Too often, however, that's not the case.
A study published in the new issue of the Journal of the American Geriatrics Society reveals that many home-care agencies hire random responders to Craigslist postings and send them into the homes of seniors suffering from dementia. Still more agencies conduct no criminal background checks or drug tests, and routinely lie to clients about the experience and training of their staff.
In the study, which was funded by the National Institute on Aging of the National Institutes of Health, researchers posed as customers to survey the hiring practices of 180 agencies nationwide.
“People have a false sense of security when they hire a caregiver from an agency,” Dr. Lee Lindquist, an associate professor of medicine at Northwestern University Feinberg School of Medicine and the lead author of the study, said in a statement. “There are good agencies out there, but there are plenty of bad ones, and consumers need to be aware that they may not be getting the safe, qualified caregiver they expect.”
Lindquist, a geriatrician, has seen unqualified caregivers up close in her practice at Northwestern Memorial Hospital in Chicago. “Some of the paid caregivers are so unqualified it’s scary and really puts the senior at risk,” she says. She cites, for example, the illiterate caregiver of a 103-year-old patient: The caregiver confused her own medications with her patient's and ended up giving the wrong medicine to the senior.
Poorly trained caregivers can also endanger patients through neglect. This can include failing to feed them properly or to get them out of bed enough, which can lead to precipitous weight loss and pressure ulcers, Lindquist says. Patients can also be vulnerable to abuse from untrained caregivers who lack the temperament to work with people living with dementia.
Lax Home-Care Hiring Practices and Limited Supervision
According to Lindquist, only 55 percent of the agencies contacted by her researchers performed federal background checks. Many checked criminal records within their own states, but that's insufficient, says Lindquist: "Someone could move from Wisconsin to Illinois and could have been convicted of abusing an elder adult, or theft or rape, and the agency would never know." Moreover, only about a third of agencies reported doing drug testing, a clear risk if drug abusers were put in a position that would give them access to an elder's prescription medications.
When it came to hiring, 58.5 percent of the agencies relied on applicants' own assessments of their skills. The candidates were rarely asked to prove they could do what they promised. Only about a third of agencies did any caregiver testing, though some claimed to use "The National Scantron Test for Inappropriate Behavior" and the "Assessment of Christian Morality Test." “To our knowledge, these tests don’t exist," Lindquist says.
Once caregivers are in patients' homes, they are indifferently supervised. Lindquist found that only about 30 percent of agencies sent supervisors into homes at least once a month to evaluate the quality of care. Many instead relied on "client feedback" for evaluations, which is typically understood to mean depending on patients or families to report errors made by home-care aides. But families are not generally around regularly to make thorough observations, and, as Lindquist puts it, “How do you expect a senior with dementia to identify what the caregiver is doing wrong?"
The National Private Duty Association, a home-care agency industry, issued a statement disputing the study's conclusions. “Once a caregiver is hired," it said, "our guidelines encourage extensive orientation, care training, supervisory visits, caregiver exams and ongoing safety training."
Lindquist urges caregiver employers to be vigilant. “These agencies are a largely unregulated industry that is growing rapidly with high need as our population ages," she says. "This is big business with potentially large profit margins and lots of people are jumping into it. The public should demand higher standards."
How to Make Sure You're Hiring Qualified Caregivers
Lindquist advises families to ask home-care agencies how they recruit caregivers; whether they do criminal background checks or drug screening; what skills, including CPR, caregivers must demonstrate before being hired; and how the agencies evaluate caregivers in the field.
If you're interviewing home-care candidates on your own, the Family Caregiving Alliance suggests asking the following questions (and observing the candidate interact with the family member for whom he or she will be providing care):
- Where have you worked before?
- What were your duties?
- Can you give me two work-related references and one personal reference?
- How do you feel about caring for a disabled person or a person with memory problems?
- Have you had experience cooking for other people?
- How do you handle people who are angry, stubborn or fearful?
- Do you have a car? Would you be able to transfer someone from a wheelchair into a car or into a bed?
- What days and hours would you be available? How many hours per week?
- Is there anything in the job description that you are uncomfortable doing?