In last week’s blog, we discussed the difficulties that are being faced by Home Health Care Agencies as they try to keep up with the growing demand of a profession that offers minimal pay for maximum work. As a result, there are many entering the field with little or no experience and may not have the best interest of the client at heart, creating major problems for the agency managers and relatives.
Every day, millions of elderly clients are visited by home health care providers who help them meet some of their basic needs like cooking, cleaning and assisting with activities of daily living. By 2030, estimates are that the need of providers will increase dramatically as the 65 plus population will increase by nearly 75%, from 40 million today to 70 million. Yet, as we discussed last week, with providers being in short supply now, what will happen just eleven short years from now?
With all forms of elder abuse on the rise, hiring the right person to provider care is of paramount concern. Research indicates that 1 in 10 Americans over the age of 60 experience some form of abuse (although some research indicates the numbers are higher) and this will surely increase if recent police reports being filed are any indication. Many of those who are victims say nothing to avoid being placed into institutional care. To date, most of the abuse has occurred at the hands of a family member, but these numbers are rapidly changing.
“We know we have a problem with elder abuse in this country,” says
certified elder law attorney RJ Connelly, III. “In the past, it was usually a family member who was responsible, but this is changing. With the increase in outside help coming into the home, we are increasingly seeing abuse perpetrated by people providing basic care. It will certainly continue to increase.”
"When 25% of home health care workers live below the poverty level, a third of them lacking health insurance and most needing to hold down a second or third job to make ends meet, it’s no surprise that abuse and financial fraud takes place. Working with seniors suffering from dementia can be trying and when you add to that a tired or frustrated employee, the situation becomes a powder keg. And given the fact that they are providing a service by themselves with no supervisor present, well, we are seeing the results,” said Connelly.
Let’s take a look at some of the recent police reports regarding this problem.
Three employees of a Georgia senior car facility were arrested after allegedly making a Snapchat video of an elderly, disabled woman who had just suffered a stroke. Police said Jorden Lanah Bruce, 21 of Jefferson, Mya Janai Moss, 21, of Colbert and Lizeth Jocelyn Cervantes, 19, of Jefferson were employees of Brantley Senior Living when a video, entitled "The End," was allegedly made. The video was made inside a room at the facility while the women were supposed to be monitoring the patient until a hospice nurse arrived. Instead they made a video of themselves cussing, vaping and joking that she's about to die.
A home health care worker in Florida was accused of robbing a woman in her own home. The victim was injured while walking her dog and needed around the clock care. She called a provider named Continuum, a local home health care company who sent the employee over. The company then sent over Latosha Taylor to care for a heavily-drugged Finnegan who says for two weeks there were no obvious problems. “She seemed so friendly and so caring, like a caregiver should be," said Finnegan. But then Finnegan says she realized things were missing. The victim claimed the missing things included "jewelry, some silver coins we had in there. Credit cards. I was sitting in that chair the whole time and I couldn't get up." Taylor was arrested, and later charged with two counts of theft in St. Charles County.
A home health aide has been accused of abusing his elderly patient and the man's family said the entire ordeal was caught on a nanny cam. CBS 2's Alice Gainer reports.
In Pennsylvania, a McKeesport man was jailed after allegations were made that he raped a Greensburg woman who was a client of his home health care service. Greensburg police arrested Roy Marks and charged him with rape, involuntary deviate sexual intercourse, sexual assault, neglect of a care-dependent person and burglary in connection with the alleged assault at his client's Luzerne Street apartment. Marks is accused of letting himself into the apartment about 3:30 p.m. Feb. 2 and sexually assaulting the woman in her bedroom.
In Indiana, a home health care worker was jailed after police say she stole and cashed checks to herself from her elderly clients. Dominique Johns, 24, was charged with multiple felonies that included forgery and fraud on a financial institution. Police say three families that had employed Johns reported checks being stolen and cashed from the accounts of elderly family members in early November. The authorizing signatures on those checks, police say, belonged to neither the account holder or the power of attorney for the person. Later, a fourth family reported a similar incident that detectives were able to connect to Johns.
In New Bedford, Massachusetts, a woman robbed of mobility due to a spinal cord injury hired a young caregiver she had found on a state-sponsored caregiver website who was happy to take care of it all her needs. “She had experience, she was smart, she was clean, she could lift me up,” said the victim, who was further reassured because she knew some of the caretaker’s relatives. What she didn’t know was that her new personal care attendant had faced 15 criminal charges since 1997, including larceny, assault and battery, shoplifting, car theft, prescription drug possession, and check forgery. Over a four-month period, from February to May of 2016, the victim lost more than $20,000 in bank withdrawals and unauthorized credit card charges — one made at a sports bar. When she confronted the attendant, her answer was, “Yeah, so what?”
A home health care worker is caught on video abusing an elderly patient.
In Florida, two Vero Beach women, who were certified nursing assistants, were jailed for stealing more than $500,000 from elderly people they cared for in Indian River Shores. Chiquita McGee and Sophia Shephard (AKA Sophia Brown) were arrested Tuesday on charges for exploitation of the elderly, organized fraud and scheme to defraud a financial institution. Indian River Shores police say the duo convinced two elderly patients to open credit cards under McGee and Shephard’s name, linked to the victims' accounts, with an unlimited credit line. Police said the total amount for all fraud related to the case is at least $543,973. The pair also fraudulently obtained checks from the victims, police say.
In New York, a home health aide was charged with stealing a large amount of money from his elderly clients over the course of a couple of years to help fund lavish holidays in Florida, Broadway tickets, and much more. Winston Nguyen, 30, was accused by prosecutors of robbing a 96-year-old legally blind man and his 92-year-old wife. Mr. Nguyen allegedly began writing personal checks to himself from their account and took off with over $335,000 of the couple’s money.
In Dallas, Texas, a home health care worker may be a serial killer. 45-year-old Billy Chemirmir is charged with capital murder in one death, but police say he may be linked to multiple home health care-related deaths in Collin and Dallas counties. Chemirmir is being investigated for several home health care-related deaths in Dallas, Plano and Richardson, according to a police source. They say Chemirmir was on the scene of several deaths of people who had home health care and were thought to have died of natural causes.
In Stoughton, Massachusetts a woman was arrested and charged in what police called "one of the worst cases of elder abuse" they have seen. Police found Marie Bois Belfort, 75, in a basement bedroom with the thermostat off and the thermometer reading 51 degrees. "She as in a small basement room that could be equated to a cell," said Stoughton police Deputy Chief Rob Devine. The woman had bed open sores and was dehydrated and malnourished, police said. "Probably some of the worst that we have seen. These officers have been here for 20, 25 years and a lot of them have never seen conditions like what this woman was being kept in," Devine said. The woman's caregiver, Sandra Calixte Lucien, a 48-year-old registered nurse from Stoughton, was arrested. The woman was found in the basement of Lucien's Paradise Circle home.
These are just a handful of the thousands of cases coming to light with the increase in seniors choosing to age in place. It is important to remember that the overwhelming majority of health care workers are honest and hard-working people, but hiring the right agency and the right person can help avoid horror stories like the ones you just read.
So how do we go about finding that right person? Attorney Connelly has some thoughts on this.
“The first thing to do is take an honest assessment of what is needed for care. What are your loved one’s likes and dislikes, what do the medical providers recommend in terms of care and does the person you are speaking to have experience in this work?”
"We all have this dream that we can provide care for our loved ones, but can we really? We have jobs, children to raise and other responsibilities. This can stress out the most loving person. And do we have the skills needed to provide this care? If time is spent with a senior who needs help, immediate family suffers, and if time is spent with the family, care for the senior suffers. This can lead to stress, guilt, fractured relationships and resentments. Seeking outside help makes sense but finding the right person or agency continues to be the problem," said Connelly.
Attorney Connelly says that hiring an independent caregiver through an ad may be less expensive than going through an agency but it is fraught with dangers.
“Hiring a person through a personal ad means you have alot of work to do. Background checks need to be done, references need to be called and remember, you will be that person’s supervisor. Hiring a person and putting them in place without any oversight opens the door to abuse -- you must continue to be an active participant. This also includes the supervision of medications, something many people don't think about.”
Don Drake, a presenter for Connelly Law Offices’ community education series discussed the need to monitor medications when in home providers are present, for reasons that may surprise you.
"When I speak about monitoring medications with family members who are seeking home health care help, they think I am referring to their loved ones getting the right dosage at the right time. Sadly, there are other reasons to be aware of how medicine is handled," said Drake.
“I had a licensed medical professional who provided oversight of med
dosing for the residents at a program. One evening, one of the residents became very ill and was rushed to the hospital after going into anaphylactic shock. The only allergy he had that we were aware of was penicillin, which obviously was not one of the meds he was taking. He was, however, on multiple opioid pain medications due to severe spinal stenosis but nothing new had been prescribed."
"While at the hospital, blood was drawn and the results were shocking – they found no opioids in his system. When we checked into his medications, we found that the pain meds were replaced with look alike penicillin tablets. The resident nearly died as the result of a provider’s drug addiction!"
“With the focus on the opioid epidemic, we are now finding an increase in similar complaints within home health care," said Drake. "If you are employing an outsider who will be handling medications, check the meds regularly and know what they look like. But it’s not just the opioids you need to be concerned with, there are other medications regularly prescribed to seniors that are abused at alarming rates. These include benzodiazepines, muscle relaxers, seroquel and gabapentin. Having a lock box or using a pharmacy that employs med packs can help in deterring the diversion of drugs, but only if you are checking them on a regular basis. There are no real fool-proof methods, but regular oversight can catch a problem early.”
To Drake’s point, here is a story out of Missouri:
Platte County prosecutors said charges were filed against a home health care worker following an investigation by the Food and Drug Administration’s Office of Criminal Investigations and the Platte County Sheriff’s Department. According to court documents, authorities were contacted when caregivers of a 95-year-old woman noticed that her hydrocodone tablets had been replaced with 500 mg acetaminophen tablets. The investigators discovered through the video surveillance that the caregiver had accessed the locked box two separate times, both in a seemingly secretive manner. The caregiver was charged as a repeat offender, having faced drug charges in the past and was facing up to 10 years in prison for each of the theft and possession charges.
“In order to avoid problems, it really comes down to doing your homework and asking the right questions,” said Attorney Connelly. "This is true when hiring an independent contractor or using an agency." To this end, Connelly Law Offices has developed a list of questions to ask when attempting to choose the right home health care agency:
What type of person and personality do you look for when filling the position? What kind of experience do you require? What type of reference checks are conducted?
Is there an education requirement for employment?
What certifications do you require and how do you insure that these employees keep their certifications current? For instance, are they required to attend CPR and first aid updates annually?
Do you do criminal background checks and/or drug screens? If so, are they in-state checks or nationwide checks? This question is important because some individuals who have committed crimes in other states move around to avoid detection. Many in-state background checks do not pick up crimes in other states - even in the age of the internet.
What type of training do you provide and what are the requirements for attendance? Are employees suspended for not meeting the agency requirements for training? How many hours of training do you require annually and in what areas?
Are employees required to do incident reports or other types of written documentation when a problem arises? Given the high turnover rates in the field, there needs to be a paper trail so new supervisory staff can keep track of problematic behaviors, activities and employees.
Do your job descriptions have physical requirements that are expected to be performed in that role and if so, how do you assess if the employee is capable of meeting those expectations.
What are your policies on providing care when a regularly assigned employee calls out sick or weather conditions such as snowstorms disrupt transportation.
If the senior or the family is not happy with the assigned employee, is there a transparent process in place for registering a complaint.
What is the supervision like? Are there written supervisions that allow for multiple supervisors to be aware of any complaints or problems with an employee? Are the supervisions done in a one-to-one setting or over the phone? Are there annual employee evaluations?
Are there regular visits to the home by the supervisor and by the supervisor’s supervisor?
What processes are in place to support employees who may be stressed or in need of support?
Do you have an employee handbook and a policy and procedure manual? Can perspective clients review the manual?
Attorney Connelly also offers this advice, “If you are hiring someone to come into your home, put cameras in the house and make the employee aware that they are present. A true professional will not be shaken by the presence of cameras and you can remind them that this level of security also protects them from any untrue accusations. Cameras provide a level of safety for all concerned."
“We also strongly urge loved ones to handle the senior's finances and if they cannot do it themselves, then turn it over to a fiduciary who offers daily money management services. Our firm offers this service and we have caught multiple cases of financial impropriety -- including relatives attempting to inappropriately withdraw money from the seniors account and scammers making fraudulent charges to credit cards. This service can identify suspicious activity early and stop fraud and financial abuse from occurring. We owe it to them,” said Connelly.
So, what does the future hold for home health care? Well...we better figure out soon because it is a need that is not going away.
“The bottom line is this,” said Attorney Connelly, “we need to insist that our politicians develop guidelines for this industry, including a requirement for better training, better supervision and of course, better salaries. If nothing is done, these jobs will go unfilled -- and as our senior population rapidly increases those who may love this work will turn to careers that offer better wages and benefits.”
“In the end, it’s not just about today's seniors, it's also about us – who will be there to care for us when we need help? Home health care jobs are a big part of America’s future and the choices we make today will be our future. Hopefully that's enough of an incentive to do what's right."
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.