BEHIND CLOSED DOORS: Stopping elder abuse in in-home care
28th November 2016 · 0 Comments
By Jennifer Margulis
Contributing Writer
Part 1 of 2 articles.
(New America Media) — They were so happy to find her. The young woman sent by Home Instead Senior Care made a good impression on the whole family. Not only was she attentive, personable and experienced, she also seemed strong enough to help Grandpa Joe in and out of his wheelchair, and she was certainly talkative enough to keep him engaged.
Joe Guarino, age 79, had always done everything for himself, but after his wife died, the disease he was fighting, progressive supranuclear palsy, had taken a turn for the worse. Guarino’s adult children found themselves in crisis, grieving the loss of their mom and trying to figure out how to keep their father safely in his home in Brockton, Mass.
While it is not possible to measure the number of caregivers whose conduct towards seniors is unethical, it is presumed to be a small fraction. But even a small number of unscrupulous caregivers and agencies without proper safeguards can have a wide and lasting negative impact. 
He Wanted to Die at Home
It wasn’t until after the Guarino’s mom passed that they realized how much the muscular disorder was affecting Grandpa Joe’s body and his brain. He had his good days and his bad days. He could be lucid and aware, cracking jokes like the man they knew and loved, or disoriented and confused, barely able to move his arms and legs. Joe had always told his four children that he wanted to die at home. Putting him in a nursing home was out of the question.
At first the family set up a schedule for the siblings and their spouses to do the grocery shopping, make sure Guarino was eating and check up on him, but it was getting to be too much for them to handle alone. They realized they needed help.
Guarino’s son-in-law, Larry Runey, did his homework. He says he called no fewer than 12 private agencies, based on referrals he got from a nonprofit that provides information about services for older adults. The first caregiver sent by Home Instead had been fabulous, and the whole family breathed a sigh of relief. But they found themselves back in crisis mode just a few months later when that in-home aide had to stop working due to a back injury.
Luckily, the new gal seemed just as promising: She gave Guarino a big hug every time she came to work, and confided to the family that her father had also been a veteran and had recently passed. At age 29, the mother of one was also very pretty. And Grandpa Joe always liked pretty girls.
Debra Blair started working full-time for the family in July, taking Grandpa Joe on outings, helping him on and off the toilet, and reminding him to take his medication. In the evenings and at night Joe, Jr. cared for his dad. The family says Home Instead Senior Care in East Bridgewater charged just over $3,000 a month for the young woman’s help.
The Guarinos and the Runeys thought they knew they were getting the highest quality care.
Senior Population to Double
In the last decade the need for personal care attendants has risen dramatically. The number of Americans age 65 and older will more than double from 35 million in 2000 to 80 million in 2030, according to U.S. Census Data. Many aging baby boomers and their older siblings became used to leading independent lives, are keen to grow old in their own homes. So it’s no surprise that along with the increased need for caregivers for older adults, there has been a huge growth in caregiver placement agencies.
Indeed, home-care aide positions are among the fasting growing jobs in America. In 2000 there were only 13 caregiver placement franchises; that number has more than quadrupled, with over 55 parent companies today. Franchisee information disseminated by Home Instead Senior Care boasts that the Nebraska-based company has over 1,000 licensed franchises in the United States and around the world and that they bring in over a billion dollars in revenue.
But what has lagged troublingly behind is these private agencies’ ability—or willingness—to thoroughly screen their workers. In a 2012 study of 180 for-profit home care agencies in the states with the largest populations of older adults (Arizona, California, Colorado, Florida, Illinois, Indiana and Wisconsin), researchers from Northwestern University found that only 55 percent did any kind of criminal background check; only 32 percent performed drug testing before hiring caregivers; and no agency screened workers on their health knowledge, even when specific duties included accompanying elderly patients to doctors’ appointments and administering medication.
Even more disturbing: not a single agency checked to see if their employees had a criminal background in any other state.
“We have a policy of testing someone for drug abuse if it’s ever questioned,” a patient care coordinator from At Home Senior Solutions in Medford, Ore., said when this reporter called for information about finding a caregiver. “We don’t do it before hire.”
Why not? According to experts, the reason is usually cost.
Background Checks Take Bite Out of Profits
“Doing the background checks and due diligence takes a bite out of the profits,” explains geriatrician Lee Lindquist, MD, an associate professor of medicine at Northwestern University Feinberg School of Medicine. “With caregivers there’s a lot of turnover in their field. They are very low-paid; many don’t speak English. If they find a better job, they’re going to jump ship.”
Carolyn L. Rosenblatt, a lawyer and registered nurse based in San Rafael, Calif., who specializes in elder issues, agrees: “The agencies don’t want to spend the money. It cuts into their profit margins. A lot can’t get good workers and they don’t think they’re going to make enough to justify spending the money for a really good background check on every employee.”
Although the price of a national background check may be as little as $100 per employee, with the industry’s high employee turn-over, that can add up to thousands of dollars a year.
But it is precisely because families are looking for carefully screened candidates that they go through agencies in the first place instead of finding caregivers on their own via the internet or word of mouth. Families pay placement agencies a premium—twice or even three times as much an hour as they would pay a caregiver directly—to insure getting competent, reliable help.
Sometimes they are. The problem is that sometimes they’re not. As of now, there’s no easy way to tell.
Not long after Blair started caring for Guarino, the change from $40 his daughter Deborah Runey had given him to pay for turkey sandwiches disappeared. When Runey asked Blair where it was, she said she didn’t know. But the next day Blair announced she found the money in Grandpa Joe’s sock drawer.
“He musta put it there and forgot,” Blair said. Runey’s father was wheelchair-bound and unable to lift his arms. Not only couldn’t he hide the money that way, but his caregiver ought to have known he couldn’t. Doubt flitted through her mind; but she ignored it. She had a helper she needed and wanted to trust, so she gave Blair the benefit of the doubt.
A few days later, some of Joe, Jr.’s new plumbing supplies went missing. The family laughed it off: Joe, Jr. was the scatterbrain. Then one day Joan Guarino, a registered nurse and a medical records reviewer, dropped by the house unexpectedly and noticed her father-in-law’s eyes looked glassy.
“His pupils were pinpoints. He was looking right through me,” she remembers. They don’t have proof but the family believes Blair was giving Grandpa Joe extra pain medication, including morphine, so he would be too doped up to notice she was stealing.
While Blair was in the house, jewelry and Grandpa Joe’s Korean War medals disappeared. Blair sometimes didn’t bother showing up for work, although the Home Instead franchise billed them for those hours.
Joe Guarino’s family says they called Home Instead several times to complain about his care. One evening Joe, Jr. came home from work to find his father alone on the floor, crawling towards the bathroom. Blair had left early without informing anyone. Larry Runey called Home Instead again and angrily told the office manager that Blair she was no longer welcome. That night they installed a nanny cam in the kitchen.
Home Instead sent a different caregiver the next day. Joe, Jr. watched the footage when he returned home from work: The tape captured this new caregiver, a man named Ralph, drinking orange juice straight from the carton and loading his backpack with steaks and frozen dinners from Grandpa Joe’s freezer.
Upset and disgusted, Deborah Runey wrote a letter to the Home Instead Senior Care’s parent company in Omaha, Neb., as well as to Old Colony Elder Services, the Home Instead franchise in East Bridgewater, the Massachusetts Attorney General’s Office, the Brockton Visiting Nurses Association, and the Better Business Bureau.
Her letter detailed the complaints against Blair, including a list of items that had gone missing. They were then told the franchise would submit an insurance claim to reimburse the family for the missing items, but the owner, Richard Sasso, wrote back denying Blair had stolen money or jewelry.
The Runeys remember sitting down with Grandpa Joe and explaining that he would have to go into a nursing home. It was the most heartbreaking moment of both of their lives. Joe comforted them, saying he understood that they could no longer care for him.
Two months later, on February 16, 2011, he died at West Acres Nursing Home. The next day, Larry Runey bought a copy of the local Enterprise, [http://tinyurl.com/pax3r4m] brought the newspaper into Santoro’s Pizza & Subs, ordered a cheeseburger, and sat back to read.
The headline he saw made him wallop the counter with his fist in anger: “Aide admits Elder thefts.”
The aide in question, Debra Blair, also known as Deborah Belcher, admitted to stealing and pawning over $30,000 in silver and other valuables during a three-month period from an elderly couple in Brockton, according to the article.
Runey assumed Home Instead Senior Care, one of the largest and most successful private non-medical in-home health franchises in the country, had fired Blair after he and his wife had complained. But, instead, they sent her to another family’s home.
Part 2 will show how home-health aide Debbie Blair got caught and convicted. Investigative journalist and science writer Jennifer Margulis, PhD, [www.JenniferMargulis.net] developed this report for The Jefferson Journal, a publication of Jefferson Public Radio (Southern Oregon and Northern California) with support from the Fund for Investigative Journalism [www.fij.org] and the Journalists in Aging Fellows Program of New America Media and the Gerontological Society of America.
This article originally published in the November 28, 2016 print edition of The Louisiana Weekly newspaper.
