Clara Migden was 84 in 2001 when an osteoporosis-related fracture landed her in the hospital. Her daughter, Hedy Migden, a doctor in Albany, N.Y., who lived nearby, turned to an agency for round-the-clock health aides to assist Clara as she recovered in her apartment.
But before long, Hedy received a distress call from her mother: Clara’s place had been ransacked, and the home aide, “Tracy,” was AWOL. It soon became clear she’d been out making bank withdrawals using Clara’s debit card—and that “she” was actually a “he” with a criminal past that included a stabbing, prostitution and crack cocaine offenses.
The aide spent 18 months in prison for robbing Clara, and the agency, Long Island-based All Metro Health Care, settled the Migdens’ breach-of-contract lawsuit for $170,000 in January. Court testimony showed that All Metro failed to do a criminal background check on the aide. Neither All Metro nor its attorney returned calls seeking comment.
Home aides, who help with such tasks as preparing meals and bathing, are key for people who want to live independently despite the infirmities of old age. While national fraud data are lacking, the rapid growth in home care is raising concern among lawmakers and consumer advocates that without strict safeguards, the homebound are at risk. “Most agencies and aides are reliable, but we still need to be concerned about this,” says Elinor Ginzler, AARP director for livable communities and co-author of AARP’s Caring for Your Parents: The Complete Family Guide. “Obviously if you need care at home, you’re in a vulnerable position.”
In an ongoing probe, the New York State Attorney General’s Office has uncovered what it calls “endemic” fraud in home care. In August, for example, it announced guilty pleas from two New Yorkers who sold fake certificates for completion of state-required training to hundreds of aides.
Regulators are seeking better protections. In one pilot program, when seven states used newly coordinated state and federal databases to do background checks on applicants for jobs in long-term and home care, 3.7 percent were deemed potentially dangerous and denied jobs. U.S. Sens. Herb Kohl (D-Wis.) and Pete Domenici (R-N.M.) have proposed similar procedures at the federal level.
Meanwhile, experts advise taking precautions to hire the right home health agency and aide:
* Check them out. Some agencies are Medicare-certified. For agencies not Medicare-certified, check to see if they’re licensed, a requirement in some states. The Joint Commission and the Accreditation Commission for Healthcare Inc. provide voluntary credentialing for agencies. Get referrals from geriatric care managers or doctors. Meet the aide before he or she starts, and talk to other families who have worked with the aide.
* Ask questions. Does the agency do background checks? How does it handle turnover? Are aides salaried? Do they get benefits? How are they monitored?
* Stay in touch. Make unannounced visits at different times of the day or week. Ask the patient in private about the care, observe how the aide and patient interact, and engage the aide as a partner.
* Complain. For problems with a Medicare-certified agency or aide, call your state’s home health hotline or the Medicare hotline at 1-800-633-4227. To learn more, go to www.medicare.gov and search “Home health.” For issues with other agencies or aides, contact your state health department and Better Business Bureau (www.bbb.org).
Katharine Greider, who lives in New York, writes about health and consumer issues.