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Who's Helping Your Parents?

Charles and Katsu Bradley of Tacoma, Wash., were well into their 80s and suffering from different levels of dementia when they hired a home health aide to help with their daily tasks. Within a year, the Bradleys were bankrupted by the home care worker, who drained their bank accounts, applied for a reverse mortgage on the family home, purchased a new home for herself in Charles Bradley’s name and stole all of Katsu Bradley’s jewelry. All told, the thief bilked the Bradleys of nearly $300,000.

Unknowingly, the Bradleys had hired a convicted criminal to watch over them. The couple died within a month of each other in the summer of 2008, weeks after the caregiver’s scheme was uncovered.

The Bradleys’ three children now live with the regret that they allowed their parents to open their home to someone who seemed caring and dedicated but in reality had a single goal: to take everything the Bradleys worked so hard for all their lives.

“Had we known about [the caregiver’s] past, had we done a background check on her, we would have had some inkling of her nature and her background,” says Carol Moye, one of the Bradleys’ daughters. The caregiver had been convicted of petty theft three years earlier, but “she enamored herself to my father and did pull the wool right over our eyes.”

Unexamined Caregivers

The Bradleys’ plight is not unusual. It’s one of a growing number of instances of health aides and other caregivers using their position to swindle older people out of their life savings. But families aren’t helpless. A new report from the AARP Public Policy Institute examines the effectiveness of screening caregivers before they’re hired. The report, “Safe at Home,” concludes that criminal background checks, thorough employment screening that includes reference checks, and drug testing can keep many such scoundrels away from the people they seek to victimize.

That’s where the Bradley children erred. They simply trusted their parents’ favorable opinion of the caregiver. The children had a good relationship with their parents. Moye, 57, called her mother each evening, and she and her sister took turns visiting every other weekend. But instead of acting like employers and asking the caregiver hard and uncomfortable questions, the daughters went along because the worker seemed to be doing a good job.

Moye regrets not doing her own research. “Get these people checked out,” Moye says. “It’s better to find out there’s nothing there than to find out later that there was. You might think you don’t want to embarrass somebody, or go to the expense, or maybe it made you feel awkward, but do it anyway. Somebody has to protect the people who can’t protect themselves.”

An Uneven Process

Paid home health aides can be contracted by Medicaid or through private agencies, or else they are hired directly by an individual or family through an ad or other casual method. There are 900,000 such employees earning an average of $10.18 per hour, according to the U.S. Bureau of Labor Statistics.

Most caregivers who assist older people in their homes have no ill intentions, according to Naomi Karp, strategic policy adviser at the AARP Public Policy Institute and one of the lead researchers on the report. “We’re not trying to make this sound like there’s a huge number of bad apples out there. But we don’t want people to have a false sense of security either.”

Those few troublemakers are the reason why Medicaid requires that states set screening standards, though there is no federal requirement for background checks. Forty-six states and the District of Columbia require varying levels of background checks as part of screening processes. Louisiana, Montana, North Dakota and Nevada do not. State law regulates private home health care agencies, and each agency has its own screening method. When people hire privately, screening is their own responsibility.

To gauge the effectiveness of background checks, AARP’s researchers looked at a pilot study sponsored by the Centers for Medicare & Medicaid Services (CMS) conducted in seven states to determine whether FBI background checks helped prevent criminals from becoming caregivers.

With this process, caregiver applicants must submit a fingerprint to the FBI, which then checks through all state, federal and international databases to determine criminal history. During the pilot, 78 percent of applicants passed the background check; 4 percent were disqualified because of the findings. The remaining 19 percent withdrew their application before the background check could be completed, deterred perhaps by the test that would fail them.

Although FBI background checks are considered the gold standard, they are not foolproof, the AARP report warned. Because elder abuse issues are under-researched, there are no statistics for how many criminals the checks fail to screen out.

Not only that, many people who commit crimes against older people are never prosecuted, says Carol Vaughn, attorney for the Bradley family, who has more than 20 years’ experience with elder abuse cases. Without convictions, she says, those names will never raise a red flag.

Gaps in the System

Based on the success of the CMS seven-state pilot study, there is an effort in Congress to include a provision for improving state criminal background checks within health care reform legislation. Background checks and smart hiring of caregivers will likely become more important over the coming years.

Currently, 17 percent of people over age 65 require assistance with activities of daily living such as bathing, cooking and cleaning, according to the “Safe at Home?” report. The boomer population is expected to double by 2030, while the likeliest pool of home health aides—women ages 25 to 54 with little education—is stagnant.

In an ideal world, all home health aide applicants would submit to an FBI background check before they are assigned to a care job. But that system, which requires the applicant to submit her fingerprint for analysis, can be costly at $19.25 per test and time-consuming, especially for municipalities that screen hundreds of applicants. In the AARP survey, the median processing time for an FBI check was 15 days, but 25 percent of checks took longer than a month. A person who needs immediate care may not be able to wait.

Hiring for the Home

That means many older people and their families are left to their own devices. Most of them lack the experience to screen aides “because most people are not employers,” says attorney and registered nurse Carolyn Rosenblatt, author of The Boomers Guide to Aging Parents: How to Choose a Homecare Worker. “Naiveté and lack of a discerning ability will stop elders from sniffing out a bad one. This is the trusting, handshake generation. This issue makes me shudder,” she says.

Adult children should assert themselves in hiring a caregiver, even if their parents resist, says Rosenblatt. She also suggests using a home health aide agency that does thorough, nationwide background screenings and advises the client to question every piece of supporting material the potential caregiver or agency provides. “Don’t trust the resumé completely, because people lie on resumés,” Rosenblatt says. “It happens every day.”

Rosenblatt also recommends not only calling the references, but finding out a little about them—they could be a friend or relative of the caregiver—and perhaps meeting in person. Even for a caregiver referred by Medicaid, the state agency’s background checks may not be as thorough as desired. Additional checking is not out of line. Calling previous employers, asking for drug testing and even a credit report can further screen applicants before a hiring decision is made.

Internet-based companies also provide background check services, for a fee. But these searches usually leave gaps because not all states make their crime data available, says AARP’s Naomi Karp.

“You can’t be too careful,” Rosenblatt says.

Justice on Hold

To date, no criminal charges have been filed against the caregiver in the Bradleys’ case. She walks free, with no record of the crimes she committed other than the court findings of a civil suit. Nothing is preventing her from pulling the same con on another unsuspecting family.

That is one reason why the Bradleys’ children, at considerable personal expense, chose to file a civil suit against the caregiver. The judge found in the family’s favor and ordered nearly $300,000 in restitution paid. The family doubts they’ll ever see the money. They are now working to persuade law enforcement to aggressively pursue the case.

“We have no proof, but we believe she has done this more than once before and that the families she took advantage of were not in position where they could do something about it,” Moye says. “But she doesn’t know this family. We’re going to go into debt trying to find some justice for my mom and dad and our family.”

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