Ask Dolly Gregory about her younger years, and out come the newspaper clippings: She was once a firefighter – one of Ohio’s first women to suit up – in a small Wood County town called Jerry City, an achievement noted in a 1973 issue of her local paper.
But the grandmother of 19 – great-grandmother to seven, she’s quick to add – isn’t as nimble as she once was. Pain from rheumatoid arthritis began creeping into her joints about six years ago, making it tough to take care of herself and her husband, Bill, who has Parkinson’s disease and suffered several strokes.
“It’s really hard to lose your independence, especially when you’ve been as active as I have,” Dolly Gregory, 71, said. “It got to the point where, if I didn’t get to a chair in time, I would just fall down.”
The couple is among tens of thousands of Ohio residents with Medicaid coverage who could choose to go to a nursing home but instead opt for home health care. It’s a choice that saves the state money and allows elderly residents to stay in their own homes with their loved ones – but it has definite drawbacks.
For one, Ohio has virtually no regulation overseeing roughly 71,000 home care workers, meaning that many of the caregivers entering elderly residents’ homes and working without supervision haven’t had background checks and have little to no training. The same is largely true in neighboring Kentucky, where legislators next year are to consider requiring background checks for home health aides.
For comparison’s sake, consider this: A nail technician in Ohio must go through 200 hours of training. A hairstylist requires 1,200 hours. A barber, 1,800 hours.
To work as a licensed plumber in Ohio, you must have been a tradesman for five continuous years under a licensed contractor, after which you have to be approved by the Ohio Construction Industry Licensing Board before facing state and federal background checks.
Dolly Gregory’s first in-home caregiver was 17 years old and, at five months pregnant, too fragile to do the housework the Gregorys needed.
“I had another girl who came in and asked what I wanted her to do, and when I explained it, she said, ‘Oh, I don’t do that. I thought I was maybe coming to help you take some pills.’ I said, ‘Well, I can take pills myself,’ so we said goodbye to her.”
Another worker stole jewelry, Gregory said. And yet another nearly hyperventilated while cleaning one of the Gregorys’ small bathrooms in their Englewood home outside Dayton. None had been properly trained for the job, she said.
“My thought was that these people are supposed to be trained, screened, and, you know, maybe had a little background check on them,” Gregory said. “These are strangers coming into your house.”
A growing contingency of advocates agrees and is making a case to state lawmakers in hopes of enacting certification guidelines in Ohio that would change the landscape of home health care here.
Legislators to consider certification program
Nearly 90 percent of Americans older than 50 want to stay in their homes as long as they can, according to AARP (formerly known as the American Association of Retired Persons). Currently, about 34,000 Ohioans older than 65 with disabilities have waivers allowing them to receive Medicaid funding for in-home care through a program called Passport, according to the Ohio Department of Aging.
It’s an option that saves the state considerable cash because the Medicaid program can provide home care to three people for the cost of serving just one person in a nursing home, according to AARP numbers.
And, like much of the country, the savings are expected to mount in coming years as the aging population grows. The number of Ohio residents age 85 and older is expected to grow 45 percent by 2030.
While nursing homes are federally monitored, home health care regulations vary state by state. In Ohio, training requirements for “personal assistant services” providers range from zero to 60 hours, depending on the care level. Indiana is similarly lax, though some personal care aides are required to pass a competency exam.
Kentucky is the Tristate’s most stringent when it comes to home care training, requiring at most a 75-hour training program with 16 hours of hands-on training. Even that isn’t enough for some. Gov. Steve Beshear’s administration is asking lawmakers next year to make a multistate background check program mandatory for workers in long-term care settings.
Ohio’s lawmakers have created an advisory work group that’s meant as a first step in crafting a home health care work certification program by Oct. 1, 2014. By October 2015, people who haven’t been certified might not be eligible for Medicaid payments, according to the state budget bill.
Despite a growing need, Ohio’s lawmakers haven’t focused on home care. In March 2010, two representatives introduced a bill that would have required licensing of home-health agencies, but it never got off the ground.
State Rep. Mike Foley, D-Cleveland, told The Enquirer last week that the Health and Human Services subcommittee he served on this year tackled a slew of issues, but none had to do with industry regulation. “There were hours and hours and hours of testimony, and 90 percent of it was on Medicaid expansion,” he said, adding that he was surprised to learn that so little training and screening was required for home health care workers.
“It seems to me there would be a higher requirement, especially if you’re going into people’s homes,” Foley said. “They do criminal background checks on everyone else.... I’d say this sounds like an issue.”
Nation's 'patchwork' hinders consistency
Some home-health agencies in Ohio have self-imposed training requirements for their workers. Jeff Bevis, who founded FirstLight Home Care about three years ago, said his business idea was triggered by his own less-than-stellar experience with in-home workers who came to help both his parents and his wife’s parents after a series of illnesses.
He was surprised at the lack of oversight, he said, and disturbed that online dating sites seem better equipped to weed out potential personality conflicts than the agencies with which he dealt. “One was a smoker who told us it wasn’t going to be a problem to smoke outside,” he said, “but she smelled like smoke. Here I have a mother-in-law with lung cancer and emphysema, and a caregiver who smells like cigarettes.”
Several others agreed to one schedule, only to have conflicts arise soon after. “We were always their second or third priority,” said Bevis, 55, of Wilmington. “We appreciated their time, but it was just a nightmare.
With franchise business in his background, Bevis launched FirstLight in Ohio, then expanded to nearly 30 states, serving 1,100 daily clients with nearly 1,000 caregivers. It’s tough to keep track of each state’s specific regulations, he said, because they vary so greatly.
Sharon Brothers agreed. Brothers is CEO of the Institute for Professional Care Education, a national training and certification program based in Oregon that would like to see states adopt more consistent regulations when it comes to home health care.
“There’s a patchwork all over the country, and that makes it really difficult,” she said. “You don’t think it matters because you think it’s all local, but, if your mom and dad live in another state, you might find they do no background checks, much less training.”
Some states, particularly on the West Coast, have passed certification requirements. Washington voters, for example, in 2011 passed a law that requires fingerprint background checks, 75 hours of training within 120 days of being hired and at least 12 hours of annual continuing education for most long-term care workers.
Brandi Kurtyka, CEO for Chicago-based recruitment company myCNAjobs, said training provides huge benefits – not least of which is a higher quality of care for some of the nation’s most vulnerable people. Studies show proper training also cuts down on turnover.
“It’s a tough job. They’re underpaid, they’re overworked and there’s about 50 percent burnout,” said Kurtyka. “For the majority of the workforce, they’re doing it for reasons beyond the paycheck. They love the industry and care for their clients, but it’s very stressful, and burnout increases without training.”
Higher turnover could translate into lesser care, Brothers said. A consistent caregiver might spot a subtle personality or physical change that could signal an infection or stroke.
“If you can catch it early, you can treat it before it becomes something big,” she said.
Her company conducted a survey this year that indicated training cuts by more than half the turnover rate among home health caregivers. The rate industry-wide is about 53 percent now, though in past years it’s climbed to 80 percent. With training, Brothers said turnover drops to about 20 percent. “Companies don’t want more regulations, but this makes good business sense,” Brothers added. “If you can save half of your new hire-related expenses, that’s huge. It could mean thousands of dollars every year.”
Training 'makes all the difference'
Workers would also benefit from training by giving them a feel for the job before being left alone in someone’s house, said John Bowblis, an assistant professor of economics at Miami University.
“These people are paid barely over minimum wage,” he said. “They might be dealing with people who have dementia or might be abusing them. Plenty might say, ‘I could work at McDonald’s and get the same pay, so why don’t I do that?’ ”
Brothers agreed. Most workers getting into the field want to help people, but their good intentions might not be enough to withstand a sometimes-grueling job that typically pays between $20,000 to $25,000 a year.
“Caregiving has a low threshold for entry. You just need to want to help people,” Brothers said. “But a lot of things in caregiving are hard. You’re taking care of people’s intimate personal body functions, invading their personal space or dealing with people who are kind of grumpy and might not want you there. The biggest tool you can use to prevent stress and burnout is to give them the research, knowledge and skills to do what they do in the best way.”
For Dolly and Bill Gregory, the sixth caregiver they hired ended up being a perfect fit. Deborah Corder, who works with the FirstLight agency, comes to the couple’s home three times a week for eight hours a day.
Corder is a nurse who wanted a change in scenery. She helps the Gregorys cook, clean, keep medical appointments and even bathe.
“She’s like a daughter,” Dolly Gregory said. “Her heart’s in it, and she’s so caring and so loving. If you have someone coming to your house three days a week, you need to trust them and feel like there’s a friend coming into your house. It makes all the difference.”