The Strangers in Our Parents' Homes

"By the end of the year, we will have prosecuted about 55 cases of elder abuse of one kind or another by home-based workers in San Diego County alone," says Paul Greenwood, director of elder-abuse prosecution at the San Diego District Attorney's Office, which prosecuted Trevino. "This is happening all over the country. We need to address this issue as a nation and take care of our elderly."

Greenwood, who's lobbied for federal and state legislation that includes stringent background checks of home health-care aides, testified this summer before the Senate Special Committee on  Aging to encourage the passage of the Patient Safety and Abuse Prevention Act of 2007. The bipartisan bill would establish a nationwide system of background checks to prevent certain individuals from getting hired by long-term care facilities. He also urged passage of a federal elder-justice bill. 

Nationwide, legislators and law-enforcement agencies are just starting to catch up with this problem. In New York, where licenses for home health-care aides are required, an ongoing statewide investigation of home-based health-care workers by state Attorney General Andrew Cuomo has uncovered widespread fraud, among other problems. One New York-based home aide claimed to be working 24 hours a day—but was caught in Greensboro, N.C., auditioning unsuccessfully for ''American Idol.''

"Our investigation of the home-health industry in New York has uncovered widespread systemic Medicaid fraud—a fraud taxpayers have been left to pay for," Cuomo tells NEWSWEEK. "It's time states across the country take a closer look at how we can strengthen protections for patients and taxpayers and make sure the care that is promised is the care that is delivered. That's why, as a first step in New York, we've proposed legislation to create a statewide online registry to track all certified home-care aides and provide a useful tool for consumers to verify the credentials of home-health aides coming into their home."

Compared to the general workforce, home-based health-care workers are more likely to be women (about 90 percent), nonwhite and unmarried with children, according to the American Association of Retired Persons (AARP). The job is typically low-paying—from below minimum wage to $12 hourly--and rarely offers benefits or paid vacations. Some aides work on their own, but most are hired through agencies that are often certified by Medicare and Medicaid, which means they get paid through those agencies. State and federal laws regulate these agencies to some degree, but there are still no guarantees that the person sent to you by an agency will be competent or trustworthy.

Gloria Fleitman, 73, a retired real-estate attorney in Plantation, Fla., turned to the agencies in her area when her 96-year-old mother needed care. But she says she went through 36 home health-care workers in two years before she found one that was acceptable. "People came to the job expecting high pay but not wanting to do the work," she says. "My mother was incontinent, and they didn't want to do that kind of personal work. They didn't commit any crimes, thankfully, but they were incompetent."