Among our greatest challenges as a nation
today is making America a safe place
to grow old
.”  — Lisa Nerenberg


Learn About Elder Abuse

Elder Abuse By Paid Caregivers

As the elderly population swells and increasingly frail elders are living at home, paid caregivers are in short supply. Workforce shortages, barriers to screening, and a lack of oversight has resulted in more abuse by caregivers coming to light. The resources on this page provide an overview of the problem and challenges to increasing the supply of workers, screening out the dangerous and unscrupulous, and ensuring accountability.

Resources on Elder Abuse by Paid Caregivers

  • “Ensuring a Qualified Long Term Care Workforce: From Pre-Employment Screens to On-the-Job Monitoring.” This study, which was prepared by the Lewin Group for the Office of Disability, Aging and Long-Term Care Policy (DALTCP) of the U.S. Department of Health and Human Services, explores, among other things, the relationship between past criminal background and subsequent abuse. To view the report, click on Ensuring a Qualified Long Term Care Workforce: From Pre-Employment Screens to On-the-Job Monitoring.
  • Developing training programs on elder abuse prevention for in-home helpers: Issues and guidelines. This publication, which I wrote for the National Center on Elder Abuse (NCEA), is available on NCEA's website at "Developing training programs on elder abuse prevention for in-home helpers: Issues and guidelines" [PDF:738kb]
  • Preventing elder abuse by in-home helpers (2000). This publication was also written for NCEA. For information on how to obtain a copy, see NCEA's website
  • Hiring In-Home Helpers. I wrote this Webcast with Rita Widergren for the Elder Financial Protection Network in partnership with SeniorNet and funded through a grant from AT&T.
  • Gross, J. (2007, March 1). New options (and risks) in home care for elderly. The New York Times.
  • Loar, L. (2006) Increasing safety for at-risk adults: Screening in-home care providers. Aging Today 27(1), 5 and 12. This article by Lynn Loar draws from her experience in child protection to offer suggestions for the elder abuse prevention network. In it, she offers tips for hiring workers: See Increasing safety for at-risk adults: Screening in-home care providers. A longer version appeared in Social Work in 2007 (volume 52, issue 3).
  • Socolof, J., & Jordan, J. (2006). Best practices for health care background screening: Warning signs that your background reports may contain incomplete or non-compliant data. Journal of Health Care Compliance, 5-10, 61-63. See Best practices for health care background screening.
  • Using criminal background checks to inform licensure decision making. Although this article was written for nursing licensing boards, it is useful to anyone concerned about the benefits and limitations of criminal background checks and the related issue of recidivism. It is available on the Web site of Emory University's School of Nursing. See Using criminal background checks to inform licensure decision making.

Promising Practices:

  • The Service Employees International Union is attempting to create a more stable pool of home care workers and reduce turnover to improve conditions for both workers and their clients. In New York, Local 1199 unionized 60,000 home-care aides, many of whom are former welfare recipients. The aides get a full array of benefits and opportunities to study English, nursing, or other skills. Recently the union began a consciousness-raising group to create a sense of community among isolated workers.
  • After reviewing a complaint alleging abuses with the county's In-Home Supportive Services (IHSS) for the elderly, which questioned the ability of elderly clients to supervise caregiver services, the 2006-2007 San Diego Grand Jury initiated an investigation. The findings, which were filed on May 23, 2007, include the following recommendations to San Diego’s Health and Human Services Agency:
    • Direct IHSS take a more proactive approach in monitoring its caregivers through unannounced home visits to consumers, with the caregiver present.
    • Direct IHSS to assign social workers to inform elderly consumers on proper practices of hiring and supervising caregivers, and assist with completion of forms.
    • Require the Quality Assurance Department of IHSS to report all abuses to Adult Protective services for investigation.
    • Require the Public Authority to coordinate with the District Attorney’s Elder Abuse Division to provide annual training to IHSS staff in recognizing the signs of abuse.
    • Require the Public Authority to expand all background checks to include National Crime Information Center (NCIC).
    • Direct the Public Authority to institute a system to monitor caregivers to ensure consumers are getting proper care.
    • Require the Public Authority to ensure that all caregivers speak English or the language of the client or be enrolled in English as a Second Language Program.
    Copies of the report are available online at San Diego county elder care program: Golden years in crisis

From My Blog:

  • Wall Street Journal Looks at Home Care Aide Crisis. Tuesday, July 15, 2008. Readers know that the shortage of in-home workers and elders’ vulnerability to abuse by criminal caregivers has long been a concern of mine. So I was delighted with Phil Shiskin’s in-depth article on the subject that appeared in today’s Wall Street Journal. It focuses on California and mentions Napa's effort to develop a local screening program. Check it out at Caregiver Abuse. Read more…
  • From the Folks Who Brought You “Friendly Fire” (February 26, 2007)
    What do the U.S. military and the long-term care network have in common? It seems we’re competing for the same criminals (reformed, hopefully) to fill critical manpower shortages. In our case, the shortage is for nursing home employees and in-home attendants. In theirs, it’s for soldiers to fight an unpopular war. We’re both struggling with the uncertainties of deciding when past criminal conduct should not stand in the way. The military’s approach is to issue an increasing number of “moral waivers,” which permit would-be personnel who’ve committed disqualifying offenses to serve. To see the full post, click on From the Folks Who Brought You “Friendly Fire”
  • Follow-up on Government-Subsidized Elder Abuse (August 22, 2006)
    Riverside County (California) convinced an IHSS administrative hearing judge to deny a client the right to continue to use an abusive independent provider using the argument that the purpose of the IHSS program is to maintain the client safely at home.(Clients who have complaints about state benefits and services can request hearings, which are presided over by administrative law judges from the California Department of Social Services. Clients [and their advocates] and representatives from their counties present their sides.) To see the full post, click on Follow-up on Government-Subsidized Elder Abuse
  • Consumer Choice or Government-Subsidized Elder Abuse? (August 17, 2006)
    Years ago, San Francisco’s multidisciplinary team was discussing a case involving flagrant abuse by a chore worker. When the group learned that the worker was being paid with public funds through the state’s In-Home Support Services program, we turned to Mary Counihan, supervisor of our APS and IHSS units, and chimed in unison “Fire him!” To see the full post, click on Consumer Choice or Government-Subsidized Elder Abuse?
  • Criminal Caregivers (June 13, 2006)
    Criminals shouldn’t be providing care to frail old people. That assumption is what’s driving more and more agencies, states and the federal government to explore criminal background checks for prospective long term care employees. To see the full post, click on Criminal Caregivers
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For more on promising practices and developments in the field, visit my blog, Prevent Elder Abuse.
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