Sept. 19, 2018 update: The Home Care Alliance of Massachusetts released a statement in response to The Boston Globe series stating the articles failed to properly explain the home care system in the state and left readers scared and confused. “The Home Care Alliance and its members have a zero-tolerance policy when it comes to patient abuse. Over many years we have worked with the Department of Public Health, Elder Affairs and Health and Human services to address issues of elder abuse and billing fraud. Our members take very seriously the responsibility of ensuring the safety and quality of care being delivered to their clients … While the article cites 20 cases of agency-hired workers committing abhorrent crimes in ‘recent years,’ it fails to contextualize the fact that home care agencies have employed over 75,000 workers and delivered care to more than 600,000 elders in the past five years … At a time when aging-in-place is a statewide priority, we should be working on solutions that expand access to these services and protects consumers in the setting that they prefer: home.”

The statement goes on to support the state developing a licensure process and legislation. 

The Home Care Alliance of Massachusetts released a statement in response to The Boston Globe series that

The in-home care industry may lack the necessary oversight to keep seniors safe, properly cared and out of harm’s way, The Boston Globe reported in its recent “Stranger in the house” two-part series.

Among the red flags raised by the series: a lot of personal care aides, specifically those in Massachusetts, are not undergoing background checks or receiving training before they are tasked with a caregiving job, according to the Boston Globe. With demand for care so high, most seniors or families looking for care are just relieved to have someone take the job.

Nearly 87% of adults over 65 years old want to stay in their current home and community as they age, according to an AARP survey from 2014. Due to that demand, home health aides and personal care aides are estimated to account for 41% of job growth by 2026, according to the Bureau of Labor Statistics.

Although many home care workers feel empowered and privileged to do the work they do, some have been caught committing crimes against their clients. The exact number is hard to track, but the problem is nationwide, according to The Boston Globe.

Indeed, there is almost no government safety net to protect people seeking home care from potentially dangerous workers, The Boston Globe reported. Unlike nurses or workers from other service industries, home aides often don’t need a state license.

In Massachusetts, anyone can become a home care worker and work privately, though state law does require home care agencies to perform background checks. Personal care attendants hired through a MassHealth program are required to attend a state-run three-hour orientation session.

Christi Grimm, chief of staff of the federal Office of Inspector General, testified in May 2017 that her office opened more than 200 investigations in the last five years involving fraud and patient harm in the Medicaid personal care services program across the country.

As part of its two-part series, The Boston Globe made visits to courthouses across Massachusetts to investigate the state’s alleged abuse cases, uncovering 47 recent cases against home care workers. Of those, 45 of the cases involved alleged robbery of a client. Another 15 involved home care aides that allegedly neglected or physically injured their clients, according to The Boston Globe’s review.

Cases included a personal care attendant that stole Clonazepam, a seizure medication, from a client with a rare form of epilepsy and replaced it with aspirin. They also included a home care coordinator who allegedly moved her family into the home of an elderly woman with dementia, moving the woman to her basement.

“You have a basic formula for exploitation,” Robert O’Regan, an attorney who practices elder abuse law for Burns & Levinson, told The Boston Globe. “[These] aides prey on isolation, manipulation, and fear.”

While some critics have expressed concern that the home care industry is largely unregulated with little oversight on a federal level, some states have taken action to regulate the industry themselves.

California, for example, established the Home Care Services Consumer Protection Act in 2016. The law requires home care organizations to be licenses and creates a public registry for home care aides who have completed background checks. The law is implemented by the Home Care Services Bureau, according to its website. The bureau conducts random agencies checks to insure compliance.

Out of the 47 cases, nearly half involved agency employees, according to the Boston Globe.

Home care agencies are not the only home-based providers drawing scrutiny for lack of oversight. Federal watchdogs have repeatedly stated their intentions to continue investigating the hospice industry for fraud, waste and abuse.

In addition to outlining oversight issues, The Boston Globe also reported on the influx of immigrants in the home care industry, specifically highlighting a growing number of workers in Massachusetts who emigrated from Ghana.

The Boston Globe’s “Stranger in the house” series was supported in part by a grant from the Fund for Investigative Journalism and a fellowship with the Schuster Institute for Investigative Journalism at Brandeis University, among other groups.

Written by Kaitlyn Mattson