Despite Home Care’s Praises, Lack of Scrutiny Remains

Home care is often lauded as a more cost-efficient method to receive health care services, especially when compared to larger, more institutionalized care settings. But as care shifts to this more preferred environment, a lack of scrutiny remains for the workers providing care, suggests a recent article from Kaiser Health News (KHN).

An investigation conducted by KHN found that caregivers in California are “largely untrained and unsupervised, even when paid by the state, leaving thousands of residents at risk of possible abuse, neglect and poor treatment.”

Specifically, the article mentions Caifornia’s state-funded In-Home Supportive Services (IHSS) program.


At $7.3 billion, the IHHS program is the largest publicly funded caregiver program in the country with a caseload that KHN says has doubled since 2001.

Now serving about 490,000 low-income clients throughout the state, the massive nature of the IHSS program may prove too much to handle for caregivers, many of which KHN found are greatly unprepared. 

Even though IHSS is not a medical program by design, some caregivers in the program become “ad hoc nursing aides,” helping to dress wounds and manage medications.  


And while the state requires caregivers receive training and authorization from physicians in these cases, only about one in nine caregivers receives it, according to KHN.

Another area of concern is the screening process for caregivers. Although state law requires criminal background checks and prevents people from becoming caregivers if they’ve been convicted of certain crimes such as elder abuse and child abuse, the IHSS program leaves the hiring to the clients. 

“Felons convicted of robbery, rape or assault can be paid caregivers if their clients get a waiver from the state,” KHN writes.

More than 830 people have received such waivers in the past four years.

“The can have criminal records, they can have drug addiction,” said Susan Strick, a prosecutor with the Los Angeles City Attorney’s office to KHN. “That’s a problem.”

Read more at Kaiser Health News.

Written by Jason Oliva