Danger 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.

"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."

Fleitman usually paid about $15 hourly ($10 went to the worker, the agency kept the rest). "I suspect the baby boomers will start to make changes in the law to protect seniors living at home as they get older, but what about us?" Fleitman asks. "I'm older than the baby-boom generation. I took care of my mother without any help from the government, but who'll take care of me? I don't have any kids. I just hope when my time comes, I'll be able to get some help."

Even if there is more legislation, many believe the problems in this industry will continue until society puts a greater value on this type of work—and on the seniors themselves. Elinor Ginzler, author of the book "Caring for Your Parents" and AARP's director of livable communities strategies, says home-based health-care aides should receive adequate wages, benefits and necessary training and education including opportunities for advancement, respect for their work and safer working conditions. "It's critical that we professionalize this job," she says, "we must make it a more attractive profession."

Unless and until that happens, Ginzler says families and friends trying to find a competent home health-care worker for a loved one should learn as much as they can about a prospective worker before they do any hiring. "Get references, do background checks, meet with the agency in person and make sure you get an agreement in writing," she says. "And after you hire them, periodically conduct unannounced visits to see how the care provider is interacting with your loved one."

As for Kim Collins, who says if she had it to do over again she would have done more diligent background checks on her own, the entire experience "was a nightmare from which my family never recovered." Her father died this past April in a nursing home before the family could legally get their house back from Trevino. A judge subsequently ordered the house returned to her mother, Dorothy Torano, who no longer recognizes Collins and still resides in the nursing home where her husband died. "This ordeal literally killed my father," says Collins, her voice cracking with emotion. "After he lost the house he just deteriorated fast. My parents were just easy picking for this woman. It was horrible." Unfortunately, Collins's tragic story is not an aberration—and law enforcement and legislators have only just begun to realize that there are more and more potential victims every year.