CHICAGO - Patrice Kadlec needed someone to help take care of her elderly father in his Oak Park, Ill., home, and she needed someone fast. Kadlec works full time, and her father, who has Parkinson's disease and related dementia, was being discharged from the hospital the next day after treatment for bladder cancer. • Kadlec scanned a long list of service providers she had received from a local organization that helps senior citizens. With panic setting in, she picked one.
Nearly a year later, she has changed agencies three times. She encountered a paid caregiver who begged for money, a worker who left her father in soiled adult diapers all day and another who was argumentative to the point of being scary.
"I was panic-stricken a lot of the time wondering what was taking place in my absence," Kadlec said.
People who hire caregivers for elderly family members might assume that agencies conduct drug testing and thorough criminal background checks, and that prospective employees have been painstakingly vetted to make sure they are experienced, competent and trained for the job.
But that is not always the case, according to a recent Northwestern University study that found many agencies do a poor job of making sure caregivers are safe, reliable and capable.
Among the study's findings: Some agencies recruit workers from Craigslist and place them in the homes of older people with dementia without checking for criminal convictions or assessing whether they are qualified. Many agencies don't do national criminal background checks or drug testing. And some agencies lie about testing caregivers' qualifications, don't require experience in the job and don't provide training.
"Our results brought forth some alarming issues among agencies that hire caregivers," said lead author Dr. Lee Lindquist, a geriatrician and associate professor of medicine at Northwestern University Feinberg School of Medicine. "There are good agencies and bad agencies, and consumers need to be educated about what to look for."
The study looked at five states with large populations of older adults — Illinois, California, Arizona, Florida and Wisconsin — plus two other states, Indiana and Colorado.
Paid caregivers include a large category of workers such as personal care attendants, private duty attendants, home care aides, direct care workers and sitters.
The National Private Duty Association, which represents more than 1,300 home care companies, acknowledged that some agencies don't do a good job but took issue with the study, criticizing it for painting all agencies with the same brush.
"The study's findings are not representative of the hiring, training and supervisory practices of the members of the NPDA who adhere to high standards and industry best practices," the organization said in a written statement.
Its member agencies employ, train, bond, insure and supervise their caregivers, who provide a variety of care, including homemaker services, companionship and home health care, the statement said.
Lindquist said the purpose of the study wasn't to vilify all agencies, because they serve a critical role.
"What we're trying to say is, don't go with the agency with the pretty website or a good story," she said. "You need to vet the website and what they tell you (over the phone) and look into it more."
Michael Doepke, who owns Home Helpers HomeCare in Hinsdale with his wife, Mary, said his agency goes beyond what state law requires.
For example, Illinois requires only a criminal background check through the state police database, but Doepke said his agency also does a national check. The agency also does routine and random drug testing, he said.
"If you're going to put an unsupervised worker in the home of an older adult, you can't take any chances," he said. "You need to make sure you have somebody in there you can trust, who can make smart decisions and doesn't have a history that you don't know about. So we take time to do criminal background checks, check references and do two rounds of interviews."
Darby Anderson, division vice president of home and community services for Addus HealthCare Inc., based in Palatine, said most caregivers do an outstanding job, and his company works hard to ensure a high-quality staff.
But he said home care is socially undervalued work, which presents challenges for agencies when it comes to recruitment and hiring.
"Home care is not viewed as a profession. It's considered an entry-level, welfare-to-work type of job," Anderson said. "That's a challenge that we are trying to overcome while balancing limited reimbursement rates from state government and from what the market will bear in terms of a private pay rate."
For the study, published last month in the Journal of the American Geriatrics Society, researchers posed as consumers and surveyed 180 agencies about hiring methods, screening measures, training and supervision practices, and testing for competency.
Some answers led to further research into state and federal legislation to verify the accuracy of the responses.
Among the findings: Some agencies reported that their employees received training at universities, but researchers later determined the schools were created by the agencies and not accredited by any educational association or commission.
Researchers also were unable to confirm the existence of some screening tests the agencies mentioned, including the National Caregiver Background Check, National Scantron Test for Inappropriate Behaviors, Assessment of Certification of Christian Morality and Quality Seal of Assurance Online Program Completion.
One agency, according to the study, said it did not give drug tests to its employees because "most of our caregivers are Filipinos, who tend not to use drugs, smoke or drink." Another said it was barred from drug-testing employees before they were hired, even though no law prohibited the agency from doing so.
Instead of pushing for more regulations, which Lindquist said could drive up the cost of home care, she suggested that consumers could exert market pressure through selecting caregivers only from high-quality agencies.
"If we can educate consumers, it's one way to bring up the standards," Lindquist said. "If there's more demand for high-quality agencies, the agencies will have to improve what they are doing."
In addition to checking whether an agency is licensed by the state health department, consumers should ask other questions before a paid caregiver comes into their home. Northwestern University researchers have put together a checklist of questions to ask:
• How does the agency recruit caregivers, and what are its hiring requirements?
• What types of screenings are done before a caregiver is hired? A federal or state criminal background check? Drug screening? Something else?
• Is the caregiver certified in CPR? Does he or she have any other health-related training?
• Is the caregiver insured and bonded through the agency?
• Does the caregiver have the skills you expect? (These could include lifting and transfers, homemaking and personal care such as bathing, dressing or toilet assistance, among others.)
• How does the agency assess what the caregiver is capable of doing?
• What is the agency's policy if the regular worker cannot provide the contracted services? Will a substitute be provided if you are dissatisfied with a particular caregiver?
• Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?
• Does supervision occur over the telephone, through progress reports or in-person at the home of the older adult?
— Deborah L. Shelton