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Safe at home: Feds, states take steps to prevent home-care crime

Safe at home: Feds, states take steps to prevent home-care crime
By Joe Carlson
Modern Health Care Magazine * January 12, 2013

As healthcare companies look toward aggressive growth in the most intimate of settings—patients' own homes—more Americans are asking how much they really know about the new home-care aide who walks through the front door.
They soon might learn more about these providers. Nationwide, many people who deliver home care will fall under a new program in the Patient Protection and Affordable Care Act that will pay for background checks for any nurse, therapist or aide who comes into contact with a long-term-care patient.

CMS officials say the program is voluntary for now, but that it might be prudent for state leaders to plan for a congressional mandate in the near future. The CMS recently made such background checks mandatory for hospice workers and is considering doing so for other providers.

The HHS' inspector general's office is studying the issue and will report later this year on how many home-health agencies employ workers with criminal backgrounds. An October report on such agencies found 92% employed at least one staffer with a criminal conviction.

The greater scrutiny of home-care worker backgrounds comes as the go-go home healthcare industry gears up for substantial growth in the coming decade. Home-care aide employment is expected to balloon by 70% between 2010 and 2020. The industry currently employs about 1.2 million people providing services to an estimated 8.6 million Americans per year, according to data from the Joint Commission and the Labor Department.

But the number of people cycling through those jobs will be far higher than the number of new positions since the industry is marred by high turnover. Wages for entry level home-care aides are among the lowest in healthcare. Moreover, “though they themselves are providing healthcare, they do not have health coverage,” says Hollis Turnham, the Midwest director of PHI, a home-health workforce development organization based in New York. “It's not just wages, it's the whole compensation package that makes these jobs unattractive and difficult to do.”

No national system exists to track crimes against home-health patients. As a result, researchers are unable to study the extent of the problem or whether wages, benefits, worker morale, rising employment or other factors are leading to an increase in crimes in home care.

Low morale and inadequate worker training drive much of the concern about patient safety. “There are people who come to this work with bad intentions and bad motives,” Turnham says. “There are also people who have not had the training and skills development to deal with stressful situations, and they do bad things. But the overwhelming majority … want to do the right thing, and want the skills to do the right thing.”

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See also, Widespread Abuse, Neglect and Death in Small Settings Serving People with Intellectual Disabilities