Home care hiring practices cause for worry

With an increasing demand for home care services, home care businesses have been springing up in communities across the country. And with the rapid expansion of these largely unregulated businesses questions about the industry’s hiring practices have begun to surface.

[See also: Home care franchises are hot, hot, hot; DoL extends comment period on home care worker wage protection .]

In the July issue of the Journal of the American Geriatrics Society, a group of researchers from Chicago’s Northwestern University published the results of a study that found that the hiring and screening practices of home care agencies may not be as stringent as older adults and their families would expect.

Focusing on five states – Illinois, California, Arizona, Florida and Wisconsin – the researchers conducted interviews with home care agencies by posing as lay people inquiring about paid caregiver services. The researchers targeted 462 agencies; only 180 agencies completed interviews.

Agencies were asked about their hiring methods, screening measures, training practices, skill competency assessments and supervision.

Among the study results, researchers found that most agencies required life experiences (68.8 percent), but only 18.3 percent required prior experience as a caregiver. Twenty-nine agencies administered a test of basic knowledge that potential hires had to pass, and while 96 percent of agencies said their caregivers could perform tasks such as medication reminding, none of the agencies performed health literacy assessments.

Just under 56 percent of agencies required federal criminal background checks (nearly 92 percent required state criminal background checks). Twenty-two agencies (12.5 percent) didn’t perform any screening before hiring.

Skill competency was largely assessed by agencies by caregiver self-report (58.5 percent). Training length for caregivers ranged from zero to seven days. Supervision of caregivers ranged from none to weekly.

“Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregiver,” the study’s authors concluded. They recommended more stringent regulations and standards at both the state and federal levels.

The study’s findings should make the industry, policymakers and consumers sit up and take notice, said Steve Edelstein, national policy director for the Paraprofessional Healthcare Institute (PHI), a national nonprofit that advocates for the direct-care workforce.

“I think we’ve been trying to save more costs than we should,” he said. “We’re not asking questions ‘cause we’re afraid of the answers. We’re not really looking at who’s providing the services because we don’t want to think about the credentialing costs and we don’t want to think about the training costs.”

It’s up to the leaders in the home care industry to set the standard high so that newcomers either rise to the standard or get out because they can’t compete, said Jisella Dolan, vice president of standards and general counsel for Omaha-based Home Instead Senior Care, an international, non-medical home care franchise business.

“As you have new entries, new folks who get into the industry, they’re smaller and they’re up-and-coming, and they may have their standards and their processes and things, but it takes some time to shore up their operations and to ensure they’re delivering quality. I think that may be part of what you’re seeing in that study,” she said.

“(If leaders of industry set the bar high) everyone else is going to have to rise to that to be able to stay competitive in this industry,” she said. “Yes, there’s great opportunity … but they’re only going to be successful if they can deliver on what they’re promising and that the other leaders of the industry are doing – like us.”

Dolan said that far from viewing the study as condemnation of the home care industry, Home Instead is excited about it. “We’re glad that there’s this research being done because it elevates awareness of the industry, and it holds all of us accountable, and that’s a good thing.”

Like Dolan, James Pacala, MD, president of the American Geriatrics Society, while recognizing the seriousness of the findings, sees the positive impact the study can have. It is a chance, he said, to examine how caregiving is valued.

Better caregiving through appropriate training may be a worthy investment, Pacala said, not just because it’s better for the health and well-being of older adults, but because of the dollars trained caregivers can save if they are able to troubleshoot, anticipate and prevent problems that may lead an older person to have to seek expensive care.

“You can have more oversight but it doesn’t really change the situation,” he said. “What we want is – we want better caregiving for our vulnerable older adults.”