In-Home Caregivers Often Lack Training, Oversight
Teri Sernett stood frozen in fear in the living room of the east St. Paul, Minn., home.
Her patient, an elderly quadriplegic man she had just met, gasped for air, his throat blocked and his eyes rolled back. Nothing in Sernett’s one hour of training as a personal care attendant had prepared her for this.
Fearing the man was about to die, Sernett fumbled with a nearby suctioning machine. She had never used one, but she turned it on and inserted a long plastic tube deep into his throat.
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“I was absolutely petrified,” she said. “I had a man’s life in my hands and had no idea of what to do.”
Each day, thousands of home-based caregivers such as Sernett are thrust into similar life-and-death situations with little training and virtually no direct supervision. They perform a dizzying array of complex medical tasks — from inserting feeding tubes and cleaning infections to monitoring intravenous fluids — that once were provided only in hospitals or nursing homes by medical professionals.
Many say they feel overwhelmed and unqualified as they struggle to help patients with serious illnesses and disabilities.
In Minnesota, where more than 100,000 care assistants serve some 36,000 vulnerable patients, all it takes to be certified as a home caregiver is a brief online quiz with questions such as, “When talking to a 911 operator, do not hang up. True or false?”
Of more than two dozen personal care attendants interviewed by the Minneapolis Star Tribune in the past two months, only one had received more than an hour’s training from their agencies. Many said they appealed to their agencies for more training and oversight but were told that state payments were too low to cover the expense.
Isolated and left to fend for themselves, many home caregivers say they have no choice but to violate rules designed to protect vulnerable adults. In interviews, unlicensed personal care attendants said they routinely sterilize wounds, administer powerful prescription drugs and even inject medications into patients’ veins — even though such tasks are prohibited under the state-funded personal care assistant program.
Often, their employers don’t know the risks they undertake because the caregivers are largely unsupervised.
The same pattern plays out across the country. Despite a decade of explosive growth in the $95 billion home-health industry, which is swelling to meet the demands of an aging population, there are no federal standards for the training, credentials and supervision of personal care attendants.
The type of work demanded of home caregivers has changed dramatically in the past two decades.
Hospitals, under pressure from insurance companies to reduce costs, are releasing more patients while they are still sick or recovering, effectively shifting the burden of medical care to the home. Caregivers have had to master the operation of respiratory ventilators, intravenous feeding tubes and home dialysis, while responding to medical complications such as wound infections and low oxygen levels.
More than 80 percent of home caregivers provide nursing care, while more than 50 percent provide help with highly complex medical tasks, according to a survey of 1,926 home care workers who cared for adult Medicaid recipients in three states.
“The burdens placed on (home caregivers) have never been greater,” said Dr. Kevin Mahoney, director of the National Resource Center for Participant-Directed Services at Boston College.
Between medical tasks, caregivers are often expected to do laundry, cook meals and perform other household chores for their clients. In Minnesota, attendants providing overnight care describe sleeping on living-room floors with air mattresses because no spare bed is available, and getting phone calls at all hours of the day from clients who need advice or just someone to talk to.
On a hot July afternoon, sweat poured down Debra Howze’s face as the personal care attendant rushed from one errand to the next. Between house visits, Howze picked up prescription drugs for a client at a pharmacy and did two loads of wash at a laundromat, carting a client’s dirty clothing in the back seat of her car. “I could make the same money waitressing and not have to put up with all this,” Howze said as she stopped at a CVS Pharmacy drive-through window. “Everything is hurry, hurry, hurry.”
The work is also physically demanding, as many caregivers must push, pull and lift patients with disabilities on a daily basis. In 2012, the average home health aide missed 14 days of work from injuries and illnesses, 55 percent more than all occupations nationally, according to the Bureau of Labor Statistics. Their median wage: $10 an hour.
For some personal care attendants, the strain can be too much.
Mona Ali, a personal care attendant, said she was asked to care for an elderly woman who depended on a ventilator machine and an intravenous feeding tube. Ali said she received no training on the equipment before being sent to the woman’s home. Instead, a nurse with her personal care agency left a handwritten note at the foot of the patient’s bed, instructing Ali to change the IV bag every two hours.
And if the red light on the ventilator stopped blinking? Call 911.
“I kept thinking, ‘What if I end up killing this person?’?” Ali said. “I could not understand why this woman was not receiving care from a skilled nurse.”
(Star Tribune staff writer Glenn Howatt contributed to this report.)