USA Today series paints sensational picture
A two-part series published in November in USA Today decrying patient abuse among home health agency employees has made the public and members of the home health industry cringe, but for different reasons.
General readers might well conclude that home health agencies are headed by morally challenged owners and staffed mostly with ex-cons. But according to directors of the hospital-based home health agencies interviewed for this story, the report was too narrow in its scope, sensationalized, and unfair.
Cathy Frasca, RN, BSN, FACHCA, executive director of South Hills Health System Home Health Agency of Homestead, PA, the largest independent hospital-based home health agency in the nation, was dismayed by the one-sided portrayal of the series.
"What worried me was that USA Today didn’t balance it in any way. Sure, out of 400,000 visits a year, you might have one or two incidents, but you don’t cover it up."
Frasca says her agency, which employs 500 people and cares for 3,000 patients, has always been concerned about patient safety. "You have to be very sensitive, and you have to put in precautions. Hospitals and VNAs have always been very concerned about this issue."
Scaring the public
The danger of such reports, as Frasca sees it, is in scaring the very public home care tries to help. "The bulk of people being cared for today are the most vulnerable of the population homebound, frail elderly. They are very frightened. They should be educated about what to look for and how to report trouble. If the patient is too weak to do this, then a family member should. Any problem needs to be reported immediately.
"People have a right to choose their health care provider, and they have a right and responsibility to report things that are wrong early on."
A most effective means of keeping abreast of problems, Frasca says, is through the patient questionnaire, which many agencies use. "The bulk of agencies do this," she says.
At South Hills, the questionnaire is mailed after discharge to an independent person such as a family member. It asks how they liked the care provided as well as things they didn’t like and what they think can improve care. "They take time to read and respond; many write us letters. The largest percent are satisfied."
Frasca says the agency responds to every letter. Any negative reports from customers receive timely follow-up.
"I’d like to see some of those good letters get published," Frasca says. "Our staff goes above and beyond. There have been times when a nurse has run out of her house in the middle of the night in her robe to help a patient who lives nearby, just because that was the fastest way to reach their home.
"I’ve had staff of mine provide food. When it’s a choice for a patient between food and medicine, our nurses buy them food."
Patients then can afford their medicine.
"I’ve gotten calls from patients saying, Tell the nurse not to bring me any more oranges or apples. I’ve got enough right now.’ One nurse had been doing it for three years. I didn’t know that."
It’s not all bad
Lisa Mitchell, RN, director of home health care at Lake of the Ozarks General Hospital in Osage Beach, MO, also was dismayed by the report. "It was very unfortunate for us who have worked so hard to prove ourselves. I was saddened by it. It was sensationalized."
The employees cited in the series were "minimum wage workers," Mitchell notes, "homemakers, sitters. Many of them are vulnerable to temptation and to accusation."
Mitchell’s agency, in addition to skilled nursing, offers certified home health aides who assist patients with personal hygiene, do minimum household cleaning, and help patients get dressed. The agency does not hire sitters or homemakers, and it pays more than minimum wage along with benefits.
"We do thorough background checks, and our aides all have to have certificates issued by the state, a minimum of 12 hours of training yearly to update their skills. We send them to continuing education courses as well."
Mitchell’s aides also have worked for the agency for more than four years. The hospital bought a local agency in 1995, she says, and the employees came with it. There has been virtually no turnover in that time, which is another plus for customers. The agency knows its employees well.
"And they all are wonderful," says Mitchell. "They have many years of experience."
Joseph P. Libera, president of Community Care, a free-standing home health agency in Burlington, NC, regards the USA Today series as instructive.
"The USA articles were very good examples of abuse," Libera says, "but however shocking those abuses are, they are anecdotal and not indicative of the industry."
Libera contends that education is key to controlling violations.
"The most effective deterrent to crime in home care is an informed consumer. Too often, patients and their families have absolutely no idea what they are being charged for home care. The insurance company picks up the bill. The physician has no idea of the incentives motivating case managers and providers. Who advocates for the patient? The clinician and the state have a role in oversight," he says.
"We as providers must educate families and patients to be better consumers. We like to say that home care is about preventive care prevention of hospitalization. Well, maybe home care is about preventive consumer education as well, prevention from abusive practices."
Karen Austin, RN, owner of Compliance Healthcare Services in Atlanta, says that patients are not the only ones who badly need education on issues of health care reimbursement. "All too often, front-line employees tend not to understand conditions of participation and other regulations. As a result, they trip themselves up."
When nurses trip, she says, they document visits incorrectly and thus unintentionally invite scrutiny, criticism, and, occasionally, investigation.
Such instances of innocent error are relatively underplayed; cases of deliberate fraud attract much more attention. The sensational anecdotes detailed in USA Today, Austin says, are exceptional. They do not typify the more pervasive problems such as employees’ ignorance of the regulations.
Kathy Sgro, president of Alterna-Care in Springfield, IL, acknowledges that freestanding agencies may be "attractive to people who would prey on the elderly and vulnerable." However, she is quick to add, "I am not referring to the thousands of honest, caring aides doing a wonderful job!" The problem, according to Sgro, is the inability of freestanding agencies to adequately screen their employees and police themselves. In her view, too many bad people are being hired. To get rid of the bad apples, employers should be allowed to make hard choices, she says.
"There should be a duty to disclose theft or suspected theft without fear of retribution to an employer."
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