An Home Health Management investigation recently conducted by Kaiser Health News suggests that despite the effectiveness of home care, there is still a large number of untrained staff members throughout the nation remain undertrained or lack the appropriate scrutiny of their performance. More specifically, the article brought California’s $7.4 billion dollar IHSS (in home support services) program into the spotlight. It also states that the caseload has more than doubled since 2001 and now serves about 490,000 low-income clients throughout the state.
“Working behind closed doors for an average of about $10 an hour, these caregivers carry immense responsibility but are subject to little scrutiny, according to law enforcement officials, elder abuse investigators, senior care experts and court records. Their lapses sometimes lead to preventable injuries and death.”
Additionally, the investigation into the IHSS program found that:
“Training for caregivers is minimal and mostly optional. California doesn’t require training for everyone – even in CPR, first aid or preventing injuries. By design, IHSS is not a medical program and caregivers are supposed to confine themselves to tasks such as feeding, dressing or bathing. But some become ad hoc nursing aides, helping to dress wounds and manage medications. The state requires caregivers receive training and authorization from physicians in these cases, but only about one in nine caregivers receives it, officials say.”
The article also makes note that employee background screening in the IHSS program is not as stringent as it should be. In fact, clients are given “wide latitude” as to hiring employees with potentially troubling backgrounds. Clients are given the ability to “waive” convicted felons or those with other troubling histories such as abuse or rape. According to the investigation, 830 waivers have been submitted and approved by the state for caregivers convicted of serious past offences. Few cases of client abuse have been documented by the state simply isn’t looking for them, rather, the annual checkup by social services is primarily concerned with whether or not the client is receiving the appropriate number hours of care.
“Counties are also supposed to report to the state “critical incidents” –potential neglect, abuse or self-harm requiring immediate action. But reporting practices vary widely, yielding puzzling results. In fiscal year 2012-2013, for instance, not a single critical incident was reported among the 235,000 clients in Los Angeles, Orange and San Diego counties, the three largest in the state. That same year, smaller Sacramento County reported 1,688 incidents – accounting for most of the problems reported statewide.”
According to Martin Hernandez, an IHSS social worker in Los Angeles County, a single yearly checkup is not enough to provide insight as to whether or not clients are being harmed/abused. His colleague, Gloria Daniels, said she has an even higher caseload – 493 clients. “The program is so big that it appears nobody knows what to do,” she said. “We are being told it’s quantity, not quality.”
The investigation cites several different cases where the lack of oversight led to client abuse. There also seems to be a lack of overall power for social service workers. “This agency is also spread thin and has limited powers, according to state records and interviews. Even if workers suspect abuse or neglect, they generally can’t remove an adult from the home without his or her permission.”
“We cannot force anybody to accept our services,” said Stacey Lindberg, program manager of Adult Protective Services in Orange County. “It is heartbreaking.”
Read the full investigation here