Your Home Caregiver Could Be Untrained or Worse

Creatas Images/ThinkStock(NEW YORK) — A study from Northwestern University finds that agencies that hire caregivers to work with the elderly rarely require or provide training. And, more troubling, many fail to do national criminal background tests or drug testing.

Federal rather than state background checks ensure that criminal offenders — sexual or otherwise — can’t move between states to find work.

The study, which was published July 13 in the Journal of American Geriatrics Society, found that some agencies even recruit from Craigslist and lie about the qualifications of caregivers who will be paid to work in the home, putting those who are most vulnerable at risk.

“My patients are mostly in their 80s, 90s and 100s and so many have dementia and caregivers,” said lead study author Dr. Lee Lindquist, a geriatrician and associate professor of medicine at Northwestern University Feinberg School of Medicine.

“Some are doing an outstanding job and the seniors look perfect,” she said. “Others have pressure ulcers and are losing weight, depressed and falling apart. The caregivers are popping gum and playing with their iPhones and could care less.”

People have a “false sense of security” when they work with an agency, according to Lindquist. “It’s kind of like the wild west — anybody from a plumber to an architect can set up shop. It’s getting worse and it’s scary because more people want to stay in their homes longer and it’s the best place for most seniors.”

More than 12 million Americans receive home health care from 33,000 providers, according to the National Association for Home Care and Hospice.

Nursing homes are regulated because they accept Medicare dollars, but regulations on home care varies from state to state, according to Lindquist.

“It’s a private pay market,” Linquist said. Patient families must pay between $25 and $50 an hour for in-home care, and but the agencies take a large chunk, leaving the aide with an average of $7.25 an hour. Private aides, without any middle-man, make $15 to $20 an hour.

Northwestern researchers interviewed 160 agencies, posing as a person who needed a home caregiver and asking about hiring, screening, training and competency assessment.

Only 55 percent of the agencies said they did a federal background check and only one-third said they did drug testing, according to the researchers.

Most agencies relied on self-reporting of experience and only one-third tested applicants for skill competency and waited for “client feedback,” the study found.

Study author Lindquist said she has seen examples of neglect in her own medical practice. She said she had a 103-year-old patient whose illiterate caregiver mixed up her own medications and those of the patient.

Another woman dropped 10 percent of her weight and developed bed sores because she was not being properly fed or taken out of bed.

Lindquist’s study found that 84 of the agencies she contacted were no longer in business. They had slick websites, but their phones were dead.

“When they make money, they leave the industry after three to five years,” she said. “Bosses change or they get out of the field.

“Most people almost try to sell a product and tell us what they thought we wanted to hear,” she said.

Some cited phony tests when asked about background checks, including one agency that said it used a “National Scantron Test for Inappropriate Behavior” and an “Assessment of Christian Morality Test” — neither of which exists, Lindquist said.

When asked about drug testing, some agencies told researchers, “Oh no, unless you pay for it.”

As for supervision, only 30 percent of the agencies did a once-a-month home check.

“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.

To find a reputable agency, Linquist advises talking to friends and family and get “word of mouth” to get recommendations for good and bad agencies. Private duty nursing associations can also be helpful, but they represent only a small number of agencies and “cannot vet everyone.”

Lindquist said ultimately, laws must change to provide more regulation of the industry, but she hopes her study will educate consumers who can put more market pressure on the bad agencies to get out of the home care business.

“We need to expect better things from an agency and a caregiver,” she said.

“A lot of people spend more time picking out a car than an agency,” Lindquist said. “Think about it — this is your loved one, your mom, your dad, your grandma. That should mean something.”

Copyright 2012 ABC News Radio