Friday, February 27, 2015

When Home Caregivers Kill the Elderly With Neglect

The lack of regulation for California's in-home support services program, which pays people to look after seniors or the sick, means many patients are left in dangerous situations.

stavros karabinas/Flickr/The Atlantic
Yolanda Farrell lay mostly paralyzed in a nursing home, unable to feed or dress herself, when her homeless daughter persuaded her to move out.

Linda Maureen Raye, who relatives say had been living in her car with her dog, used her mother’s Social Security to pay for a one-bedroom Riverside, California, apartment and took over as Farrell’s sole caregiver in 2010.

Over the next two years, according to police and court records, Raye took her elderly mother to the doctor once. As her mother’s health declined, Raye stopped cooperating with a nurse sent to advise her on preventing bedsores.

Yet in 2012, Raye was hired officially: She began collecting about $900 a month from taxpayers under the state’s in-home care program for poor people, according to law-enforcement authorities.

By the end of that year, Farrell, an 85-year-old former real-estate underwriter who loved to travel, had died of septic shock resulting from severe bedsore infections. Originally charged with murder, Raye, 60, pleaded guilty to elder abuse in September and was sentenced to 11 years in prison.

“She essentially neglected her to death,” said Riverside Police Detective Christian Vaughan, who investigated the case.

California’s frail elderly and disabled residents increasingly are receiving care in their own homes, an arrangement that saves the government money and offers many people a greater sense of comfort and autonomy than life in an institution. Yet caregivers are largely untrained and unsupervised, even when paid by the state, leaving thousands of residents at risk of possible abuse, neglect and poor treatment.

The move from nursing-home to in-home care is part of a massive shift across the nation, driven by cost-cutting and patient preference. In California, at least four times more elderly and disabled residents receive in-home care than live in nursing facilities—a rate that is only expected to rise as baby boomers age.

Many families either provide care for relatives without compensation or pay out of pocket for caregivers they find through word of mouth, referral agencies, or private companies. But a growing number of elderly and disabled people have incomes low enough to qualify for state-funded care under the In-Home Supportive Services program, or IHSS—the same one that paid Raye to care for her mother.

California’s $7.3 billion IHSS program is the largest publicly funded caregiver program in the nation. The caseload has more than doubled since 2001 and now serves about 490,000 low-income clients throughout the state.

Working behind closed doors for an average of about $10 an hour, these caregivers carry immense responsibility but are subject to little scrutiny, according to law-enforcement officials, elder-abuse investigators, senior-care experts, and court records. Their lapses sometimes lead to preventable injuries and death.

Many clients are too feeble or afraid to complain or ask for assistance. “We don’t know how many times Yolanda cried for help,” Detective Vaughan said. “She didn’t have a voice. She was deprived of that.”

An investigation into the IHSS program found that:
  • Training for caregivers is minimal and mostly optional. California doesn’t require training for everyone—even in CPR, first aid, or preventing injuries. By design, IHSS is not a medical program and caregivers are supposed to confine themselves to tasks such as feeding, dressing, or bathing. But some become ad-hoc nursing aides, helping to dress wounds and manage medications. The state requires caregivers receive training and authorization from physicians in these cases, but only about one in nine caregivers receives it, officials say.
  • Most clients in California, 73 percent, are related to their caregivers, up from 43 percent in 2000. The arrangements assume an inherent trust between client and caretaker—a trust that can go awry when the relationships are dysfunctional, abusive, or financially driven. While many states allow some paid family caregiving, most prohibit spouses from taking the job and some bar relatives entirely. California has no such restrictions.
  • Screening, though improved in recent years, has potentially dangerous gaps. State law requires criminal background checks and bars people from becoming caregivers if they have been convicted of certain crimes, such as elder and child abuse. But the IHSS program leaves the hiring to clients and gives them wide latitude. Felons convicted of robbery, rape, or assault can be paid caregivers if their clients get a waiver from the state. In the past four years, more than 830 people have received such waivers for caregivers convicted of serious offenses. “They can have criminal records, they can have drug addiction,” said Susan Strick, a prosecutor with the Los Angeles City Attorney’s office. “That’s a problem.”
  • Few incidents of abuse and neglect by IHSS workers are documented because authorities aren’t looking for them. County social-services workers are supposed to check on the clients once a year on the state’s behalf but are not primarily focused on the quality of care provided. Their main job is to determine whether clients are receiving the proper number of hours of care and whether their needs have changed. And because social workers are assigned hundreds of clients each, their visits are frequently brief—as short as 30 minutes a year.
Counties are also supposed to report to the state “critical incidents”—potential neglect, abuse, or self-harm requiring immediate action. But reporting practices vary widely, yielding puzzling results. In fiscal year 2012-2013, for instance, not a single critical incident was reported among the 235,000 clients in Los Angeles, Orange, and San Diego counties, the three largest in the state. That same year, smaller Sacramento County reported 1,688 incidents—accounting for most of the problems reported statewide.   (Continue Reading)

Full Article & Source:
When Home Caregivers Kill the Elderly With Neglect


StandUp said...

It absolutely happens. People have good intentions but caregiving can be a bigger job than they expected.

And even though it does happen, I believe most people are safer and better taken care of at home.

Charlie Zins said...

I know the intent of this article is to bring awareness to the problems of caregiving at home. But, how often does this neglect happen compared to the neglect at a nursing home? Nobody's keep track of nursing home neglect. When people file complaints, those complaints are dismissed time and time again.