had been convicted elsewhere would appear to have a clean record. English language proficiency was assessed via the interview, and no agencies assessed health literacy (ability to understand physician recommendations, dosage schedules, and so forth). 31% conducted drug screening. 7% verified citizenship or visa status. Training and supervision were very limited. The researchers conclude:
The screening and training practices in use by caregiver agencies are highly variable and often of poor quality. Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregivers.

Home care for the elderly has the makings of a perfect storm. It brings together vulnerable elderly with a marginalized population of poor, often immigrant, workers. This is a setup for exploitation - sometimes of the elderly by the "caretaker," and sometimes of the caretaker by the agencies that hire them.

When my father, who lived 1,000 miles from where I was, lost his vision and entered the early stage of cognitive decline, my cousin needed a place to live and moved in with him. He provided eyesight, companionship, and driving. My father provided lodging and paid for food. It was a true win/win situation.

But this kind of good luck is the exception, not the rule.  Agencies, like the 180 surveyed in the study, are filling a vacuum in our fragmented society. Unfortunately, as the study reveals, being hired by an agency is not a reliable stamp of approval.


eric said...

And what will the political solution to this perfect storm be? Will it be prioritizing hands-on care over developing me-too statins? Will it be more respect and remuneration for the people who deal with "the messiness of human life"? No. It will be regulation, regulation, regulation.

Jim Sabin said...

Hi Eric -

We both know that in the current economic configuration for U.S. health care, me-too statins and the like will continue to be born in profusion. And you're right that more regulation is the likely outcome of attention to the area of home care. The authors of the article I wrote about comment on (a) the potential value of sensible regulation but (b) the increased cost more regulation would entail. Your lament reflects the risk that bad regulation can create time-consuming, mind-numbing bureaucratic Mickey Mouse demands.

With the growing over 65 population, there's a lot of money to be made in home care. We're sure to see a series of scandals in the next few years, and these will lead to demands for more regulation. I hope that people like yourself - who work with homebound elderly - will influence the way that process unfolds.

As to compensation - one reason home care is an attractive business opportunity is the spread between how much can be charged for the services and how little it's possible to pay poor people who can't find other work. Not surprisingly, the turnover rate among employees is very high.