Concerns over the loose regulation of some home care workers is leading several states to consider bills aimed at increasing oversight and requirements for this workforce.
Measures being considered include establishing mandatory training hours and requiring background checks for these workers, as well as the licensing of home-care agencies.
Bernie Vonderheide, president and founder of Kentuckians for Nursing Home Reform, says that complaints about home health workers – often related to their questionable background – seem to be increasing by the year. Lawmakers are becoming aware that constituents are asking them to do something about this, he says.
Vonderheide says there is a "building resentment among the general public" regarding state and federal agencies that regulate this workforce. He says people are becoming aware that it is necessary to have more control in order to prevent more neglect and abuse from these workers.
Ohio resident Dolly Gregory, 71, says she has had first-hand experience with home care workers who lacked the appropriate training and could not fulfill the duties assigned to her. Gregory's recent caregiver – Debbie Corder – ended up being a good fit.
"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.
The home health care workforce is made up of two kinds of workers, explains Christopher Kelly, associate professor at the Department of Gerontology at University of Nebraska at Omaha, who has studied the issue. There are home health aides, who provide medical services and are employed by home health agencies, and home care aides, who provide non-medical services, including help with personal care, toileting and feeding.
While home health aides are regulated under Medicare and receive 75 hours of training , the regulation of home care aides is left to the states, Kelly says.
Kelly, who published a study in 2012 on states' differences in training for home care workers and licensing of home care providers, says states vary widely in areas such as training requirements. Very few require "anywhere near the 75 hours Medicare requires of home health aides," he says.
Recent state developments for home care regulation include:
— California: In October, Democratic Gov. Jerry Brown signed the Home Care Services Consumer Protection Act. Beginning in 2016, this law will require the regulation and licensing of home care organizations. It also requires background checks, a minimum of five hours of entry-level training and registration for home care aide applicants.
— Iowa: In April, Republican Gov. Terry Branstad signed a bill that includes a mandatory study of background checks for home health workers, says Joshua Ewing, a policy specialist for the Health Program at the National Conference of State Legislatures. The study, which will be led by the Department of Inspections and Appeals, will look at background check improvements and requirements for certain providers of home heath, including individuals and agencies that are not subject to state certification, licensing or regulation. Findings must be submitted to the governor and General Assembly by Dec. 15.
— Kentucky: Kentucky currently has the Kentucky Applicant Registry and Employment Screening Program (KARES), which is a voluntary fingerprint-supported state and FBI background check program for long-term care employers. Kerri Richardson, communications director of the office of Democratic Gov. Steve Beshear,says the governor supports legislation that will make this mandatory and that this legislation is still being drafted.
In addition, there is the Personal and Home Care Aide State Training Program (PHCAST), a measure authorized under the Affordable Care Act, that has been funded in California, Iowa, Maine, Massachusetts, Michigan, and North Carolina.
Its purpose is the development of education and training models, which cover "key legislatively dictated topics" for personal and home care aides such as personal care skills, health care support, nutritional support, safety and emergency training, among others, says Jennifer Craft Morgan. Craft Morgan is an assistant professor at the Gerontology Institute of Georgia State University and co-leads the evaluation for the North Carolina PHCAST grant.
Craft Morgan believes the problem is that "states are unprepared to support and develop" the home health and personal care aide workforce, which is expected to have grown 70% from 2010 to 2020, she says. Though she says the majority of workers are passionate about their work, "the lack of consistent preparation" renders them unprepared for their duties.
She also says turnover comes from inadequate preparation, which leads to "less consistent" care for clients.
"Without standardized training, employers have difficulty identifying well-qualified workers," she said.
Carla Washington, executive director for Direct Care Alliance, says her organization supports increased regulation and oversight of the home care workforce. Direct Care Alliance is a national not-for-profit advocacy organization, which provides a voice for direct care workers in long term care.
"We support measures that will allow consistency and setting standards nationally," Washington said. She says such standards include national credentialing and training requirements for the home care workforce.
Direct Care Alliance has been at the forefront of advocating such standards, she says, and has created the Personal Care and Support Credential, a competency-based test "that will distinguish workers that will have the minimum requirements." This is being used by D.C. as a sole way for credentialing home care workers, she says, while the organization has presented it for use to other states.
Bill Dombi, vice president for policy at the National Association for Home Care & Hospice (NAHC) says, "for the bare minimum end of consumer," a background check is essential.
"There is no more risky situation than having a stranger in the client's residence," Dombi said. "If the consumer at least knows the worker has had a background check, it lets them have an informed choice."
Kelly also says the matter merits great attention.
"It is not to be taken lightly. When you are talking about home care, you are talking about the most intimate level of care you can receive," Kelly said.
Contributing: Amber Hunt, The Cincinnati Enquirer