Caregiver misgivings: Who are we letting in?
Published: Saturday, April 7, 2012 at 9:03 p.m.
Last Modified: Saturday, April 7, 2012 at 9:03 p.m.
Editor's note: As America ages, more people are hiring at-home caregivers to provide basic services. But do you really know who you are allowing into the home of your elderly family member? The Star-Banner looks at concerns about this growing health care industry.
GAINESVILLE — He was a 78-year-old man — a father, a grandfather, a veteran — living alone.
Like many elderly people, he had hired a caretaker to visit his Blues Creek home to help prepare his food and perform other daily chores.
But one terrifying night, Paul Quandt's link to that former caregiver reportedly led to a robbery and beating that turned out to be fatal.
Maranda Joy Martin of Gainesville, Quandt's one-time caregiver, and her cousin, Austin Mark Jones of Fort White, both 22, are accused of invading Quandt's house and stealing more than $20,000 worth of gold, silver and currency along with guns, cash, electronics, his vehicle and cellphone.
Quandt was beaten savagely, tied up and left for dead, investigators say.
Using cooking oil, he managed to slip out of his bindings, crawl to his motorized chair and make it to a neighbor's house for help.
He died from his injuries days after the Jan. 9 attack.
His alleged assailants could face the death penalty if convicted.
While it's a worst-case example, the fatal abuse points to a major concern in a relatively young industry designed to help a growing population of the nation's elderly.
About 34 million older Americans need assistance, according to a 2004 survey from the National Alliance for Caregiving done in collaboration with AARP.
Most of these elderly, surveys have found, want to stay in their homes as the infirmities of age creep up.
Thus, homemaker companions — people who perform daily chores for elderly clients, often earning wages near the bottom of the pay scale — will be one of the fastest-growing fields in the next 20 years when almost a fifth of Florida's population is expected to be older than 65, according to the U.S. Department of Labor.
But how much do the clients really know about who they are allowing into their homes and their lives?
For a large part of this emerging industry, ensuring that thorough background checks have been completed has largely been left to those who provide the service.
- The state requires that each person going into clients' homes undergoes an FBI background check and that homemaker companions who have been convicted of certain offenses be excluded.
However, unless there's a complaint, the state does not verify that the 2,223 registered homemaker companion businesses in Florida actually perform these checks.
- The state has no clearinghouse for consumers who want to find out about who's coming into their home or a loved one's home to provide care.
And individuals who advertise their services as homemaker companions or any sort of in-home medical help don't have to register with the state at all.
- Several of the 68 homemaker companion businesses in Alachua County were operating without registering with the Department of State, as required.
And a number of the businesses listed with the state agency were no longer operating.
As more people need these services, authorities are raising concerns about an evolving industry in which clients must have faith that the proper checks are being conducted.
Shortly after the Quandt tragedy, Gainesville Police Department Crime Prevention Officer Ernest Graham said people looking to hire a company to provide a service such as home health care or housekeeping should ask if a thorough background check has been done on employees.
Graham said agencies across the state have noticed the trend: "A lot of folks are hiring these at-home health care workers, but nobody is really doing good background checks on them."
Absent a complaint, only home health agencies — licensed to provide medical care — and nurse registries are subject to state verification that they are properly conducting background checks.
If the state receives a complaint about a homemaker companion business — where caregivers provide services such as transportation, light housekeeping and cooking — they will check on whether a caregiver has been screened.
It's in keeping with the law, said an Agency for Health Care Administration spokeswoman.
"The agency's inspection authority is limited to inspection of complaints only because it is written as a regulation-only program," spokeswoman Michelle Dahnke wrote in an email.
Mary Twomey, co-director of the Center of Excellence on Elder Abuse and Neglect, based in Irvine, Calif., said an entire shadow economy has grown up around caring for the elderly in their homes.
And it's a sector ripe for abuse.
"This is one of the last frontiers in terms of creating a safety net for long-term care,'' she said. "There is a huge, generally unregulated market that millions of Americans rely on to get assistance for the elderly."
Rules have gaps
To some, Florida's regulations on in-home health businesses are sufficient and might even put undue restrictions on some aspects of care.
Florida's certified nursing assistants, for example, are allowed to provide personal, hands-on care such as bathing.
But they are prohibited from doing medical tasks that parents often are trained to do for their medically needy children at home.
"In most states, a nurse can delegate that to a CNA,'' said Jocelyn Holt, who runs the local Comfort Keepers franchise with her mother, Lynn Domenech.
One of the country's largest in-home caretaking chains, Comfort Keepers also is the company that had employed Maranda Martin.
The last time Martin had worked for Comfort Keepers was about three months prior to the night in which Quandt was robbed and beaten.
Some states, such as California, do not require that homemaker companion services even register with the state.
Florida began requiring it in 1987.
The rules, however, have gaps.
No formal training is required to become a homemaker companion. And registering as such a business requires little more than the $50 filing fee, a $43.25 background screening, and a $15 processing fee for each managing employee and chief financial officer.
Most of the 102 complaints in the past two years that were filed against this category of elderly care — clearly the least-restricted category of the market — found no violations of the state's rules.
The complaints in which violations were found largely involved homemaker companions providing hands-on care that the law prohibits, such as steadying a client on his or her feet, or providing baths or help with medicine.
AHCA's Dahnke, whose agency regulates the industry, said the three registration revocations the state has made in the past two years don't tell the whole story.
"The Agency has issued many denials of renewals and initial applications for registrations," she wrote in an email. In the past two years, "there were 47 denials," she said.
‘We did it right'
The company that hired Martin to help Quandt said it goes beyond what Florida law requires for screening and training of in-home health workers.
For Domenech of Comfort Keepers, her former employee's arrest on alleged crimes against a former client — murder, home invasion robbery, armed burglary and false imprisonment — proves there is no accounting for the vagaries of human nature.
"We really did it, we did it right, and we didn't leave anything out," Domenech said, referring to the national background check, drug testing and rigorous review that each of the company's hires must pass before going into their clients' homes.
Comfort Keepers reruns its background check every quarter on continuing caregivers, whereas the state requires that step only every five years.
For someone so young, Martin had a substantial work history, working for one employer for a year and another for three years, Domenech pointed out. It had been about three months between the time she worked for Quandt and when the attack occurred.
"One of her references told us that she was the best employee they had ever had," Domenech said.
Police advise people to make sure outsiders brought into the home to provide care have a background check, but short of conducting the check themselves, there's no independent way for consumers to verify this has been done.
And even a genuine, clean report offers only so much assurance, they say.
"Even under that circumstance, you can never predict what a person's behavior is going to be in the future," said Cpl. Angelina Valuri, a spokeswoman for Gainesville police.
She pointed to the Quandt case.
"(Martin) had no criminal history, and she was involved in one of the most violent crimes our detectives have seen in many years," Valuri said.
For Vidya Hogan, director of consumer affairs for Elder Options of Mid-Florida, news about exploited elders comes far too often. She said she has seen statistics showing that one out of 11 elders has been abused or exploited by family members, acquaintances or caregivers, and that's not hard for her to believe.
Hogan has a close elderly friend who became a victim of a scammer — much to her dismay, she said. The perpetrator made off with thousands of dollars of her friend's money and disappeared once Hogan became aware of the exploitation. The cellphone number she gave didn't work.
Hogan said her own personal experience has shown her that scammers' opportunities arise from elders' isolation and their confusion.
"Older people don't have a lot of other people to talk to, and they don't have a lot of people who care about them and give them attention," Hogan said, pointing out that it's often a matter of pride that keeps parents from telling their kids about their financial affairs.
"They are sitting ducks," she said.