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Behind Closed Doors

The Risky Business of Home Care

Hiring nonmedical home-care workers is rife with potential peril for unwary families because of poor oversight in many states and little training for workers who are charged with caring for a vulnerable segment of the population. What’s worse is that background checks to catch workers who have criminal histories often fall short.

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After her 91-year-old mother nearly died of a hospital-borne infection, Sherry Mulne hired a home-care agency in 2005 to supply caregivers to assist her mother with meals, household cleaning and other daily activities and allow her to remain in her Youngstown, Ohio, home. Mulne, 59, figured that she was being careful, because the agency that she chose was bonded and insured, and it screened its workers for criminal convictions.

But about 2 months after her mother began receiving care through the agency, Mulne’s family discovered that jewelry that Mulne estimates had a value of $50,000 was missing. A video camera later caught a worker who had briefly cared for her mother swapping the cache for $200 at a local pawnshop.

More than half of the jewelry eventually was located and returned to the family, but Mulne says she still has not recovered “tens of thousands” in damages from the agency. Her mother—although physically recovered—still mourns the incident.

“It changed my mother,” Mulne says. “She was devastated that someone would come into her home and do this.”

Many home-care agencies hire workers who do a good job of caring for elderly and disabled clients who might otherwise be forced to live in nursing homes. Even Mulne is quick to describe several of the workers who cared for her mother as “wonderful” and crucial to her rehabilitation. But, as Mulne discovered, home care is rife with perils for consumers—including theft by caregivers. It also has no federal oversight or national standards. Many workers have scant training, and dangerous gaps exist in systems that identify workers who have convictions for drug abuse or even violent crimes.

Another concern is the possibility that a caregiver could pursue or develop an inappropriate relationship with the client. By inappropriate relationship, we mean romantic or exploitative in a way that—after the caregiver earns the trust of the client—the caregiver could take advantage of the client. The caregiver could convince the client to purchase gifts for him/her, provide access to the client’s bank accounts or credit cards, or revise a will to put himself/herself in line for an inheritance. (Editor’s note: If such a situation has already happened, you should know that an elder-care attorney can help you to uncover the laws in your state that could serve as the basis for the dismissal of a caregiver who has overstepped his/her bounds and played on the emotions of the client for personal gain.)

Home Health Care: Funding Crossroads Ahead

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The bottom line is that you must shoulder much of the burden of vetting caregivers for your loved ones—even when agencies say they do that for you.

HELPING HAND. The aging of the U.S. population drives the growth of home-care services. By 2014, the number of Americans who are 85 years and older will swell to 5.9 million—up from 4.2 million in 2007—and reach 19 million by 2050, according to Census Bureau projections. Demand for home care presumably will grow accordingly. The number of home-care agencies has more than doubled to 25,000 from 12,000 over the past 10 years, according to William Dombi of National Association for Home Care and Hospice, which is a trade group for caregiver agencies. Today, 1 in 6 Americans over age 65 needs help with daily activities.

Families who are scattered across the country or work full-time increasingly hire caregivers to drive elderly loved ones to appointments, remind them to take their medications, assist with cooking and cleaning, or simply provide companionship.

Home-care workers are not hired to provide medical assistance. For that, people must hire home health-care workers, who are skilled nurses or who otherwise have been specially trained as caregivers. (See “Home Health Care: Funding Crossroads Ahead.") This story focuses on home-care workers, but it’s worth noting that—depending on the state in which you live or the agency with which you’re dealing—you’re likely to see home-care workers also referred to as personal care attendants, chore workers, homemaker companions or home-health aides, among other terms.

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