AARP Eye Center
When Denise Goodwin was hired to do housework and other chores in the San Diego home of Carolyn and Gerald Rabourn, she was welcomed with open arms. Carolyn, 91, in the final stages of lung cancer, was receiving home hospice care, and Gerald, 88, a lifelong tennis and health buff, was worn out from the daily grind of supporting and aiding his wife.
"He thought she was just wonderful," Bill Mitchell, deputy district attorney in San Diego, says of Gerald Rabourn's feelings for Goodwin. "He pretty much saw her as his angel."
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But after Carolyn died, Goodwin didn't just clean house; she started cleaning up. First, she absconded with nearly $600,000 in assets, including the title to the Rabourn home. Once the money was gone, Gerald Rabourn disappeared, too, under mysterious circumstances. Arrested in 2011, Goodwin was preparing to leave for a Mediterranean cruise; she was later charged with Gerald Rabourn's murder.
Every day, in millions of homes across the country, legions of home health aides are helping to meet the basic needs of America's older adults — cooking, cleaning and assisting with activities of daily living. Nearly 10 million adults age 65 and older receive care at home or in residential care settings other than nursing homes. That number is projected to skyrocket as the 65-plus population rises from 40 million today to more than 70 million in 2030, according to U.S. Census Bureau figures.
While many home health aides are stellar, others, like Goodwin, could be your worst nightmare. Financial, physical and emotional abuse is on the rise, if the number of arrest warrants and abuse complaints is any indication. Research suggests that 1 in 10 Americans 60 and over have experienced some form of elder abuse. But even as prosecutors around the country target elder abuse, many cases go unreported. Some older adults fear that if they complain, they will end up in a nursing home. Those with dementia may not be able to remember that they have been abused: Studies show that more than a third of people with dementia suffer psychological or physical abuse at the hands of people providing care. Meanwhile, their natural advocates and watchdogs — family members — often live hundreds or thousands of miles away.
Consider the case of Ruthann Jacox, a Tucson, Ariz., woman with multiple sclerosis whose only sibling lived in Pennsylvania. Never married, Jacox had hired an aide to provide care, who subsequently rationed her food and water so she wouldn't have to take her to the bathroom. Only after Jacox was hospitalized with bedsores down to the bone was the abuse ever reported to adult protective services. Jacox — a retired nurse — later died. Her aide got two years in jail.
An unregulated industry
Laura Mosqueda, M.D., is co-director of the National Center on Elder Abuse, a federally funded initiative that serves as a coordinating body and clearinghouse for research and training on elder abuse, neglect and exploitation. She points to the intersection of a growing elderly population with a burgeoning, virtually unregulated industry of home health care workers as the real culprit.
For starters, there are no federal regulations covering home-care workers, other than broad standards for care provided under Medicaid. Only about half of all states require home-care agencies to conduct any sort of training for their employees. Just 15 states require agencies to conduct periodic in-home reviews to make sure workers are doing their jobs. Most states require criminal background checks of home-care workers but do not require agencies to check records in other states.
One 2012 study published in the Journal of the American Geriatrics Society found that less than a third of home-care agencies screened their employees for illegal drug use, and just 16 percent tested for basic knowledge about providing care in the home. "The people who work [in homes] try their best, but the problem is they are not always supported by the agencies that hire them," says study coauthor Lee Lindquist, M.D., chief of geriatrics at the Northwestern University Feinberg School of Medicine. "The agencies will charge $50 or more an hour, but keep a lot of the profit for themselves rather than investing it in education, training and supervision."
Personal care aides and home-health aides are the nation's second- and third-fastest growing occupations, according to the U.S. Bureau of Labor Statistics. That has not led to higher pay or benefits for workers.
One in 4 home-care workers live in households below the federal poverty line, and a third lack health insurance, according to the Paraprofessional Healthcare Institute, a Bronx, N.Y.-based research and advocacy group. Long hours and low pay — the median wage is $9.61 an hour — contribute to high turnover and inconsistent care.
The role of the family
While they have their own troubling history of abuse, families remain the bedrock of home care to ailing seniors. AARP estimated in 2009 that more than 42 million family members provide care to an older adult. But there is also a growing care gap, as boomers transition from giving care to needing care themselves. Even among the most devoted families, strains are already developing.
The children of 99-year-old Peter Mazza exhausted the inheritance from their father's estate on private home care before turning to the New York Medicaid program. Family members continued to make daily visits to check on him, and even installed video cameras in his Staten Island home. They ended up with a horror show: A video from last April shows their father falling and breaking three ribs while reaching for his walker to go to the bathroom as his home aide watches impassively. Mazza was hospitalized and died two months later in a nursing home. The family has filed suit in the state Supreme Court in Manhattan.
"We were not a family that was not involved. That is the scary thing," says Carol Ann Mazza, who lived 10 minutes away from her father and who checked the video online over coffee as part of her morning routine. "We were involved and we were there every single day. Other than living there, there is nothing more we could have done."
A call for solutions
Across the country, lawmakers are starting to recognize the need to ensure better care for homebound seniors.