By Deborah L. Shelton, Chicago Tribune reporter
August 12, 2012
Patrice Kadlec needed someone to help take care of her elderly father in his Oak Park home, and she needed someone fast. Kadlec works full time, and her father, who has Parkinson'sdiseaseand related dementia, was being discharged from the hospital the next day after treatment for bladder cancer.
Kadlec scanned a long list of service providers she had received from a local organization that helps senior citizens. With panic setting in, she picked one.
Nearly a year later, she has changed agencies three times. She encountered a paid caregiver who begged for money, a worker who left her father in soiled adult diapers all day and another who was argumentative to the point of being scary.
"I was panic-stricken a lot of the time wondering what was taking place in my absence," Kadlec said.
People who hire caregivers for elderly family members might assume that agencies conduct drug testing and thorough criminal background checks, and that prospective employees have been painstakingly vetted to make sure they are experienced, competent and trained for the job.
But that is not always the case, according to a recent Northwestern University study that found many agencies do a poor job of making sure caregivers are safe, reliable and capable.
Among the study's findings: Some agencies recruit workers from Craigslist and place them in the homes of older people with dementia without checking for criminal convictions or assessing whether they are qualified. Many agencies don't do national criminal background checks or drug testing. And some agencies lie about testing caregivers' qualifications, don't require experience in the job and don't provide training.
"Our results brought forth some alarming issues among agencies that hire caregivers," said lead author Dr. Lee Lindquist, a geriatrician and associate professor of medicine at Northwestern University Feinberg School of Medicine. "There are good agencies and bad agencies, and consumers need to be educated about what to look for."
The study looked at five states with large populations of older adults — Illinois, California, Arizona, Florida and Wisconsin — plus two other states, Indiana and Colorado. Lindquist said she did not break out the results by state, but Illinois ranks in the middle in terms of legal requirements.
Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, which licenses agencies that supply paid caregivers, said the state stays on top of potential problems.
"Illinois has some of the more stringent regulations for home-services agencies among the states," she said. "Illinois laws require home-services agencies to be licensed by (the department) and to provide criminal-history background checks for all employees. Home-services workers must pass a competency evaluation provided by the agency, successfully complete a training program and complete a minimum of eight hours of training each year."
The state health department said it bars people from working as caregivers if they are convicted of certain crimes that show up on an Illinois State Police background check, unless they apply for a waiver and it's approved.
Yet criminal background checks don't always pick up all the information that consumers might want to know about a potential caregiver. For example, although theft is on the state's list of disqualifying offenses, a theft conviction would not show up on an Illinois police check if it was a Class C misdemeanor or the person was sentenced to supervision. If the conditions of supervision are met, the court can dismiss the charges.
Paid caregivers include a large category of workers such as personal care attendants, private duty attendants, home care aides, direct care workers and sitters. In Illinois, training must cover patient confidentiality, basic hygiene and basic infection-control practices, recognition of emergencies and proper response, and personal care skills for clients, including bathing, shaving, dressing, feeding and remembering to take medication, among other tasks.
The National Private Duty Association, which represents more than 1,300 home care companies, acknowledged that some agencies don't do a good job but took issue with the study, criticizing it for painting all agencies with the same brush.
"The study's findings are not representative of the hiring, training and supervisory practices of the members of the NPDA who adhere to high standards and industry best practices," the organization said in a written statement.
Its member agencies employ, train, bond, insure and supervise their caregivers, who provide a variety of care, including homemaker services, companionship and home health care, the statement said.
Lindquist said the purpose of the study wasn't to vilify all agencies, because they serve a critical role.
"What we're trying to say is, don't go with the agency with the pretty website or a good story," she said. "You need to vet the website and what they tell you (over the phone) and look into it more."
Michael Doepke, who owns Home Helpers HomeCare in Hinsdale with his wife, Mary, said his agency goes beyond what state law requires. For example, Illinois requires only a criminal background check through the state police database, but Doepke said his agency also does a national check. The agency also does routine and random drug testing, he said.
"If you're going to put an unsupervised worker in the home of an older adult, you can't take any chances," he said. "You need to make sure you have somebody in there you can trust, who can make smart decisions and doesn't have a history that you don't know about. So we take time to do criminal background checks, check references and do two rounds of interviews."
Darby Anderson, division vice president of home and community services for Addus HealthCare Inc., based in Palatine, said most caregivers do an outstanding job, and his company works hard to ensure a high-quality staff.
But he said home care is socially undervalued work, which presents challenges for agencies when it comes to recruitment and hiring.
"Home care is not viewed as a profession. It's considered an entry-level, welfare-to-work type of job," Anderson said. "That's a challenge that we are trying to overcome while balancing limited reimbursement rates from state government and from what the market will bear in terms of a private pay rate."
For the study, published last month in the Journal of the American Geriatrics Society, researchers posed as consumers and surveyed 180 agencies about hiring methods, screening measures, training and supervision practices, and testing for competency. Some answers led to further research into state and federal legislation to verify the accuracy of the responses.
Among the findings: Some agencies reported that their employees received training at universities, but researchers later determined the schools were created by the agencies and not accredited by any educational association or commission.
Researchers also were unable to confirm the existence of some screening tests the agencies mentioned, including the National Caregiver Background Check, National Scantron Test for Inappropriate Behaviors, Assessment of Certification of Christian Morality and Quality Seal of Assurance Online Program Completion.
One agency, according to the study, said it did not give drug tests to its employees because "most of our caregivers are Filipinos, who tend not to use drugs, smoke or drink." Another said it was barred from drug-testing employees before they were hired, even though no law prohibited the agency from doing so.
Instead of pushing for more regulations, which Lindquist said could drive up the cost of home care, she suggested that consumers could exert market pressure through selecting caregivers only from high-quality agencies.
"If we can educate consumers, it's one way to bring up the standards," Lindquist said. "If there's more demand for high-quality agencies, the agencies will have to improve what they are doing."
After Kadlec's bad experiences, she said she feels fortunate to have found Devy Mearday, of Northwest Home Care, whom she considers conscientious, hardworking and trustworthy — a "breath of fresh air."
"I like doing this," Mearday said recently as she sat with Kadlec's 89-year-old father, Edward Anderson, in his home. "I like people. I like working with older people because they depend on you. … It makes me feel like I'm needed."
But even this happy ending illustrates the complexity of the issue. Although Mearday passed her criminal background check, she has had brushes with the law. Charged in 2006 with misdemeanor property theft, Mearday was ordered to complete 10 days of community service, court records show. The charges later were dismissed and did not become part of her record. An arrest warrant for Mearday is still active after she did not attend court hearings regarding a 2010 misdemeanor theft charge, according to police and court records.
Illinois State Police said neither matter would show up on its background checks. Mearday, of Chicago, said she was not aware of the warrant until told by the Tribune but would get the matter resolved.
"It was something I got caught up in, and it has nothing to do with my ability to do my job," she said of her 2010 arrest. "Good workers aren't perfect people."
Cheryl Aguirre, home care manager at Northwest Home Care, said Mearday presented excellent references when she was hired as a certified nurse's aide about a year ago and has been a valued worker since.
"We follow all of the regulations that the state of Illinois puts forth," she said. "If the state says she's OK to be employed and she's doing a good job, I have no problem."
Informed of Mearday's legal history, Kadlec said the struggle to find a good caregiver has made her less inclined to be judgmental, something she said others will better understand when they are in her situation.
"If we lost her, it would make a huge difference because she far outshines anyone we ever had ... and I would never find anybody like her," Kadlec said. "It might sound strange, but (her arrest record) doesn't matter."
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