Home care shakeup affects caregivers, clients
Recent legislation provides safeguards, but could increase costs
The new year is bringing new standards to the home care industry as California adopts stricter requirements for individuals and agencies who provide home care, including background checks, mandatory training hours and licensing.
The Home Care Services Consumer Protection Act (HCSCPA), scheduled to take effect on Jan. 1, 2016, requires the certification of home care aides and agencies, something new in California. Currently only those providing in-home medical services are required to have certification and background checks. Home care aides providing non-skilled, non-medical home services (like running errands, cooking dinner, dressing and bathing assistance) are not as regulated. According to the bill’s sponsor, Assemblywoman Bonnie Lowenthal (D-Long Beach), thousands of privately funded home care organizations operate in California with nothing more than a business license. An unknown number of independent home care aides provide services without any oversight or regulation.
Recent cases of fraud, abuse and embezzlement at the hands of home care aides, including some in the North Bay, prompted California, and a handful of other states, to seek legislation to tighten the oversight on home health care services.
“Right now, I can check the license status of an air-conditioning repair person, but if I need to hire someone to help bathe a loved one, I’m at a loss,” said Lowenthal in a press release. “Consumers have the right to know if the person they let into their home is safe.”
In the northern Sonoma Valley, with more than 60 percent of the population age 65 or older, the effects are sure to be widely felt.
“Probably every third house [in Oakmont] will require some form of outside service to help them stay in their home in the next two years,” said Steve Brooks, director of WeCare Home Assistants, which has an office in Oakmont. “Some may just be for a couple of hours, prescribed by a doctor after coming home from surgery, and some are 24/7 on a semi-permanent basis.”
As of Jan. 1, all agencies providing home care services will be required to apply for a two-year license (or face a $900 per day fine), which is contingent on things like following worker’s compensation laws, reporting any suspected client abuse, and making sure all employees have passed a background check, received training hours, and are registered on the Home Care Aid Registry, a statewide database overseen by the Home Care Services Bureau (HCSB) of the California Department of Social Services. Caregivers unaffiliated with an agency will also have the option to be listed on the Home Care Aid Registry, as long as they complete the required background check, tuberculosis screening, and pay a $25 application fee.
“There’s no question that there are pros. People will be more careful about who they hire, people will be sure to do background checks and training. All those are good things,” said Stanton Lawson, owner of Sequoia Senior Solutions, which also serves Oakmont.
Advocates see the HCSCPA as a way to standardize how agencies across California screen and hire. “The Home Care Services Consumer Protection Act helps ensure the safety of our parents, grandparents, and those with disabilities who rely on private pay home care to continue to live at home with dignity,” said Laphonza Butler, provisional president for Service Employees International Union Local 2015, which represents over 315,000 long term care providers throughout the state.
Both Sequoia Senior Solutions and WeCare Home Assistants have always made it a policy to background check employees prior to hiring, but that isn’t the case with all agencies.
“If you can fog a mirror, you can get a job as a caregiver, and that’s not how this should be,” said Lawson. “This will raise the professionalism in our industry.”
Although it’s a good idea to hold all agencies to a higher standard, compliance has its costs, too. The license application fee alone costs $5,165 and it’s still unclear whether satellite offices each need their own licenses. For Sequoia Senior Solutions, which has satellite offices in six different counties, this could really add up.
Current employees cannot be “grandfathered in” and both WeCare Home Assistants and Sequoia Senior Solutions have been forced to duplicate their background check and fingerprint processes. Brooks estimates the additional fees, paperwork and effort will cost them $250 per employee. WeCare Home Assistants employs 45 caregivers. Sequoia Senior Solutions has 200.
“It’s going to affect what we will be charging our clients in the coming years,” said Lawson.
This new legislation is just part of a series of changes that have swept the home care industry over the last few years. Designed to protect the rights of workers who are often needed around the clock, these changes have included regulating the number of consecutive hours for home health care workers and requiring overtime pay for shifts longer than nine hours. This can include “sleep time” for a worker, which used to not count as overtime. Brooks said in some cases, this has more than doubled the cost of care.
Additionally, Brooks anticipates the cost of hiring a caregiver to rise even more with California’s minimum wage set to increase from $9 to $10 per hour, also scheduled for Jan. 1. Currently, WeCare pays its caregivers about $25 per hour, with 24-hour care aides being paid minimum wage to accommodate all the overtime pay. When the minimum wage goes up – roughly a 10 percent increase – the cost to hire a caregiver will go up, too.
“It will become that only the wealthy can afford in home care. So that’s a concern we have,” said Brooks. “People may do without.”
They may do without – or turn to the “gray market” like Craigslist, which will still go unregulated even after HCSCPA kicks in.
“The administration thinks this will be a way to cure elder abuse by requiring agencies to do background checks, but my frustration is that nothing is being done where I think the most abuse is coming from, which is direct-hires,” said Brooks.
Even so, informed people seeking services for themselves or loved ones will have a safeguard in the new legislation and registry.
People should only hire caregivers who have been background checked and fingerprinted, said Lawson. If they haven’t, that should be a red flag. However, Lawson warned that private caregivers are not held to the same training standards as agency-affiliated caregivers, even if they are included on the new Home Care Aid Registry.
From reminding patients to take their medicine to driving them to doctors appointments or making home cooked meals, quality home care has a huge and positive impact on hospital admissions and health care costs, for individuals and doctors and hospitals, said Lawson. “As a business person, I wish we didn’t have to do this because it’s really expensive, but it’s the right thing. This is a step in the right direction.”
The Home Care Aid Registry will go live on Jan. 1 at the DDS website at www.ccld.ca.gov/pg3654.htm. However, the HCSCPA provides a three-to-six month grace period for processing licenses and registrations and allows applicants who submit applications prior to Jan. 1 to continue providing services while going through the application process. Officials said that the registry will become more robust and complete as licenses and registrations are approved and added.
Sarah Phelps is an editor and reporter. She was raised in Kenwood and has a BA from Loyola Marymount University.