Stranger in the house

Most home health aides offer vital care to the frail and aged. But some have other designs, leaving too many clients vulnerable to theft and worse. It is a crisis largely unseen, one which state authorities have done little about.

By Linda Matchan, Globe Correspondent September 15, 2018

NEW BEDFORD — At first, Sarah Estrella seemed like the answer to Deborah Lesco’s prayers.

An old spinal injury had slowly robbed Lesco of her ability to walk, leaving her lower body racked with pain that only medical marijuana could ease. The 68-year-old former special education teacher got around in a wheelchair and needed help with her daily activities.

Luckily, Lesco had found this “nice, sweet girl” on a state-sponsored caregiver website who was happy to take care of it all. “She had experience, she was smart, she was clean, she could lift me up,” said Lesco, who was further reassured because she knew some of Estrella’s relatives.

 

What could go wrong?

 

Everything. When she hired Estrella in September 2015, Lesco didn’t know 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.

Soon, strange things began to happen. Lesco started getting late charges on credit cards that she couldn’t find. Her rent check bounced and she discovered she had a $2,500 tab at Target even though she’d never opened an account there. Over a four-month period, from February to May of 2016, Lesco estimates she lost more than $20,000 in bank withdrawals and unauthorized credit card charges — one made at a sports bar.

Horrified, she confronted Estrella and accused the younger woman of using her credit cards. “She didn’t deny it,” recalled Lesco, who said Estrella was “sneering and sarcastic. . . . She was like, ‘Yeah, so what?’ ”

Estrella pleaded innocent to charges of larceny and credit card fraud in the spring of 2016.

PEOPLE LIKE SARAH ESTRELLA are the stuff of baby boomers’ nightmares as they increasingly rely on an army of nurse’s aides, personal care attendants, and others to help them remain in their homes deep into old age. The category of personal care aide is projected to add more jobs by 2026 than any other occupation in the country, according to the Bureau of Labor Statistics.

Many of these aides enter the home as virtual unknowns, undergoing no background check and receiving little, if any, training. Consumers often know more about what aides cost than whether they can be trusted. And with demand for home aides so high, those seeking care are simply relieved to find someone to take the job.

Theirs is an honorable calling, and many home aides feel gratified to help clients in their time of need. Some become dear friends, almost family members.

But sometimes they help themselves — to their clients’ money, belongings, medications, even identities. It can be a predator’s dream career.

Astonishingly, there is almost no government safety net to protect people seeking home care from these dangerous strangers. Unlike nurses — or even hairdressers or manicurists — home aides don’t need a state license. Anyone can call him or herself a home care worker in Massachusetts and work privately, though state law mandates that home care agencies perform criminal background checks on workers. Agencies typically offer greater accountability and supervision of aides than workers hired privately, but they’re too expensive for many families.

There are also essentially no credentials required to work as someone’s caregiver, just a willingness to do tedious, sometimes backbreaking work that typically pays $11 to $13 an hour. Personal care attendants hired through a MassHealth program, like Sarah Estrella, are merely required to attend a state-run three-hour orientation session. Additional training is entirely optional.

Massachusetts lags in required training for workers seeking to be certified, too — among New England states, it is tied with Connecticut for the fewest hours mandated.

Adding to the general lack of oversight, major websites where customers seek home aides, such as Craigslist or, until recently, the state-sponsored Rewarding Work site, don’t screen workers or check the criminal backgrounds of job seekers at all, making it easy for people such as Estrella to slip through.

Crimes committed by home aides against their clients get little public attention in Massachusetts, in part because no single agency is charged with keeping track of the home aide workforce. Consequently it’s impossible to know, or even estimate, how common it is for Massachusetts home aides to victimize their clients.’’

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Stranger in the house