The Strangers in Our Parents' Homes

When Kim Collins hired a home health-care aide to look after her elderly parents in January 2006, she thought she was doing the right thing. Her parents, Pat and Dorothy Torano, wanted to stay in the dream home they had shared for 40 years in Cardiff, Calif., just north of San Diego. But the couple was having trouble caring for themselves. Pat, 87, was nearly blind and partially paralyzed from a stroke; Dorothy, 93, was blind and suffering from dementia. 

During a monthlong search for the right home health-care worker, Collins and her parents took an immediate liking to Gina Trevino, who they found through a national agency, Visiting Angel. Trevino began working in the Toranos' home in January 2006, and everything seemed to be going well. "She was very nice, the house was clean, and there was always good food. My parents were happy," says Collins. "I assumed everything was fine; there was never a problem."

But by the end of that summer, Collins was stunned when the San Diego Sheriff's Department informed her that Trevino had opened 30 credit card accounts in the Toranos' name and purchased three vehicles worth $50,000 with the Toranos' credit card. Trevino had also convinced the elderly couple to provide her with power of attorney and then managed to have them sign over ownership of their house, valued at $650,000. In September, Trevino and her husband, Robert Holman, were arrested on suspicion of multiple grand-theft and credit-card-fraud violations.

As egregious as it sounds, stories like this are becoming increasingly common. As the country's population ages and life expectancies continue to rise, the home-based health-care industry is a fast-growing national service, driven by the large numbers of people who want to spend their final years at home, as well as by government policies intended to encourage home health-care as an alternative to more costly hospital and nursing-home care. Over the past decade, Medicare spending on home health-care agencies has grown more rapidly than for any other health-care service. And as the industry expands, it diversifies. Home health-care agencies are focusing more on care management and more-skilled nursing services and subcontracting the work of recruiting, training and supervising lower-skilled and less regulated home health-care aides. The number of contracting agencies that handle that recruiting and supervision has nearly doubled since the early 1990s.

But because no federal standards or regulations exist for home-based health-care aides and because state regulations are generally weak and vary widely, the industry is plagued with corruption and attracts opportunistic predators. In many instances, simple background checks aren't being done at all—or, in the Trevino case, all that thoroughly—by the agencies. The majority of home health-care workers may be ethical and caring, but reports of fraud, theft, forgery and physical and psychological abuse against elders by home-based health-care aides are increasing. In California, where Trevino was prosecuted and convicted, nurses and other medical professionals sent to homes are required to have a license, but health-care aides, who assist with nonmedical personal care, including bathing and feeding, are not.

During the trial, it was revealed that Trevino had served time in prison for child abuse, receiving stolen property and forging checks. She hadn't revealed her criminal history to Visiting Angels, which was not named in the criminal proceedings because home health-care agencies are only required by state law to check employee backgrounds for the past seven years (Trevino's prior convictions had occurred more than seven years before her hire). Trevino eventually admitted stealing the family's home and was sentenced to eight years in prison. Holman, who knew about the fraud, was sentenced to two years in prison.