Tuesday, February 15, 2011

Elder Care and Abuse Prevention

Carolyn L. Rosenblatt
Carolyn L. Rosenblatt

The term “elder abuse” sometimes makes us think of a scam artist selling a bogus financial investment to older people. Sometimes we see ads from the local District Attorney’s office showing bruised faces of an older person, and we are horrified. What does the term really mean?

The National Committee for the Prevention of Elder Abuse defines it as “any form of mistreatment that results in harm or loss to an older person”. It is usually divided into the categories of physical abuse, sexual abuse, domestic violence, psychological abuse, financial abuse, and neglect/self-neglect.

Since elder abuse has been called “the crime of the century”, it is important to be aware that with elders at home, it can be a crime of opportunity for the worker. Financial abuse affects millions of seniors, as most of us know. Preventing it must include a consciousness of protecting elders at home from those who enter the home freely and who work unsupervised for long hours.

The resistance of the aging person himself or herself is just part of the picture. Getting past the resistance is usually the job of the adult child, who may be the first to see the need. According to Erin Winter, co-owner of Hired Hands Homecare Inc., in Novato, California, “about 75% of the elders we serve don’t think they need help when it is obvious to those around them that they do”.

One must gently push ahead, presenting the idea that the help is needed for the peace of mind of the adult child. It’s the “humor me” approach. It seems to work, for most, Ms. Winter reports. If the adult child is able to persuade the elder to try it, and the worker is consistent, kindly and respectful of the elder, the elder actually may be relieved to have the help.

Weigh the costs versus the care

Choosing the worker is a different challenge. Many people, worried about the ongoing expense of having help at home, which can be as much as $27 an hour and up, seek helpers through the newspaper or general internet advertising. Invariably, it is cheaper to go this route than to use a home care agency to find a worker. We suggest that it is far more dangerous to hire a worker independently.

If the statistics on identity theft and financial elder abuse are not enough to convince the consumer to use an agency, consider the economic times. Desperate people, even those whom you think you know, can do desperate things. The temptation to take money, valuables, or misuse a credit card can be overwhelming for a worker whose spouse has lost a job, or who feels economic pressure in this recession. A licensed agency offers several layers of protection for the consumer.

First, the agency doing its job properly will do a thorough background check of every worker. This should include a national criminal records search. Hiring on one’s own seldom involves checking anything more than the applicant’s references. Those, as we know, can be falsified. Next, the agency should be insured, bonded, and licensed. If a worker steals, at least there is a remedy.

If a worker one hires from a newspaper ad steals, it might just be too bad. Homeowner’s insurance may or may not cover the loss. The deductible may be too high to make it worth making a claim. Identity theft would likely not be covered by such a policy.

Do your research
Finally, a quality employer agency providing home care workers will screen for suitability for the job, may do drug testing, and will train and supervise its workers. It will also replace them if one leaves suddenly. Many workers in this field have roots in other countries, and leaving the job for family emergencies or other reasons, to return to one’s home country, is not uncommon.

The vulnerable elder who hires on one’s own does not have the capacity to replace the worker as quickly as an agency can. Not all agencies are alike, and not all are employer agencies. Do your research on the agencies you are considering. Longevity in the field is a good sign. With the increase in need, new agencies are springing up rapidly to meet it, making it harder for the consumer to check on past performance of the agency.

Doing your own background checking is essential if the agency checks only your state. Ask about the training and supervision of caregivers. Not all agencies provide this. Some use certified nursing assistants, and some do not. We believe that the extra cost of using established employer-model agencies is well worth the security they can provide to keep elders safe.

Those agencies which place independent contractors only are out of the picture to monitor quality or to supervise the workers, once they are placed and the placement fee is collected. It is certainly much simpler for the agency to keep only independent contractors as workers, but is more risky for the recipient of services. In many instances, reliance on an elder’s ability to monitor care, especially when the elder has cognitive impairment, does not make sense.

What’s the takeaway message here?

Follow these tips, and enhance your chances of safely using a home care worker to help an aging loved one stay at home.

1. Meet an aging loved one’s resistance to help at home with the “humor me” approach (it’s for your sake), and keep respectfully urging when you see the elder resisting.

2. Use an established, employer-model home care agency to find a qualified home care worker for an aging loved one.

3. Do your research on the agencies you are considering. Not all are employer agencies, and not all provide training and supervision. A supervised worker is safer for an elder.

--Carolyn L. Rosenblatt is an R. N. and Attorney at Law who specializes in elder care issues. For more useful tips on how to make the best choice of a worker, and consumer information about the pros and cons of hiring on your own are available in The Boomer’s Guide to Aging Parents, Vol. 2, How to Choose a Home Care Worker, at http://www.agingparents.com/

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