"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."