Many In-Home Caregivers in California Lack Training, Oversight

Elderly Californians and residents with disabilities are increasingly receiving in-home care, but their caregivers -- including those paid by the state -- are largely untrained and unsupervised, putting thousands of individuals at risk, according to an investigation by Kaiser Health News.

Increased Use of In-Home Care

According to the investigation, at least four times more elderly residents and California residents with disabilities receive in-home care than live in nursing homes. That rate is expected to increase as baby boomers age.

A large number of families provide uncompensated care for relatives or pay out-of-pocket costs for caregivers, KHN reports. However, more elderly residents and residents with disabilities have incomes low enough to qualify for state-funded care under California's In-Home Supportive Services program.

IHSS is the largest publicly funded caregiver program in the country. It serves about 490,000 low-income individuals.

Details of Investigation

For the investigation, KHN talked to elder abuse investigators, law enforcement officials and senior care experts. Investigators also examined court documents.

The investigation found that:

• 73% of individuals who receive in-home care are related to their caregivers, up from 43% in 2000, which can lead to issues when relationships are dysfunctional;
• Few cases of abuse and neglect by IHSS caregivers are documented because authorities only provide brief visits to ensure that caregivers are delivering the proper number of hours of care;
• Few in-home caregivers are trained, as the state does not require training for caregivers who only feed, bathe and dress individuals; and
• IHSS allows clients to hire their own caregivers without background checks, which poses gaps in the screening process.

According to the investigation, lapses in care and oversight of caregivers can lead to patients experiencing:

• Abuse;
• Poor treatment;
• Preventable deaths and injuries; and
• Neglect.

Further, the investigation found that there are "puzzling" variations in the number of critical incident -- neglect, abuse or self-harm -- reports by county (Gorman, Kaiser Health News, 1/5).