Hospitals Now Required to Keep Caregivers Informed
Many Californians Unaware of Program That Pays Family Members for Caregiving
Plenty of Responsibility, But No Required Training, for In-Home Caregivers
Lack of Oversight for In-Home Caregivers Can Lead to Neglect and Death
California Caregivers Sue Their Employer for Wage Violations
Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care
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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"adembosky":{"type":"authors","id":"3205","meta":{"index":"authors_1591205172","id":"3205","found":true},"name":"April Dembosky","firstName":"April","lastName":"Dembosky","slug":"adembosky","email":"adembosky@kqed.org","display_author_email":false,"staff_mastheads":["news","science"],"title":"KQED Health Correspondent","bio":"April Dembosky is the health correspondent for KQED News and a regular contributor to NPR. She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of 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FM","link":"/"}},"stateofhealth_129014":{"type":"posts","id":"stateofhealth_129014","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"129014","score":null,"sort":[1451574906000]},"guestAuthors":[],"slug":"california-hospitals-require-keep-caregivers-informed","title":"Hospitals Now Required to Keep Caregivers Informed","publishDate":1451574906,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Diana Matsushima cares for both her husband and sister-in-law full-time, giving them their medications and driving them to their doctor appointments.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new state law ensures caregivers have the information they need to take care of a patient at home.\u003c/aside>\n\u003cp>But when either ends up hospitalized, Matsushima said her role as their primary caregiver is often overlooked. She isn’t always included in the discussions at the hospital, and she sometimes leaves confused about how to best care for them when she gets home. When they are discharged, she said the nurses hand her a stack of papers without much -- if any -- explanation.\u003c/p>\n\u003cp>“They print out these cryptic notes,” said Matsushima. “My background is health education and I don’t know what these things mean to me and my family.”\u003c/p>\n\u003cp>Beginning Jan. 1, family caregivers like Matsushima could have a much different experience. A new California law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">SB 675\u003c/a>, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.\u003c/p>\n\u003cp>The law, sponsored by state Sen. Carol Liu, D-La Cañada Flintridge, mandates that hospitals give patients an opportunity to identify a caregiver, notify that caregiver when the patient is to be discharged and provide information and instruction on patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California is among 18 states to pass such laws over the past two years, including Arkansas, New Hampshire, Oregon and Virginia. It’s part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a relative’s hospitalization.\u003c/p>\n\u003cp>How hospitals communicate with caregivers is expected to become more important as the population ages and the number of unpaid family caregivers continues to increase. An estimated 40 million Americans have cared for a relative in the past year, according to a 2015 study by the National Alliance for Caregiving and AARP.\u003c/p>\n\u003cp>The changes are largely being driven by AARP, which is leading a campaign to reduce barriers for family caregivers. The impetus comes from the organization’s 2012 survey, which found that 46 percent of caregivers perform medical tasks, such as giving injections, most without any training or guidance from medical professionals. AARP crafted model legislation known as the Caregiver Advise, Record, Enable, or CARE Act, and is promoting it around the nation.\u003c/p>\n\u003cfigure id=\"attachment_132363\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-132363 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/Matsushima-3-400x267.jpg\" alt=\"Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister who has had two major operations in the last few years.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister-in-law who has had two major operations in the last year. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Elaine Ryan, AARP’s vice president of state advocacy and strategy, said the legislation is designed to improve caregivers’ competency and give them peace of mind.\u003c/p>\n\u003cp>“A piece of paper can’t really educate people how to fill a syringe or clean a PICC line,” Ryan said, referring to a catheter inserted into a vein in a patient’s arm. The laws “make sure that family caregivers have all the information they need to safely care for their loved one at home.”\u003c/p>\n\u003cp>Matsushima said she has struggled to get that sort of information since 2009, when her husband had a stroke and she became a caregiver. During one hospital visit, she had to demand that nurses instruct her how to remove her husband’s catheter.\u003c/p>\n\u003cp>Over the past year, she has also helped her sister-in-law through two surgeries and two lengthy hospital stays. The first time her sister-in-law was discharged, Matsushima said she got very little notice or guidance. Two days later, her sister-in-law fell while getting out of bed and ended up back in the hospital.\u003c/p>\n\u003cp>Matsushima said she feels “fed up with hospitals” and hopes the new law will make things better for her and other caregivers.\u003c/p>\n\u003cp>Around the country, however, some hospital associations say their members already include caregivers in the discharge planning process and that adding specific requirements only adds more work. At the same time, hospitals face increased pressure from the Centers for Medicare & Medicaid Services to keep patients from being readmitted, and some recognize that improving communication with family caregivers can’t hurt.\u003c/p>\n\u003cp>In New Jersey, where a similar law passed last year, the state’s hospital association had some reservations but made a political decision to work with AARP to tailor their model legislation to the state, said Neil Eicher, vice president of government relations for the association. That meant making changes, including stripping out time requirements for notifying caregivers of discharge.\u003c/p>\n\u003cp>“We understand the importance of having good discharge planning,” he said. “We just didn’t want our hands tied to those time frames.”\u003c/p>\n\u003cp>Oklahoma also passed a caregiver law last year, and Sandra Harrison of the state’s hospital association said some members find it challenging to implement.\u003c/p>\n\u003cp>“You’ve now got a requirement to educate the caregiver,” she said. “But not everybody has a caregiver … And not all caregivers want to learn or carry out the instructions.”\u003c/p>\n\u003cp>Currently, hospital staff members often make incorrect assumptions about who the caregivers are or how much they know, said Donna Benton, associate research professor of gerontology at University of Southern California. They send people home without knowing whether food is in the house or someone to get patients’ medication or bring them to a follow-up appointment.\u003c/p>\n\u003cp>“This is a very important bill,” said Benton, co-director of the Los Angeles Caregiver Resource Center. “This really puts the pressure on the hospital to actually identify the caregiver and try to meet with them according to their schedule.”\u003c/p>\n\u003cp>Pamela Bingham, an engineer who lives in Virginia, said she quickly felt overwhelmed by everything she had to learn to care for her parents. Her father, who died earlier this year, had kidney disease, diabetes and high blood pressure. She still takes care of her mother, who is blind and has dementia and diabetes.\u003c/p>\n\u003cp>“It was like I was a nurse,” she said. “And it takes nurses years to learn this stuff.”\u003c/p>\n\u003cp>Bingham said she was relieved to see a law pass in Virginia earlier this year so caregivers can get more guidance. She said doctors and nurses are focused on treating patients while they are at the hospital – not on what happens after they and their caregivers leave.\u003c/p>\n\u003cp>“Bills like this are important,” she said. “They force the hospitals to really focus on the discharge process.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was reported while participating in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"A law taking effect Jan. 1 requires that hospitals involve caregivers in discussions when patients are hospitalized or discharged.","status":"publish","parent":0,"modified":1451524792,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1169},"headData":{"title":"Hospitals Now Required to Keep Caregivers Informed | KQED","description":"A law taking effect Jan. 1 requires that hospitals involve caregivers in discussions when patients are hospitalized or discharged.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Hospitals Now Required to Keep Caregivers Informed","datePublished":"2015-12-31T15:15:06.000Z","dateModified":"2015-12-31T01:19:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"129014 http://ww2.kqed.org/stateofhealth/?p=129014","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/31/california-hospitals-require-keep-caregivers-informed/","disqusTitle":"Hospitals Now Required to Keep Caregivers Informed","source":"Kaiser Health News","sourceUrl":"www.khn.org","nprByline":"Anna Gorman","path":"/stateofhealth/129014/california-hospitals-require-keep-caregivers-informed","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Diana Matsushima cares for both her husband and sister-in-law full-time, giving them their medications and driving them to their doctor appointments.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new state law ensures caregivers have the information they need to take care of a patient at home.\u003c/aside>\n\u003cp>But when either ends up hospitalized, Matsushima said her role as their primary caregiver is often overlooked. She isn’t always included in the discussions at the hospital, and she sometimes leaves confused about how to best care for them when she gets home. When they are discharged, she said the nurses hand her a stack of papers without much -- if any -- explanation.\u003c/p>\n\u003cp>“They print out these cryptic notes,” said Matsushima. “My background is health education and I don’t know what these things mean to me and my family.”\u003c/p>\n\u003cp>Beginning Jan. 1, family caregivers like Matsushima could have a much different experience. A new California law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">SB 675\u003c/a>, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.\u003c/p>\n\u003cp>The law, sponsored by state Sen. Carol Liu, D-La Cañada Flintridge, mandates that hospitals give patients an opportunity to identify a caregiver, notify that caregiver when the patient is to be discharged and provide information and instruction on patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California is among 18 states to pass such laws over the past two years, including Arkansas, New Hampshire, Oregon and Virginia. It’s part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a relative’s hospitalization.\u003c/p>\n\u003cp>How hospitals communicate with caregivers is expected to become more important as the population ages and the number of unpaid family caregivers continues to increase. An estimated 40 million Americans have cared for a relative in the past year, according to a 2015 study by the National Alliance for Caregiving and AARP.\u003c/p>\n\u003cp>The changes are largely being driven by AARP, which is leading a campaign to reduce barriers for family caregivers. The impetus comes from the organization’s 2012 survey, which found that 46 percent of caregivers perform medical tasks, such as giving injections, most without any training or guidance from medical professionals. AARP crafted model legislation known as the Caregiver Advise, Record, Enable, or CARE Act, and is promoting it around the nation.\u003c/p>\n\u003cfigure id=\"attachment_132363\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-132363 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/Matsushima-3-400x267.jpg\" alt=\"Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister who has had two major operations in the last few years.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister-in-law who has had two major operations in the last year. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Elaine Ryan, AARP’s vice president of state advocacy and strategy, said the legislation is designed to improve caregivers’ competency and give them peace of mind.\u003c/p>\n\u003cp>“A piece of paper can’t really educate people how to fill a syringe or clean a PICC line,” Ryan said, referring to a catheter inserted into a vein in a patient’s arm. The laws “make sure that family caregivers have all the information they need to safely care for their loved one at home.”\u003c/p>\n\u003cp>Matsushima said she has struggled to get that sort of information since 2009, when her husband had a stroke and she became a caregiver. During one hospital visit, she had to demand that nurses instruct her how to remove her husband’s catheter.\u003c/p>\n\u003cp>Over the past year, she has also helped her sister-in-law through two surgeries and two lengthy hospital stays. The first time her sister-in-law was discharged, Matsushima said she got very little notice or guidance. Two days later, her sister-in-law fell while getting out of bed and ended up back in the hospital.\u003c/p>\n\u003cp>Matsushima said she feels “fed up with hospitals” and hopes the new law will make things better for her and other caregivers.\u003c/p>\n\u003cp>Around the country, however, some hospital associations say their members already include caregivers in the discharge planning process and that adding specific requirements only adds more work. At the same time, hospitals face increased pressure from the Centers for Medicare & Medicaid Services to keep patients from being readmitted, and some recognize that improving communication with family caregivers can’t hurt.\u003c/p>\n\u003cp>In New Jersey, where a similar law passed last year, the state’s hospital association had some reservations but made a political decision to work with AARP to tailor their model legislation to the state, said Neil Eicher, vice president of government relations for the association. That meant making changes, including stripping out time requirements for notifying caregivers of discharge.\u003c/p>\n\u003cp>“We understand the importance of having good discharge planning,” he said. “We just didn’t want our hands tied to those time frames.”\u003c/p>\n\u003cp>Oklahoma also passed a caregiver law last year, and Sandra Harrison of the state’s hospital association said some members find it challenging to implement.\u003c/p>\n\u003cp>“You’ve now got a requirement to educate the caregiver,” she said. “But not everybody has a caregiver … And not all caregivers want to learn or carry out the instructions.”\u003c/p>\n\u003cp>Currently, hospital staff members often make incorrect assumptions about who the caregivers are or how much they know, said Donna Benton, associate research professor of gerontology at University of Southern California. They send people home without knowing whether food is in the house or someone to get patients’ medication or bring them to a follow-up appointment.\u003c/p>\n\u003cp>“This is a very important bill,” said Benton, co-director of the Los Angeles Caregiver Resource Center. “This really puts the pressure on the hospital to actually identify the caregiver and try to meet with them according to their schedule.”\u003c/p>\n\u003cp>Pamela Bingham, an engineer who lives in Virginia, said she quickly felt overwhelmed by everything she had to learn to care for her parents. Her father, who died earlier this year, had kidney disease, diabetes and high blood pressure. She still takes care of her mother, who is blind and has dementia and diabetes.\u003c/p>\n\u003cp>“It was like I was a nurse,” she said. “And it takes nurses years to learn this stuff.”\u003c/p>\n\u003cp>Bingham said she was relieved to see a law pass in Virginia earlier this year so caregivers can get more guidance. She said doctors and nurses are focused on treating patients while they are at the hospital – not on what happens after they and their caregivers leave.\u003c/p>\n\u003cp>“Bills like this are important,” she said. “They force the hospitals to really focus on the discharge process.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was reported while participating in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/129014/california-hospitals-require-keep-caregivers-informed","authors":["byline_stateofhealth_129014"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_459","stateofhealth_73","stateofhealth_2519"],"featImg":"stateofhealth_132361","label":"source_stateofhealth_129014"},"stateofhealth_48444":{"type":"posts","id":"stateofhealth_48444","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"48444","score":null,"sort":[1437117187000]},"guestAuthors":[],"slug":"many-californians-unaware-of-program-that-pays-family-members-for-caregiving","title":"Many Californians Unaware of Program That Pays Family Members for Caregiving","publishDate":1437117187,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>WASHINGTON — Christine McCormack quit her job as a restaurant manager two years ago to care for her 88-year-old mother-in-law. While it doesn't make up for all of her lost income, she's getting some financial help through an innovative program that allows many of California's low-income senior citizens and disabled residents to remain in their home.\u003c/p>\n\u003cp>McCormack gets paid $11 an hour through the In-Home Supportive Services Program, which pays family members and other caregivers to help about 467,000 enrollees with such things as housecleaning, bathing, grocery shopping and laundry so they can stay at home rather than move to a nursing home or other care facility.\u003c/p>\n\u003cp>\u003ca href=\"http://www.longtermcarepoll.org/Pages/Default.aspx\" target=\"_blank\">A poll \u003c/a>by the Associated Press-NORC Center for Public Affairs Research shows that less than one-third of Californians age 40 and over have heard of the program, which dates back to the 1950s.\u003c/p>\n\u003cp>Participants in the program are eligible for Medi-Cal, the state's Medicaid program. They generally have a monthly income of $877 or below and no more than $2,000 in assets. The program's elderly and disabled participants hire the person who provides their care, and caregivers can be family members or friends.\u003c/p>\n\u003cp>Those living in poorer California households do seem more aware of the program than others. Forty-two percent of those with household incomes under $50,000 a year say they have heard of the program compared with 22 percent of those with household incomes of more than $50,000.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Even today, after serving as a caregiver for a sister and now her mother-in-law, McCormack doesn't think much about planning for her future long-term care needs.\u003c/p>\n\u003cp>\"We live day-to-day with our paychecks,\" she said.\u003c/p>\n\u003cp>Advocacy groups say they're not surprised that so few people are aware of the program, even though they consider it a national model.\u003c/p>\n\u003cp>\"Most people don't know anything about long-term care until it is in their face,\" said Deborah Doctor, a legislative advocate for Disability Rights California.\u003c/p>\n\u003cp>Michael Weston, a spokesman at the California Department of Social Services, said the program's income requirements mean that most Californians will never come in contact with it.\u003c/p>\n\u003cp>He noted that enrollment has grown by nearly 40 percent over the past 12 years, showing that counties and advocacy groups are helping get the word out to those who could benefit.\u003c/p>\n\u003cp>In recent years, advocacy groups have voiced some concerns about the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/plenty-of-responsibility-but-no-required-training-for-in-home-caregivers/\" target=\"_blank\">lack of training requirements\u003c/a> in the program. And caregivers have sought overtime pay, only to be denied after Labor Department regulations requiring overtime and minimum wage protection for home health care workers were overturned.\u003c/p>\n\u003cp>A clear majority of older Californians support requiring caregivers to undergo formal training. But they are divided on the impact of paying the workers overtime. While a large majority believes overtime pay is at least somewhat likely to lead more qualified people to enter the field and improve working conditions, many also see a troubling tradeoff: Participants might not get the care they need because the state may limit the hours caregivers work to rein in costs.\u003c/p>\n\u003cp>Caregivers participating in the program take an orientation class and must pass a criminal background check. Dr. Bruce Chernof, president and CEO of the SCAN Foundation, a charity devoted to encouraging independence for senior citizens, said developing training programs is difficult because participants have such a wide array of health conditions, from Alzheimer's to strokes, for example.\u003c/p>\n\u003cp>\"There isn't just a standard set of skills, you plug them into everybody, and they're good to go,\" said Chernof, whose foundation paid for the poll.\u003c/p>\n\u003cp>McCormack, 54, of Woodland, Calif., said she has taken voluntary classes such as CPR and is willing to take more.\u003c/p>\n\u003cp>Doctor said the disabilities rights group favors voluntary but not mandatory training, and also favors overtime for caregivers. \"The work is respectable work,\" she said. \"It deserves the same degree of respect as other work.\"\u003c/p>\n\u003cp>In the new poll, Hispanics showed the most support for a training requirement at 83 percent, while 80 percent of blacks and 58 percent of whites supported training requirements.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AP-NORC Center survey was conducted by telephone April 7 to May 15 among a random national sample of 1,735 adults age 40 or older, including 460 California residents age 40 and older, with funding from the SCAN Foundation. Results for the full survey have a margin of sampling error of plus or minus 3.2 percentage points, and results in California have a margin of sampling error of plus or minus 5.4 percentage point.\u003c/p>\n\n","blocks":[],"excerpt":"California's In-Home Supportive Services Program pays family members and others to help people stay in their own homes.","status":"publish","parent":0,"modified":1437140721,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":777},"headData":{"title":"Many Californians Unaware of Program That Pays Family Members for Caregiving | KQED","description":"California's In-Home Supportive Services Program pays family members and others to help people stay in their own homes.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Many Californians Unaware of Program That Pays Family Members for Caregiving","datePublished":"2015-07-17T07:13:07.000Z","dateModified":"2015-07-17T13:45:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"48444 http://ww2.kqed.org/stateofhealth/?p=48444","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/17/many-californians-unaware-of-program-that-pays-family-members-for-caregiving/","disqusTitle":"Many Californians Unaware of Program That Pays Family Members for Caregiving","nprByline":"Kevin Freking, Associated Press","path":"/stateofhealth/48444/many-californians-unaware-of-program-that-pays-family-members-for-caregiving","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>WASHINGTON — Christine McCormack quit her job as a restaurant manager two years ago to care for her 88-year-old mother-in-law. While it doesn't make up for all of her lost income, she's getting some financial help through an innovative program that allows many of California's low-income senior citizens and disabled residents to remain in their home.\u003c/p>\n\u003cp>McCormack gets paid $11 an hour through the In-Home Supportive Services Program, which pays family members and other caregivers to help about 467,000 enrollees with such things as housecleaning, bathing, grocery shopping and laundry so they can stay at home rather than move to a nursing home or other care facility.\u003c/p>\n\u003cp>\u003ca href=\"http://www.longtermcarepoll.org/Pages/Default.aspx\" target=\"_blank\">A poll \u003c/a>by the Associated Press-NORC Center for Public Affairs Research shows that less than one-third of Californians age 40 and over have heard of the program, which dates back to the 1950s.\u003c/p>\n\u003cp>Participants in the program are eligible for Medi-Cal, the state's Medicaid program. They generally have a monthly income of $877 or below and no more than $2,000 in assets. The program's elderly and disabled participants hire the person who provides their care, and caregivers can be family members or friends.\u003c/p>\n\u003cp>Those living in poorer California households do seem more aware of the program than others. Forty-two percent of those with household incomes under $50,000 a year say they have heard of the program compared with 22 percent of those with household incomes of more than $50,000.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Even today, after serving as a caregiver for a sister and now her mother-in-law, McCormack doesn't think much about planning for her future long-term care needs.\u003c/p>\n\u003cp>\"We live day-to-day with our paychecks,\" she said.\u003c/p>\n\u003cp>Advocacy groups say they're not surprised that so few people are aware of the program, even though they consider it a national model.\u003c/p>\n\u003cp>\"Most people don't know anything about long-term care until it is in their face,\" said Deborah Doctor, a legislative advocate for Disability Rights California.\u003c/p>\n\u003cp>Michael Weston, a spokesman at the California Department of Social Services, said the program's income requirements mean that most Californians will never come in contact with it.\u003c/p>\n\u003cp>He noted that enrollment has grown by nearly 40 percent over the past 12 years, showing that counties and advocacy groups are helping get the word out to those who could benefit.\u003c/p>\n\u003cp>In recent years, advocacy groups have voiced some concerns about the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/plenty-of-responsibility-but-no-required-training-for-in-home-caregivers/\" target=\"_blank\">lack of training requirements\u003c/a> in the program. And caregivers have sought overtime pay, only to be denied after Labor Department regulations requiring overtime and minimum wage protection for home health care workers were overturned.\u003c/p>\n\u003cp>A clear majority of older Californians support requiring caregivers to undergo formal training. But they are divided on the impact of paying the workers overtime. While a large majority believes overtime pay is at least somewhat likely to lead more qualified people to enter the field and improve working conditions, many also see a troubling tradeoff: Participants might not get the care they need because the state may limit the hours caregivers work to rein in costs.\u003c/p>\n\u003cp>Caregivers participating in the program take an orientation class and must pass a criminal background check. Dr. Bruce Chernof, president and CEO of the SCAN Foundation, a charity devoted to encouraging independence for senior citizens, said developing training programs is difficult because participants have such a wide array of health conditions, from Alzheimer's to strokes, for example.\u003c/p>\n\u003cp>\"There isn't just a standard set of skills, you plug them into everybody, and they're good to go,\" said Chernof, whose foundation paid for the poll.\u003c/p>\n\u003cp>McCormack, 54, of Woodland, Calif., said she has taken voluntary classes such as CPR and is willing to take more.\u003c/p>\n\u003cp>Doctor said the disabilities rights group favors voluntary but not mandatory training, and also favors overtime for caregivers. \"The work is respectable work,\" she said. \"It deserves the same degree of respect as other work.\"\u003c/p>\n\u003cp>In the new poll, Hispanics showed the most support for a training requirement at 83 percent, while 80 percent of blacks and 58 percent of whites supported training requirements.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AP-NORC Center survey was conducted by telephone April 7 to May 15 among a random national sample of 1,735 adults age 40 or older, including 460 California residents age 40 and older, with funding from the SCAN Foundation. Results for the full survey have a margin of sampling error of plus or minus 3.2 percentage points, and results in California have a margin of sampling error of plus or minus 5.4 percentage point.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/48444/many-californians-unaware-of-program-that-pays-family-members-for-caregiving","authors":["byline_stateofhealth_48444"],"categories":["stateofhealth_11"],"tags":["stateofhealth_459"],"featImg":"stateofhealth_48674","label":"stateofhealth"},"stateofhealth_23341":{"type":"posts","id":"stateofhealth_23341","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23341","score":null,"sort":[1420652602000]},"guestAuthors":[],"slug":"plenty-of-responsibility-but-no-required-training-for-in-home-caregivers","title":"Plenty of Responsibility, But No Required Training, for In-Home Caregivers","publishDate":1420652602,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_23344\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-e1420584165747.jpg\">\u003cimg class=\"size-large wp-image-23344\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-640x427.jpg\" alt=\"Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\"> \u003c/a>\u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Born just a year apart, Oliver Massengale and his brother Charles grew up together. Now, in a two-story home in Compton, they are growing old together. But Charles Massengale, 71, can do little on his own.\u003c/p>\n\u003cp>The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure. Six years ago, Oliver took over as his brother’s full-time caregiver. He's paid about $10.00 an hour by the state.\u003c/p>\n\u003cp>It was not a job he was trained to do.\u003c/p>\n\u003cp>“I didn’t have a clue,” said Oliver, a retired grounds manager at a college. “I was just so afraid of what I was doing.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He constantly worried –- about giving Charles the wrong medication, about him getting bedsores, about his blood pressure. And he had no idea how easily his brother could fall over. One day, he was cooking and Charles was on a stool at the kitchen counter.\u003c!--more-->\u003c/p>\n\u003cp>“I heard BAM,” he said. “I turned around and he was on the kitchen floor.”\u003c/p>\n\u003cfigure id=\"attachment_23346\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-e1420584871222.jpg\">\u003cimg class=\"size-large wp-image-23346\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-640x427.jpg\" alt=\"Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>No overall training is required for the more than 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Without instruction even in CPR or first aid, these caregivers can quickly become overwhelmed and their sick or disabled clients can get hurt, according to interviews with caregivers, advocates and elder abuse experts.\u003c/p>\n\u003cp>The lack of training is “of enormous concern,” said Gary Passmore, a vice president of the Congress of California Seniors, an advocacy organization. “We are dealing with a lot of frail, elderly people.”\u003c/p>\n\u003cp>The need for in-home caregivers is rising as the elderly and disabled population grows. The demand for personal aides –- most of whom work in the home -- is expected to increase by 37 percent over the next decade, requiring about 1.3 million new positions, according to \u003ca title=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" href=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" target=\"_blank\">research published last year\u003c/a> by the New-York based Paraprofessional Healthcare Institute, an advocacy group that also provides training\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>The federal government is trying to meet that need by stepping up efforts to expand and train the work force. But for now, there are no federal training requirements for in-home-caregivers. It’s up to states to set them in Medicaid-funded programs like California’s. As a result, training policies vary dramatically.\u003c/p>\n\u003cp>\u003cstrong>Often Providing Medical Care \u003c/strong>\u003c/p>\n\u003cp>In California’s IHSS program, clients are in charge of hiring, managing and training their own caregivers. The program stands out because of its sheer size -- it is the nation’s largest publicly-funded home care program –- and because such a high percentage of caregivers are relatives directly employed by the clients rather than agencies, said Abby Marquand, director of policy research for the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>“It is a lot easier to ensure a minimum level of training if the person is employed through an agency,” she said.\u003c/p>\n\u003cp>IHSS was never intended to be a medical program. The caregivers are distinct from visiting nurses and the certified home health aides often dispatched after a hospital stay. IHSS caregivers are not certified or licensed and are hired to do personal care and household tasks.\u003c/p>\n\u003cp>But more than a quarter of IHSS clients are 80 or over, and many have chronic health conditions or dementia. In these and other cases, caregivers can end up providing basic medical care -– helping to administer insulin shots, manage other medication or dress wounds, for instance.\u003c/p>\n\u003cfigure id=\"attachment_23348\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev.jpg\">\u003cimg class=\"size-medium wp-image-23348\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev-300x449.jpg\" alt=\"Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>When such “paramedical” services are needed by individual clients, IHSS caregivers are required to get instruction and approval from a health care professional. But the state doesn’t sponsor the training or pay caregivers more for getting it. Only 12 percent of clients have caregivers who have received it.\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which oversees IHSS, said the program doesn’t have a lot of training requirements because it was set up to give clients the choice of how they want their care delivered.\u003c/p>\n\u003cp>For caregivers who want it, the state offers comprehensive \u003ca title=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" href=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" target=\"_blank\">voluntary training information online\u003c/a> on topics such as fall prevention and use of medical equipment, she said.\u003c/p>\n\u003cp>Carroll said many people are fully able to direct their own care and supervise their caregivers, but some aren’t. “Our task is how to work harder to support those who have greater need,” she said.\u003c/p>\n\u003cp>Oliver Massengale, for example, can’t depend on his brother to tell him what he wants or needs -- Charles no longer talks much. “Because of the nature of the injuries and his different ailments, he could never train,” Oliver said. “He can’t even take care of himself.”\u003c/p>\n\u003cp>The situation worsened recently because Charles’ health insurance plan changed, and he no longer is being visited by a nurse. So every day Oliver sits inches from Charles, checking his blood pressure and blood sugar and coaching him step-by-step on how to inject insulin into his own arm.\u003c/p>\n\u003cp>“Hold the back of that needle up,” he told Charles on a recent day. “Put it in right there. Now pump the medicine in. Good, good.”\u003c/p>\n\u003cp>When he heard about a training class in Los Angeles, Oliver said he jumped at the chance.\u003c/p>\n\u003cp>“If I’d had this class in advance, it would have made it a lot easier,” he said.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/192785628\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>A Sensitive Matter\u003c/strong>\u003c/p>\n\u003cp>Whether to require training for those who care for California’s 490,000 low-income elderly and disabled home care clients is a sensitive political -- and personal -- issue.\u003c/p>\n\u003cp>Carroll said the state is in a tough situation. Training is a positive thing, she said, “but you have a very strong adult disabled community in this program who … oppose any mandatory training.”\u003c/p>\n\u003cp>Many disability rights advocates say a training mandate would make it more difficult for IHSS consumers to find caregivers, chip away at clients’ autonomy and drain resources from the program.\u003c/p>\n\u003cp>“The idea of choice is really paramount,” said Deborah Doctor, legislative advocate at Disability Rights California. “Anything that puts a requirement that erodes that choice is a problem.”\u003c/p>\n\u003cfigure id=\"attachment_23349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-e1420585465561.jpg\">\u003cimg class=\"size-large wp-image-23349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-640x427.jpg\" alt=\"Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Relatives, who make up nearly three-quarters of paid IHSS caregivers, often say they know what is best for their loved ones. And clients are inclined to trust family members and say they can instruct them on what they need\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>A mother who has been taking care of a child for 20 or 30 or 40 years doesn’t need mandatory training on how to take care of that person,” Doctor said.\u003c/p>\n\u003cp>Training should be made available to those who want it, but should be entirely voluntary, said Nancy Becker Kennedy, who was paralyzed in a diving accident 40 years ago.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ZDWZeL7IA0WaNYn7VwnhrQXAGx4kEPFd\"]\u003c/p>\n\u003cp>“There is no one size fits all,” said Becker Kennedy, who founded IHSS Consumers Union, a group that advocates for both consumers and workers. “The population is much too diverse to mandate anything across the board.”\u003c/p>\n\u003cp>Many other clients agree. Sheela Gunn-Cushman, who is blind, diabetic and has mild cerebral palsy, lives with roommates in San Lorenzo, Calif., with the help of an IHSS caregiver whom she trained herself.\u003c/p>\n\u003cp>“I don’t feel like anyone is capable of training a [caregiver] about what I need better than I do,” she said. “I am capable of telling them what I need.”\u003c/p>\n\u003cp>A union that represents caregivers, however, sees advantages to a minimum level of training.\u003c/p>\n\u003cp>SEIU-United Healthcare Workers West proposed a \u003ca title=\"http://www.seiu-uhw.org/archives/16457\" href=\"http://www.seiu-uhw.org/archives/16457\" target=\"_blank\">statewide initiative\u003c/a> last year that would have required 75 hours of training, but the union didn’t get enough signatures to put the measure on the ballot. SEIU plans to try again for the 2016 ballot.\u003c/p>\n\u003cp>Requiring training would “save lives,” said Loretta Jackson, who serves on the union’s executive board and is an IHSS caregiver in Sacramento. It would also reduce the risk of injuries to caregivers, she added.\u003c/p>\n\u003cp>Jackson cares for her sister, who was left partially paralyzed by a stroke 15 years ago. When Jackson first started, she had to call paramedics every few weeks because her sister would fall. Once, Jackson said, her sister took too many pills and started shaking violently.\u003c/p>\n\u003cp>“I didn’t know what to do,” she said. “I started panicking.”\u003c/p>\n\u003cp>Other caregivers tell similar stories.\u003c/p>\n\u003cp>Ariana Ramos, 28, who is taking a training class, said a paralyzed client got a bed sore after sleeping in his wheelchair. Ramos thought it would heal on its own, but it just got worse.\u003c/p>\n\u003cp>“Now I know that we need to keep it covered up,” said Ramos, who lives in South Gate. “Now I know about bacteria and all the things that could get in a bed sore.”\u003c/p>\n\u003cfigure id=\"attachment_23350\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev.jpg\">\u003cimg class=\"size-medium wp-image-23350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev-300x449.jpg\" alt=\"Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>Caregivers without any medical background or training may not know when to call 911 or how to recognize a heart attack or stroke, said Frances Chuc, who takes care of her paralyzed husband at their home in South Gate and was trained as a nurse aide before she met him. “That person could die in their hands.”\u003c/p>\n\u003cp>A little bit of training can go a long way, said Joanne Spetz, director of UC San Francisco’s newly created Health Workforce Research Center. It can help caregivers recognize when their clients are having bad reactions to medications, for instance, or help them safely lift a person to avoid falls.\u003c/p>\n\u003cp>Training can also reduce turnover in a field that has low job retention, said Marquand of the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>Several states are experimenting with different models of training. Washington State, for example,\u003ca title=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" href=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" target=\"_blank\"> began requiring 75 hours of training\u003c/a> for home caregivers in 2012.\u003c/p>\n\u003cp>It doesn’t make sense that caregivers in the home require less training nationwide than caregivers in nursing homes, said Charissa Raynor, executive director of the SEIU Healthcare NW Training Partnership, which trains 40,000 providers annually. (Certified aides in nursing homes are required by the federal government to have 75 hours of training.)\u003c/p>\n\u003cp>The Washington initiative, Raynor said, will help professionalize the workforce, reduce on-the-job injuries and lead to better care.\u003c/p>\n\u003cp>But not everyone has been happy with the new mandate.\u003c/p>\n\u003cp>“There are a lot of folks who just want to be a caregiver in someone’s home,” said Betty Schwieterman, director of systems advocacy at Disability Rights Washington. “They are not on a career path.”\u003c/p>\n\u003cp>\u003cstrong>Grants From The Government\u003c/strong>\u003c/p>\n\u003cp>The debate over mandatory training is far from resolved. But in the meantime, the federal government is putting money into pilot training efforts in various states.\u003c/p>\n\u003cp>Through the Affordable Care Act, it has awarded about \u003ca title=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" href=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" target=\"_blank\">$15 million in grants to California\u003c/a> and five other states to recruit and train qualified caregivers for the elderly and disabled populations\u003cstrong>. \u003c/strong>Classes started in 2011 in cities throughout the state, including San Francisco, Anaheim and Walnut.\u003c/p>\n\u003cp>The class Massengale attended is part of a separate federal grant of nearly $12 million given to the California Long-Term Care Education Center in Los Angeles. The center is training about 6,000 IHSS caregivers in Los Angeles, San Bernardino and Contra Costa counties.\u003c/p>\n\u003cp>An early evaluation of the program, as yet unpublished, by UC San Francisco researchers shows that clients with trained providers are less likely to go to the emergency room or be admitted to a hospital than those with untrained providers.\u003c/p>\n\u003cp>Corinne Eldridge, who runs the program, said trained caregivers can play an important role on a client’s health care team. “They can be the eyes and the ears in the home … and communicate back to the health care provider,” she said.\u003c/p>\n\u003cp>At a recent session in Compton, about two dozen caregivers gathered in a classroom at the public library, their binders of training materials spread out before them. The topic of the day was preventing bed sores and controlling infections.\u003c/p>\n\u003cp>The teacher, nurse Lori Picou, asked the class about the signs and symptoms of infection. The students yelled out answers: Redness. Fever. Fluid or discharge.\u003c/p>\n\u003cp>One offered a story about a bruise that swelled up like a basketball. Another said her paralyzed son was sweating so much that she had to repeatedly change his shirt.\u003c/p>\n\u003cp>Picou reminded the group to wash their hands frequently. “It is one of the most important things an individual can ever do to help control infection,” she said.\u003c/p>\n\u003cp>Oliver Massengale, who is in the class, said he is feeling a little bit more confident about keeping his brother safe. “The more I learn, the better I am to cope with this,” he said.\u003c/p>\n\u003cp>But being a caregiver for someone with so many health conditions is still scary to him.\u003c/p>\n\u003cp>“As I come down those stairs,” he said, “I am saying a prayer and just hoping that everything is all right when I get to the bottom.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca title=\"Kaiser Health News\" href=\"www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News \u003c/a>is an editorially independent program of the \u003ca title=\"Kaiser Family Foundation\" href=\"www.kff.org\" target=\"_blank\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The lack of instruction in California program, even CPR and first aid, puts clients at risk, experts say.","status":"publish","parent":0,"modified":1424804668,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":70,"wordCount":2443},"headData":{"title":"Plenty of Responsibility, But No Required Training, for In-Home Caregivers | KQED","description":"The lack of instruction in California program, even CPR and first aid, puts clients at risk, experts say.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Plenty of Responsibility, But No Required Training, for In-Home Caregivers","datePublished":"2015-01-07T17:43:22.000Z","dateModified":"2015-02-24T19:04:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"23341 http://blogs.kqed.org/stateofhealth/?p=23341","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/01/07/plenty-of-responsibility-but-no-required-training-for-in-home-caregivers/","disqusTitle":"Plenty of Responsibility, But No Required Training, for In-Home Caregivers","path":"/stateofhealth/23341/plenty-of-responsibility-but-no-required-training-for-in-home-caregivers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23344\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-e1420584165747.jpg\">\u003cimg class=\"size-large wp-image-23344\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-640x427.jpg\" alt=\"Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\"> \u003c/a>\u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Born just a year apart, Oliver Massengale and his brother Charles grew up together. Now, in a two-story home in Compton, they are growing old together. But Charles Massengale, 71, can do little on his own.\u003c/p>\n\u003cp>The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure. Six years ago, Oliver took over as his brother’s full-time caregiver. He's paid about $10.00 an hour by the state.\u003c/p>\n\u003cp>It was not a job he was trained to do.\u003c/p>\n\u003cp>“I didn’t have a clue,” said Oliver, a retired grounds manager at a college. “I was just so afraid of what I was doing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He constantly worried –- about giving Charles the wrong medication, about him getting bedsores, about his blood pressure. And he had no idea how easily his brother could fall over. One day, he was cooking and Charles was on a stool at the kitchen counter.\u003c!--more-->\u003c/p>\n\u003cp>“I heard BAM,” he said. “I turned around and he was on the kitchen floor.”\u003c/p>\n\u003cfigure id=\"attachment_23346\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-e1420584871222.jpg\">\u003cimg class=\"size-large wp-image-23346\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-640x427.jpg\" alt=\"Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>No overall training is required for the more than 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Without instruction even in CPR or first aid, these caregivers can quickly become overwhelmed and their sick or disabled clients can get hurt, according to interviews with caregivers, advocates and elder abuse experts.\u003c/p>\n\u003cp>The lack of training is “of enormous concern,” said Gary Passmore, a vice president of the Congress of California Seniors, an advocacy organization. “We are dealing with a lot of frail, elderly people.”\u003c/p>\n\u003cp>The need for in-home caregivers is rising as the elderly and disabled population grows. The demand for personal aides –- most of whom work in the home -- is expected to increase by 37 percent over the next decade, requiring about 1.3 million new positions, according to \u003ca title=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" href=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" target=\"_blank\">research published last year\u003c/a> by the New-York based Paraprofessional Healthcare Institute, an advocacy group that also provides training\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>The federal government is trying to meet that need by stepping up efforts to expand and train the work force. But for now, there are no federal training requirements for in-home-caregivers. It’s up to states to set them in Medicaid-funded programs like California’s. As a result, training policies vary dramatically.\u003c/p>\n\u003cp>\u003cstrong>Often Providing Medical Care \u003c/strong>\u003c/p>\n\u003cp>In California’s IHSS program, clients are in charge of hiring, managing and training their own caregivers. The program stands out because of its sheer size -- it is the nation’s largest publicly-funded home care program –- and because such a high percentage of caregivers are relatives directly employed by the clients rather than agencies, said Abby Marquand, director of policy research for the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>“It is a lot easier to ensure a minimum level of training if the person is employed through an agency,” she said.\u003c/p>\n\u003cp>IHSS was never intended to be a medical program. The caregivers are distinct from visiting nurses and the certified home health aides often dispatched after a hospital stay. IHSS caregivers are not certified or licensed and are hired to do personal care and household tasks.\u003c/p>\n\u003cp>But more than a quarter of IHSS clients are 80 or over, and many have chronic health conditions or dementia. In these and other cases, caregivers can end up providing basic medical care -– helping to administer insulin shots, manage other medication or dress wounds, for instance.\u003c/p>\n\u003cfigure id=\"attachment_23348\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev.jpg\">\u003cimg class=\"size-medium wp-image-23348\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev-300x449.jpg\" alt=\"Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>When such “paramedical” services are needed by individual clients, IHSS caregivers are required to get instruction and approval from a health care professional. But the state doesn’t sponsor the training or pay caregivers more for getting it. Only 12 percent of clients have caregivers who have received it.\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which oversees IHSS, said the program doesn’t have a lot of training requirements because it was set up to give clients the choice of how they want their care delivered.\u003c/p>\n\u003cp>For caregivers who want it, the state offers comprehensive \u003ca title=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" href=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" target=\"_blank\">voluntary training information online\u003c/a> on topics such as fall prevention and use of medical equipment, she said.\u003c/p>\n\u003cp>Carroll said many people are fully able to direct their own care and supervise their caregivers, but some aren’t. “Our task is how to work harder to support those who have greater need,” she said.\u003c/p>\n\u003cp>Oliver Massengale, for example, can’t depend on his brother to tell him what he wants or needs -- Charles no longer talks much. “Because of the nature of the injuries and his different ailments, he could never train,” Oliver said. “He can’t even take care of himself.”\u003c/p>\n\u003cp>The situation worsened recently because Charles’ health insurance plan changed, and he no longer is being visited by a nurse. So every day Oliver sits inches from Charles, checking his blood pressure and blood sugar and coaching him step-by-step on how to inject insulin into his own arm.\u003c/p>\n\u003cp>“Hold the back of that needle up,” he told Charles on a recent day. “Put it in right there. Now pump the medicine in. Good, good.”\u003c/p>\n\u003cp>When he heard about a training class in Los Angeles, Oliver said he jumped at the chance.\u003c/p>\n\u003cp>“If I’d had this class in advance, it would have made it a lot easier,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/192785628&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/192785628'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>A Sensitive Matter\u003c/strong>\u003c/p>\n\u003cp>Whether to require training for those who care for California’s 490,000 low-income elderly and disabled home care clients is a sensitive political -- and personal -- issue.\u003c/p>\n\u003cp>Carroll said the state is in a tough situation. Training is a positive thing, she said, “but you have a very strong adult disabled community in this program who … oppose any mandatory training.”\u003c/p>\n\u003cp>Many disability rights advocates say a training mandate would make it more difficult for IHSS consumers to find caregivers, chip away at clients’ autonomy and drain resources from the program.\u003c/p>\n\u003cp>“The idea of choice is really paramount,” said Deborah Doctor, legislative advocate at Disability Rights California. “Anything that puts a requirement that erodes that choice is a problem.”\u003c/p>\n\u003cfigure id=\"attachment_23349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-e1420585465561.jpg\">\u003cimg class=\"size-large wp-image-23349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-640x427.jpg\" alt=\"Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Relatives, who make up nearly three-quarters of paid IHSS caregivers, often say they know what is best for their loved ones. And clients are inclined to trust family members and say they can instruct them on what they need\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>A mother who has been taking care of a child for 20 or 30 or 40 years doesn’t need mandatory training on how to take care of that person,” Doctor said.\u003c/p>\n\u003cp>Training should be made available to those who want it, but should be entirely voluntary, said Nancy Becker Kennedy, who was paralyzed in a diving accident 40 years ago.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There is no one size fits all,” said Becker Kennedy, who founded IHSS Consumers Union, a group that advocates for both consumers and workers. “The population is much too diverse to mandate anything across the board.”\u003c/p>\n\u003cp>Many other clients agree. Sheela Gunn-Cushman, who is blind, diabetic and has mild cerebral palsy, lives with roommates in San Lorenzo, Calif., with the help of an IHSS caregiver whom she trained herself.\u003c/p>\n\u003cp>“I don’t feel like anyone is capable of training a [caregiver] about what I need better than I do,” she said. “I am capable of telling them what I need.”\u003c/p>\n\u003cp>A union that represents caregivers, however, sees advantages to a minimum level of training.\u003c/p>\n\u003cp>SEIU-United Healthcare Workers West proposed a \u003ca title=\"http://www.seiu-uhw.org/archives/16457\" href=\"http://www.seiu-uhw.org/archives/16457\" target=\"_blank\">statewide initiative\u003c/a> last year that would have required 75 hours of training, but the union didn’t get enough signatures to put the measure on the ballot. SEIU plans to try again for the 2016 ballot.\u003c/p>\n\u003cp>Requiring training would “save lives,” said Loretta Jackson, who serves on the union’s executive board and is an IHSS caregiver in Sacramento. It would also reduce the risk of injuries to caregivers, she added.\u003c/p>\n\u003cp>Jackson cares for her sister, who was left partially paralyzed by a stroke 15 years ago. When Jackson first started, she had to call paramedics every few weeks because her sister would fall. Once, Jackson said, her sister took too many pills and started shaking violently.\u003c/p>\n\u003cp>“I didn’t know what to do,” she said. “I started panicking.”\u003c/p>\n\u003cp>Other caregivers tell similar stories.\u003c/p>\n\u003cp>Ariana Ramos, 28, who is taking a training class, said a paralyzed client got a bed sore after sleeping in his wheelchair. Ramos thought it would heal on its own, but it just got worse.\u003c/p>\n\u003cp>“Now I know that we need to keep it covered up,” said Ramos, who lives in South Gate. “Now I know about bacteria and all the things that could get in a bed sore.”\u003c/p>\n\u003cfigure id=\"attachment_23350\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev.jpg\">\u003cimg class=\"size-medium wp-image-23350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev-300x449.jpg\" alt=\"Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>Caregivers without any medical background or training may not know when to call 911 or how to recognize a heart attack or stroke, said Frances Chuc, who takes care of her paralyzed husband at their home in South Gate and was trained as a nurse aide before she met him. “That person could die in their hands.”\u003c/p>\n\u003cp>A little bit of training can go a long way, said Joanne Spetz, director of UC San Francisco’s newly created Health Workforce Research Center. It can help caregivers recognize when their clients are having bad reactions to medications, for instance, or help them safely lift a person to avoid falls.\u003c/p>\n\u003cp>Training can also reduce turnover in a field that has low job retention, said Marquand of the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>Several states are experimenting with different models of training. Washington State, for example,\u003ca title=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" href=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" target=\"_blank\"> began requiring 75 hours of training\u003c/a> for home caregivers in 2012.\u003c/p>\n\u003cp>It doesn’t make sense that caregivers in the home require less training nationwide than caregivers in nursing homes, said Charissa Raynor, executive director of the SEIU Healthcare NW Training Partnership, which trains 40,000 providers annually. (Certified aides in nursing homes are required by the federal government to have 75 hours of training.)\u003c/p>\n\u003cp>The Washington initiative, Raynor said, will help professionalize the workforce, reduce on-the-job injuries and lead to better care.\u003c/p>\n\u003cp>But not everyone has been happy with the new mandate.\u003c/p>\n\u003cp>“There are a lot of folks who just want to be a caregiver in someone’s home,” said Betty Schwieterman, director of systems advocacy at Disability Rights Washington. “They are not on a career path.”\u003c/p>\n\u003cp>\u003cstrong>Grants From The Government\u003c/strong>\u003c/p>\n\u003cp>The debate over mandatory training is far from resolved. But in the meantime, the federal government is putting money into pilot training efforts in various states.\u003c/p>\n\u003cp>Through the Affordable Care Act, it has awarded about \u003ca title=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" href=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" target=\"_blank\">$15 million in grants to California\u003c/a> and five other states to recruit and train qualified caregivers for the elderly and disabled populations\u003cstrong>. \u003c/strong>Classes started in 2011 in cities throughout the state, including San Francisco, Anaheim and Walnut.\u003c/p>\n\u003cp>The class Massengale attended is part of a separate federal grant of nearly $12 million given to the California Long-Term Care Education Center in Los Angeles. The center is training about 6,000 IHSS caregivers in Los Angeles, San Bernardino and Contra Costa counties.\u003c/p>\n\u003cp>An early evaluation of the program, as yet unpublished, by UC San Francisco researchers shows that clients with trained providers are less likely to go to the emergency room or be admitted to a hospital than those with untrained providers.\u003c/p>\n\u003cp>Corinne Eldridge, who runs the program, said trained caregivers can play an important role on a client’s health care team. “They can be the eyes and the ears in the home … and communicate back to the health care provider,” she said.\u003c/p>\n\u003cp>At a recent session in Compton, about two dozen caregivers gathered in a classroom at the public library, their binders of training materials spread out before them. The topic of the day was preventing bed sores and controlling infections.\u003c/p>\n\u003cp>The teacher, nurse Lori Picou, asked the class about the signs and symptoms of infection. The students yelled out answers: Redness. Fever. Fluid or discharge.\u003c/p>\n\u003cp>One offered a story about a bruise that swelled up like a basketball. Another said her paralyzed son was sweating so much that she had to repeatedly change his shirt.\u003c/p>\n\u003cp>Picou reminded the group to wash their hands frequently. “It is one of the most important things an individual can ever do to help control infection,” she said.\u003c/p>\n\u003cp>Oliver Massengale, who is in the class, said he is feeling a little bit more confident about keeping his brother safe. “The more I learn, the better I am to cope with this,” he said.\u003c/p>\n\u003cp>But being a caregiver for someone with so many health conditions is still scary to him.\u003c/p>\n\u003cp>“As I come down those stairs,” he said, “I am saying a prayer and just hoping that everything is all right when I get to the bottom.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca title=\"Kaiser Health News\" href=\"www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News \u003c/a>is an editorially independent program of the \u003ca title=\"Kaiser Family Foundation\" href=\"www.kff.org\" target=\"_blank\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23341/plenty-of-responsibility-but-no-required-training-for-in-home-caregivers","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_459","stateofhealth_474"],"featImg":"stateofhealth_23344","label":"stateofhealth"},"stateofhealth_23329":{"type":"posts","id":"stateofhealth_23329","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23329","score":null,"sort":[1420574931000]},"guestAuthors":[],"slug":"lack-of-oversight-for-in-home-caregivers-can-lead-to-neglect-and-death","title":"Lack of Oversight for In-Home Caregivers Can Lead to Neglect and Death","publishDate":1420574931,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_23331\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-06-at-11.36.41-AM.png\">\u003cimg class=\"wp-image-23331 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-06-at-11.36.41-AM-640x424.png\" alt=\"Linda Maureen Raye at her sentencing at the Riverside County Hall of Justice. Raye pleaded guilty to elder abuse that led to the death of her mother. (Heidi de Marco/KHN)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Linda Maureen Raye at her sentencing at the Riverside County Hall of Justice. Raye pleaded guilty to elder abuse that led to the death of her mother. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman, \u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/as-caregiving-shifts-to-the-home-scrutiny-is-lacking/\" href=\"http://kaiserhealthnews.org/news/as-caregiving-shifts-to-the-home-scrutiny-is-lacking/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Yolanda Farrell lay mostly paralyzed in a nursing home, unable to feed or dress herself, when her homeless daughter persuaded her to move out.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Essentially neglected to death\" by her own daughter. \u003c/aside>\n\u003cp>Linda Maureen Raye, who relatives say had been living in her car with her dog, used her mother’s Social Security to pay for a one-bedroom Riverside apartment and took over as Farrell’s sole caregiver in 2010.\u003c/p>\n\u003cp>Over the next two years, according to police and court records, Raye, 60, took her elderly mother to the doctor once. As her mother’s health declined, Raye stopped cooperating with a nurse sent to advise her on preventing bedsores.\u003c/p>\n\u003cp>Yet in 2012, Raye was hired officially: She began collecting about $900 a month from taxpayers under the state’s in-home care program for poor people, according to law enforcement authorities.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_23335\" class=\"wp-caption alignright\" style=\"max-width: 218px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Yolanda-Farrell.jpg\">\u003cimg class=\"size-medium wp-image-23335\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Yolanda-Farrell-300x412.jpg\" alt=\"(Courtesy of the Raye family)\" width=\"218\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy of the Raye family)\u003c/figcaption>\u003c/figure>\n\u003cp>By the end of that year, Farrell, an 85-year-old former real estate underwriter who loved to travel, had died of septic shock resulting from severe bed sore infections. Originally charged with murder, Raye pleaded guilty to elder abuse in September and was sentenced to 11 years in prison.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“She essentially neglected her to death,” said Riverside Police Det. Christian Vaughan, who investigated the case.\u003c/p>\n\u003cp>California’s frail elderly and disabled residents increasingly are receiving care in their own homes, an arrangement that saves the government money and offers many people a greater sense of comfort and autonomy than life in an institution. Yet caregivers are largely untrained and unsupervised, even when paid by the state, leaving thousands of residents at risk of possible abuse, neglect and poor treatment, a Kaiser Health News investigation found.\u003c/p>\n\u003cp>The move from nursing-home to in-home care is part of a massive shift across the nation, driven by cost-cutting and patient preference. In California, at least four times more elderly and disabled residents receive in-home care than live in nursing facilities -– a rate that is only expected to rise as baby boomers age.\u003c/p>\n\u003cp>Many families either provide care for relatives without compensation or pay out of pocket for caregivers they find through word-of-mouth, referral agencies or private companies. But a growing number of elderly and disabled people have incomes low enough to qualify for state-funded care under the In-Home Supportive Services program, or IHSS -- the same one that paid Raye to care for her mother.\u003c/p>\n\u003cp>California’s $7.3 billion IHSS program is the largest publicly-funded caregiver program in the nation. The caseload has more than doubled since 2001 and now serves about 490,000 low-income clients throughout the state.\u003c/p>\n\u003cp>Working behind closed doors for an average of about $10 an hour, these caregivers carry immense responsibility but are subject to little scrutiny, according to law enforcement officials, elder abuse investigators, senior care experts and court records. Their lapses sometimes lead to preventable injuries and death.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/192638766\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Many clients are too feeble or afraid to complain or ask for assistance. “We don’t know how many times Yolanda cried for help,” Det. Vaughan said. “She didn’t have a voice. She was deprived of that.”\u003c/p>\n\u003cp>Kaiser Health News’ investigation into the IHSS program found that:\u003c/p>\n\u003cul>\n\u003cli>Training for caregivers is minimal and mostly optional. California doesn’t require training for everyone – even in CPR, first aid or preventing injuries. By design, IHSS is not a medical program and caregivers are supposed to confine themselves to tasks such as feeding, dressing or bathing. But some become ad hoc nursing aides, helping to dress wounds and manage medications. The state requires caregivers receive training and authorization from physicians in these cases, but only about one in nine caregivers receives it, officials say.\u003c/li>\n\u003cli>Most clients in California, 73 percent, are related to their caregivers, up from 43 percent in 2000. The arrangements assume an inherent trust between client and caretaker –- a trust that can go awry when the relationships are dysfunctional, abusive or financially driven. While many states allow some paid family caregiving, most prohibit spouses from taking the job and some bar relatives entirely. California has no such restrictions.\u003c/li>\n\u003cli>Screening, though improved in recent years, has potentially dangerous gaps. State law requires criminal background checks and bars people from becoming caregivers if they have been convicted of certain crimes, such as elder and child abuse. But the IHSS program leaves the hiring to clients and gives them wide latitude. Felons convicted of robbery, rape or assault can be paid caregivers if their clients get a waiver from the state. In the past four years, more than 830 people have received such waivers for caregivers convicted of serious offenses. “They can have criminal records, they can have drug addiction,” said Susan Strick, a prosecutor with the Los Angeles City Attorney’s office. “That’s a problem.”\u003c/li>\n\u003cli>Few incidents of abuse and neglect by IHSS workers are documented because authorities aren’t looking for them. County social services workers are supposed to check on the clients once a year on the state’s behalf but are not primarily focused on the quality of care provided and seldom spot problems. Often assigned to hundreds of clients each, their visits are frequently brief — as short as 30 minutes a year\u003cstrong>.\u003c/strong> Their main job is to determine whether clients are receiving the proper number of hours of care and whether their needs have changed.\u003c/li>\n\u003c/ul>\n\u003cp>Counties are also supposed to report to the state \"critical incidents\" -- potential neglect, abuse or self-harm requiring immediate action. But reporting practices vary widely, yielding puzzling results. In fiscal year 2012-2013, for instance, not a single critical incident was reported among the 235,000 clients in Los Angeles, Orange and San Diego counties, the three largest in the state. That same year, smaller Sacramento County reported 1,688 incidents –- accounting for most of the problems reported statewide\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>“There is no evidence indicating that Sacramento County has a disproportionately higher number of critical incidents than other counties,” a Sacramento county spokeswoman said.\u003c/p>\n\u003cp>Beyond statistics such as these, nearly all records of IHSS are confidential. So unless a caregiver is criminally prosecuted, the details of any alleged mistreatment are unavailable to the public. Prosecutors and experts on elder abuse say only a small fraction of problem\u003cstrong>s \u003c/strong>come to light. When they do, it is sometimes too late.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Mjj65enUOAsu91fyUNWiA4LdqPCQF1Vq\"]\u003c/p>\n\u003cp>Neglect and abuse by paid home caregivers happens “far more regularly than we know,” said Paul Greenwood, a national expert in elder abuse and a prosecutor with the San Diego County District Attorney’s office. “We are still scratching the surface.”\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which runs IHSS, said the program “works very well for people who are capable and able to self-direct.” She acknowledged that more problems can arise when clients are older than 85, for instance, or have dementia.\u003c/p>\n\u003cp>In general, she said, the state tries to ensure that clients are receiving the services they need safely in their homes without compromising their independence.\u003c/p>\n\u003cp>The state recently has made improvements to its quality assurance program and has clarified reporting standards for critical incidents, she said. But mandating training or increasing oversight further could fundamentally change IHSS from a program based on the consumers’ social needs to one based on their medical needs, she said.\u003c/p>\n\u003cp>“It’s a slippery slope,” she said. “I don’t think it is in our interest to force recipients and providers to do anything.”\u003c/p>\n\u003cp>\u003cstrong>Clients Are The Bosses\u003c/strong>\u003c/p>\n\u003cp>The In-Home Supportive Services program has its roots in the 1950s, when a small group of polio patients was moved out of Rancho Los Amigos Hospital, a rehabilitation center in Downey. Officials recognized that it would be less expensive for people to be taken care of in their homes, and the March of Dimes began to pay for domestic help.\u003c/p>\n\u003cp>The current in-home care program, created by the state legislature in 1973, retained the historical emphasis on supporting clients’ autonomy. The state pays the bills, but the elderly or disabled resident is the boss –- responsible for hiring, firing, supervising and training the caregiver.\u003c/p>\n\u003cp>To be eligible, most clients must qualify for Medi-Cal, the state insurance program for the poor, and be over 65, blind or disabled. They also must show a need for help in the home.\u003c/p>\n\u003cp>Many swear by the program.\u003c/p>\n\u003cp>“I get to continue making choices,” said Margaret Belton, 82, who receives help seven days a week from IHSS caregivers at her Pasadena apartment. “When you go into a nursing home, you lose your ability to make decisions.”\u003c/p>\n\u003cp>Belton, a former nurse with arthritis, diabetes, thyroid problems, hip and knee replacements and a history of falls, said she appreciates being able to train her own providers.\u003c/p>\n\u003cp>But for others, supervising a caregiver can be a struggle. That is especially true when clients are very old, severely physically or mentally impaired or when the employees are family members with whom clients have difficult relationships.\u003c/p>\n\u003cp>The IHSS program can be a “perfect scenario for elder or dependent abuse,” said Julie Batz, staff attorney at Legal Assistance for Seniors in Oakland. The clients may trust the providers because they share a history or because they assume that the government has screened and trained them, she said, but “that is not necessarily true.”\u003c/p>\n\u003cp>\u003cstrong>“I Never Thought She Could Do This to Me”\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_23336\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Toni-Giusto-4-e1420574566723.jpg\">\u003cimg class=\"size-large wp-image-23336\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Toni-Giusto-4-640x427.jpg\" alt=\"Toni Giusto keeps a box within reach filled with the pens, paper and letters to keep her busy. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Toni Giusto keeps a box within reach filled with the pens, paper and letters to keep her busy. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Toni Giusto, 54, said she trusted Yvonne Belanger, her domestic partner of many years, with her life. The Oakland woman hired Belanger as her IHSS caregiver in 2000, after an abscess in her neck left her paralyzed from the waist down. Giusto said she needed help with everything –- eating, bathing, sitting up.\u003c/p>\n\u003cp>Instead, Giusto said Belanger locked her in a room. “She wouldn’t give me water or nothing,” she said. Belanger didn’t take her to the doctor, even when she developed bed sores that attracted maggots, Giusto said. Belanger sprayed bug poison on her to get rid of them, according to court papers.\u003c/p>\n\u003cp>Responding to a call from Giusto’s sister, police came to the house in 2010 and found Giusto with 23 open sores and an abdomen swollen from waste backed up in her bowels, according to court papers. Belanger was convicted of elder abuse and sentenced to county jail. She died last year.\u003c/p>\n\u003cp>“I was so trusting,” said Giusto, who now lives in a rehabilitation facility in Alameda. “I never thought she could do this to me.”\u003c/p>\n\u003cp>For some clients, choosing a caregiver is less about trust than about mutual need. The parents of Erica Aguirre, now 29, knew she had a drug problem. But they needed help and she needed money, so they applied to IHSS and hired her.\u003c/p>\n\u003cp>For about two years, Aguirre said, IHSS paid her to care for her 72-year-old mother, Guadalupe, who has asthma, diabetes, high blood pressure and depression, and her father, Jesus, 69, who has heart problems, diabetes and early dementia.\u003c/p>\n\u003cp>Guadalupe Aguirre said she and her daughter soon had arguments that ended in yelling and hitting. “I thought she was going to be different than she was,” the mother said in Spanish.\u003c/p>\n\u003cp>In 2012, Erica Aguirre was charged with physically and verbally abusing her mother. She was convicted and sentenced to 60 days in county jail and drug treatment, according to court documents.\u003c/p>\n\u003cp>In an interview at the family’s home in South Los Angeles, Erica Aguirre said she is a recovering drug addict and also suffers from depression and anxiety. Despite that, Aguirre said she followed doctors’ instructions and tried to help her parents. She said she quit working as an IHSS caregiver before her criminal case began.\u003c/p>\n\u003cp>“I tried my best as a caregiver,” she said. But “I wasn’t the appropriate one.”\u003c/p>\n\u003cp>Deborah Doctor, a legislative advocate at Disability Rights California, said there is nothing to suggest that the IHSS program fosters abuse or that people are less safe at home than they would be in an institution. The best way to ensure a high quality workforce is to pay caregivers better -- not to increase regulation, she said.\u003c/p>\n\u003cp>“I am sure there are some bad actors but the efforts to quantify that have never come up with anything more than a minuscule perspective,” Doctor said.\u003c/p>\n\u003cp>\u003cstrong>Focus on Fraud\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_23337\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Maggie-Belton-2.jpg\">\u003cimg class=\"size-medium wp-image-23337\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Maggie-Belton-2-300x449.jpg\" alt=\"Maggie Belton suffers from arthritis and diabetes. The 82-year-old gets in-home care from Armida Pineda, 64, at her Pasadena apartment. (Heidi de Marco/KHN)\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maggie Belton suffers from arthritis and diabetes. The 82-year-old gets in-home care from Armida Pineda, 64, at her Pasadena apartment. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Martin Hernandez, an IHSS social worker in Los Angeles County, has a tough job.\u003c/p>\n\u003cp>He has about 440 active cases, including people with multiple sclerosis, diabetes, mental illness and a history of strokes. He is generally expected to visit each client once a year, though occasionally he sees someone who hasn’t been visited in two years.\u003c/p>\n\u003cp>Even once a year is “not enough to tell who is being harmed and who is not being harmed,” he said. “It’s very hard unless a neighbor calls or you see some kind of physical evidence.”\u003c/p>\n\u003cp>His colleague, Gloria Daniels, said she has an even higher caseload – 493 clients. “The program is so big that it appears nobody knows what to do,” she said. “We are being told it’s quantity, not quality.”\u003c/p>\n\u003cp>In Los Angeles County, the most populous county in the nation, social workers have an average of 265 clients each. Under their union contract, their caseloads aren’t supposed to exceed 249. Above that, workers can’t be held to the usual disciplinary standards. But other counties have even higher ratios – in Riverside County, case workers average about 500 clients each.\u003c/p>\n\u003cp>There are no statewide standards for how many cases a social worker can carry. Carroll said in some smaller counties workers have caseloads as low as 7. In the areas with high caseloads, she said, the state has been urging counties to hire.\u003c/p>\n\u003cp>“We do want to see cases become better balanced,” she said. “We do want to see [clients] assessed every year.”\u003c/p>\n\u003cp>During their visits county workers focus much more on possible fraud than on quality of care, statistics suggest. From 2008 through 2012, workers in the five most populous California counties -- Los Angeles, San Diego, Orange, Riverside and San Bernardino -- reported 960 cases of fraudulent overpayment to caregivers. During that same period, the workers reported a total of 32 “critical events” –- potential neglect, abuse or self-harm.\u003c/p>\n\u003cp>The state has another limited quality assurance program that aims to ensure clients are safe and that county workers are following proper procedures. Inspectors conduct “desk reviews” of case files and other documents, along with a very small number of home visits. In 2013, just 3.8 percent of IHSS cases were reviewed under the program.\u003c/p>\n\u003cp>Since last summer, more desk reviews and unannounced visits are taking place, Carroll said.\u003c/p>\n\u003cp>Case workers – and caregivers-- are required by law to report suspected abuse or neglect. But IHSS officials and family members mostly depend on another state agency, Adult Protective Services, to investigate those concerns.\u003c/p>\n\u003cp>This agency is also spread thin and has limited powers, according to state records and interviews. Even if workers suspect abuse or neglect, they generally can’t remove an adult from the home without his or her permission.\u003c/p>\n\u003cp>“We cannot force anybody to accept our services,” said Stacey Lindberg, program manager of Adult Protective Services in Orange County. “It is heartbreaking.”\u003c/p>\n\u003cp>\u003cstrong>Suffering In Seclusion \u003c/strong>\u003c/p>\n\u003cp>The result, in some cases, is prolonged abuse and neglect by IHSS caregivers. Examples can be found in court records throughout the state.\u003c/p>\n\u003cp>In Fresno, a 26-year-old woman, disabled by a severe spine condition, hired her brother and his wife as IHSS caregivers. Police and prosecutors say the couple, Joe and Denise Roman, didn't turn her in bed, and her tissue broke down so much that metal rods in her spine became exposed. She died and the caregivers were convicted in 2011 of abusing her.\u003c/p>\n\u003cp>In Lake Isabella, Kern County, Joseph McCoy was a paid caregiver over many years for his 90-year-old grandmother, who raised him. McCoy left her unattended, and officials discovered her stuck to her sheets with gruesome bedsores in a fly-infested room, according to prosecutors. She died shortly afterward. McCoy was convicted in 2012 of elder abuse.\u003c/p>\n\u003cp>“This was a really, really horrible case,” said Michelle Domino, Kern County deputy district attorney. “She had clearly been left neglected for some time.”\u003c/p>\n\u003cp>In Yolanda Farrell’s case, relatives say they are stunned that Linda Maureen Raye even was able to become a paid caregiver for her mother. Farrell was unable to walk and had very limited use of her arms as a result of a bout with polio years earlier. Maureen Raye had longstanding emotional problems, her brother Terrence said. She’d tried to take care of her mother in the past but always found herself overwhelmed. “My mom would always try to believe that she was better,” he said.\u003c/p>\n\u003cp>Maureen “went behind our backs and convinced my mom that she would be better off being taken care of in a private residence with her,” Terrence Raye said. Later, he said, Maureen Raye told him that she needed the IHSS funds as well as Farrell’s Social Security money.\u003c/p>\n\u003cp>Terrence Raye said she wouldn’t allow him to visit his mom, or even talk to her, so he called police and adult protection authorities. They interviewed his mother in Maureen Raye’s presence, he said, and told him they found nothing wrong.\u003c/p>\n\u003cp>The last time he saw Farrell was at Riverside Community Hospital, where she had arrived sickened from ulcers that went to the bone.\u003c/p>\n\u003cp>“My mom was old enough and in bad [enough] health never to recover,” he said.\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Data analyst Ronald Campbell contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"California’s publicly funded in-home care program leaves elderly and disabled clients vulnerable to abuse and poor treatment, Kaiser Health News investigation finds. ","status":"publish","parent":0,"modified":1424731528,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":74,"wordCount":3198},"headData":{"title":"Lack of Oversight for In-Home Caregivers Can Lead to Neglect and Death | KQED","description":"California’s publicly funded in-home care program leaves elderly and disabled clients vulnerable to abuse and poor treatment, Kaiser Health News investigation finds. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Lack of Oversight for In-Home Caregivers Can Lead to Neglect and Death","datePublished":"2015-01-06T20:08:51.000Z","dateModified":"2015-02-23T22:45:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"23329 http://blogs.kqed.org/stateofhealth/?p=23329","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/01/06/lack-of-oversight-for-in-home-caregivers-can-lead-to-neglect-and-death/","disqusTitle":"Lack of Oversight for In-Home Caregivers Can Lead to Neglect and Death","path":"/stateofhealth/23329/lack-of-oversight-for-in-home-caregivers-can-lead-to-neglect-and-death","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23331\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-06-at-11.36.41-AM.png\">\u003cimg class=\"wp-image-23331 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-06-at-11.36.41-AM-640x424.png\" alt=\"Linda Maureen Raye at her sentencing at the Riverside County Hall of Justice. Raye pleaded guilty to elder abuse that led to the death of her mother. (Heidi de Marco/KHN)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Linda Maureen Raye at her sentencing at the Riverside County Hall of Justice. Raye pleaded guilty to elder abuse that led to the death of her mother. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman, \u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/as-caregiving-shifts-to-the-home-scrutiny-is-lacking/\" href=\"http://kaiserhealthnews.org/news/as-caregiving-shifts-to-the-home-scrutiny-is-lacking/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Yolanda Farrell lay mostly paralyzed in a nursing home, unable to feed or dress herself, when her homeless daughter persuaded her to move out.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Essentially neglected to death\" by her own daughter. \u003c/aside>\n\u003cp>Linda Maureen Raye, who relatives say had been living in her car with her dog, used her mother’s Social Security to pay for a one-bedroom Riverside apartment and took over as Farrell’s sole caregiver in 2010.\u003c/p>\n\u003cp>Over the next two years, according to police and court records, Raye, 60, took her elderly mother to the doctor once. As her mother’s health declined, Raye stopped cooperating with a nurse sent to advise her on preventing bedsores.\u003c/p>\n\u003cp>Yet in 2012, Raye was hired officially: She began collecting about $900 a month from taxpayers under the state’s in-home care program for poor people, according to law enforcement authorities.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_23335\" class=\"wp-caption alignright\" style=\"max-width: 218px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Yolanda-Farrell.jpg\">\u003cimg class=\"size-medium wp-image-23335\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Yolanda-Farrell-300x412.jpg\" alt=\"(Courtesy of the Raye family)\" width=\"218\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy of the Raye family)\u003c/figcaption>\u003c/figure>\n\u003cp>By the end of that year, Farrell, an 85-year-old former real estate underwriter who loved to travel, had died of septic shock resulting from severe bed sore infections. Originally charged with murder, Raye pleaded guilty to elder abuse in September and was sentenced to 11 years in prison.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“She essentially neglected her to death,” said Riverside Police Det. Christian Vaughan, who investigated the case.\u003c/p>\n\u003cp>California’s frail elderly and disabled residents increasingly are receiving care in their own homes, an arrangement that saves the government money and offers many people a greater sense of comfort and autonomy than life in an institution. Yet caregivers are largely untrained and unsupervised, even when paid by the state, leaving thousands of residents at risk of possible abuse, neglect and poor treatment, a Kaiser Health News investigation found.\u003c/p>\n\u003cp>The move from nursing-home to in-home care is part of a massive shift across the nation, driven by cost-cutting and patient preference. In California, at least four times more elderly and disabled residents receive in-home care than live in nursing facilities -– a rate that is only expected to rise as baby boomers age.\u003c/p>\n\u003cp>Many families either provide care for relatives without compensation or pay out of pocket for caregivers they find through word-of-mouth, referral agencies or private companies. But a growing number of elderly and disabled people have incomes low enough to qualify for state-funded care under the In-Home Supportive Services program, or IHSS -- the same one that paid Raye to care for her mother.\u003c/p>\n\u003cp>California’s $7.3 billion IHSS program is the largest publicly-funded caregiver program in the nation. The caseload has more than doubled since 2001 and now serves about 490,000 low-income clients throughout the state.\u003c/p>\n\u003cp>Working behind closed doors for an average of about $10 an hour, these caregivers carry immense responsibility but are subject to little scrutiny, according to law enforcement officials, elder abuse investigators, senior care experts and court records. Their lapses sometimes lead to preventable injuries and death.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/192638766&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/192638766'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Many clients are too feeble or afraid to complain or ask for assistance. “We don’t know how many times Yolanda cried for help,” Det. Vaughan said. “She didn’t have a voice. She was deprived of that.”\u003c/p>\n\u003cp>Kaiser Health News’ investigation into the IHSS program found that:\u003c/p>\n\u003cul>\n\u003cli>Training for caregivers is minimal and mostly optional. California doesn’t require training for everyone – even in CPR, first aid or preventing injuries. By design, IHSS is not a medical program and caregivers are supposed to confine themselves to tasks such as feeding, dressing or bathing. But some become ad hoc nursing aides, helping to dress wounds and manage medications. The state requires caregivers receive training and authorization from physicians in these cases, but only about one in nine caregivers receives it, officials say.\u003c/li>\n\u003cli>Most clients in California, 73 percent, are related to their caregivers, up from 43 percent in 2000. The arrangements assume an inherent trust between client and caretaker –- a trust that can go awry when the relationships are dysfunctional, abusive or financially driven. While many states allow some paid family caregiving, most prohibit spouses from taking the job and some bar relatives entirely. California has no such restrictions.\u003c/li>\n\u003cli>Screening, though improved in recent years, has potentially dangerous gaps. State law requires criminal background checks and bars people from becoming caregivers if they have been convicted of certain crimes, such as elder and child abuse. But the IHSS program leaves the hiring to clients and gives them wide latitude. Felons convicted of robbery, rape or assault can be paid caregivers if their clients get a waiver from the state. In the past four years, more than 830 people have received such waivers for caregivers convicted of serious offenses. “They can have criminal records, they can have drug addiction,” said Susan Strick, a prosecutor with the Los Angeles City Attorney’s office. “That’s a problem.”\u003c/li>\n\u003cli>Few incidents of abuse and neglect by IHSS workers are documented because authorities aren’t looking for them. County social services workers are supposed to check on the clients once a year on the state’s behalf but are not primarily focused on the quality of care provided and seldom spot problems. Often assigned to hundreds of clients each, their visits are frequently brief — as short as 30 minutes a year\u003cstrong>.\u003c/strong> Their main job is to determine whether clients are receiving the proper number of hours of care and whether their needs have changed.\u003c/li>\n\u003c/ul>\n\u003cp>Counties are also supposed to report to the state \"critical incidents\" -- potential neglect, abuse or self-harm requiring immediate action. But reporting practices vary widely, yielding puzzling results. In fiscal year 2012-2013, for instance, not a single critical incident was reported among the 235,000 clients in Los Angeles, Orange and San Diego counties, the three largest in the state. That same year, smaller Sacramento County reported 1,688 incidents –- accounting for most of the problems reported statewide\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>“There is no evidence indicating that Sacramento County has a disproportionately higher number of critical incidents than other counties,” a Sacramento county spokeswoman said.\u003c/p>\n\u003cp>Beyond statistics such as these, nearly all records of IHSS are confidential. So unless a caregiver is criminally prosecuted, the details of any alleged mistreatment are unavailable to the public. Prosecutors and experts on elder abuse say only a small fraction of problem\u003cstrong>s \u003c/strong>come to light. When they do, it is sometimes too late.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Neglect and abuse by paid home caregivers happens “far more regularly than we know,” said Paul Greenwood, a national expert in elder abuse and a prosecutor with the San Diego County District Attorney’s office. “We are still scratching the surface.”\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which runs IHSS, said the program “works very well for people who are capable and able to self-direct.” She acknowledged that more problems can arise when clients are older than 85, for instance, or have dementia.\u003c/p>\n\u003cp>In general, she said, the state tries to ensure that clients are receiving the services they need safely in their homes without compromising their independence.\u003c/p>\n\u003cp>The state recently has made improvements to its quality assurance program and has clarified reporting standards for critical incidents, she said. But mandating training or increasing oversight further could fundamentally change IHSS from a program based on the consumers’ social needs to one based on their medical needs, she said.\u003c/p>\n\u003cp>“It’s a slippery slope,” she said. “I don’t think it is in our interest to force recipients and providers to do anything.”\u003c/p>\n\u003cp>\u003cstrong>Clients Are The Bosses\u003c/strong>\u003c/p>\n\u003cp>The In-Home Supportive Services program has its roots in the 1950s, when a small group of polio patients was moved out of Rancho Los Amigos Hospital, a rehabilitation center in Downey. Officials recognized that it would be less expensive for people to be taken care of in their homes, and the March of Dimes began to pay for domestic help.\u003c/p>\n\u003cp>The current in-home care program, created by the state legislature in 1973, retained the historical emphasis on supporting clients’ autonomy. The state pays the bills, but the elderly or disabled resident is the boss –- responsible for hiring, firing, supervising and training the caregiver.\u003c/p>\n\u003cp>To be eligible, most clients must qualify for Medi-Cal, the state insurance program for the poor, and be over 65, blind or disabled. They also must show a need for help in the home.\u003c/p>\n\u003cp>Many swear by the program.\u003c/p>\n\u003cp>“I get to continue making choices,” said Margaret Belton, 82, who receives help seven days a week from IHSS caregivers at her Pasadena apartment. “When you go into a nursing home, you lose your ability to make decisions.”\u003c/p>\n\u003cp>Belton, a former nurse with arthritis, diabetes, thyroid problems, hip and knee replacements and a history of falls, said she appreciates being able to train her own providers.\u003c/p>\n\u003cp>But for others, supervising a caregiver can be a struggle. That is especially true when clients are very old, severely physically or mentally impaired or when the employees are family members with whom clients have difficult relationships.\u003c/p>\n\u003cp>The IHSS program can be a “perfect scenario for elder or dependent abuse,” said Julie Batz, staff attorney at Legal Assistance for Seniors in Oakland. The clients may trust the providers because they share a history or because they assume that the government has screened and trained them, she said, but “that is not necessarily true.”\u003c/p>\n\u003cp>\u003cstrong>“I Never Thought She Could Do This to Me”\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_23336\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Toni-Giusto-4-e1420574566723.jpg\">\u003cimg class=\"size-large wp-image-23336\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Toni-Giusto-4-640x427.jpg\" alt=\"Toni Giusto keeps a box within reach filled with the pens, paper and letters to keep her busy. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Toni Giusto keeps a box within reach filled with the pens, paper and letters to keep her busy. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Toni Giusto, 54, said she trusted Yvonne Belanger, her domestic partner of many years, with her life. The Oakland woman hired Belanger as her IHSS caregiver in 2000, after an abscess in her neck left her paralyzed from the waist down. Giusto said she needed help with everything –- eating, bathing, sitting up.\u003c/p>\n\u003cp>Instead, Giusto said Belanger locked her in a room. “She wouldn’t give me water or nothing,” she said. Belanger didn’t take her to the doctor, even when she developed bed sores that attracted maggots, Giusto said. Belanger sprayed bug poison on her to get rid of them, according to court papers.\u003c/p>\n\u003cp>Responding to a call from Giusto’s sister, police came to the house in 2010 and found Giusto with 23 open sores and an abdomen swollen from waste backed up in her bowels, according to court papers. Belanger was convicted of elder abuse and sentenced to county jail. She died last year.\u003c/p>\n\u003cp>“I was so trusting,” said Giusto, who now lives in a rehabilitation facility in Alameda. “I never thought she could do this to me.”\u003c/p>\n\u003cp>For some clients, choosing a caregiver is less about trust than about mutual need. The parents of Erica Aguirre, now 29, knew she had a drug problem. But they needed help and she needed money, so they applied to IHSS and hired her.\u003c/p>\n\u003cp>For about two years, Aguirre said, IHSS paid her to care for her 72-year-old mother, Guadalupe, who has asthma, diabetes, high blood pressure and depression, and her father, Jesus, 69, who has heart problems, diabetes and early dementia.\u003c/p>\n\u003cp>Guadalupe Aguirre said she and her daughter soon had arguments that ended in yelling and hitting. “I thought she was going to be different than she was,” the mother said in Spanish.\u003c/p>\n\u003cp>In 2012, Erica Aguirre was charged with physically and verbally abusing her mother. She was convicted and sentenced to 60 days in county jail and drug treatment, according to court documents.\u003c/p>\n\u003cp>In an interview at the family’s home in South Los Angeles, Erica Aguirre said she is a recovering drug addict and also suffers from depression and anxiety. Despite that, Aguirre said she followed doctors’ instructions and tried to help her parents. She said she quit working as an IHSS caregiver before her criminal case began.\u003c/p>\n\u003cp>“I tried my best as a caregiver,” she said. But “I wasn’t the appropriate one.”\u003c/p>\n\u003cp>Deborah Doctor, a legislative advocate at Disability Rights California, said there is nothing to suggest that the IHSS program fosters abuse or that people are less safe at home than they would be in an institution. The best way to ensure a high quality workforce is to pay caregivers better -- not to increase regulation, she said.\u003c/p>\n\u003cp>“I am sure there are some bad actors but the efforts to quantify that have never come up with anything more than a minuscule perspective,” Doctor said.\u003c/p>\n\u003cp>\u003cstrong>Focus on Fraud\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_23337\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Maggie-Belton-2.jpg\">\u003cimg class=\"size-medium wp-image-23337\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Maggie-Belton-2-300x449.jpg\" alt=\"Maggie Belton suffers from arthritis and diabetes. The 82-year-old gets in-home care from Armida Pineda, 64, at her Pasadena apartment. (Heidi de Marco/KHN)\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maggie Belton suffers from arthritis and diabetes. The 82-year-old gets in-home care from Armida Pineda, 64, at her Pasadena apartment. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Martin Hernandez, an IHSS social worker in Los Angeles County, has a tough job.\u003c/p>\n\u003cp>He has about 440 active cases, including people with multiple sclerosis, diabetes, mental illness and a history of strokes. He is generally expected to visit each client once a year, though occasionally he sees someone who hasn’t been visited in two years.\u003c/p>\n\u003cp>Even once a year is “not enough to tell who is being harmed and who is not being harmed,” he said. “It’s very hard unless a neighbor calls or you see some kind of physical evidence.”\u003c/p>\n\u003cp>His colleague, Gloria Daniels, said she has an even higher caseload – 493 clients. “The program is so big that it appears nobody knows what to do,” she said. “We are being told it’s quantity, not quality.”\u003c/p>\n\u003cp>In Los Angeles County, the most populous county in the nation, social workers have an average of 265 clients each. Under their union contract, their caseloads aren’t supposed to exceed 249. Above that, workers can’t be held to the usual disciplinary standards. But other counties have even higher ratios – in Riverside County, case workers average about 500 clients each.\u003c/p>\n\u003cp>There are no statewide standards for how many cases a social worker can carry. Carroll said in some smaller counties workers have caseloads as low as 7. In the areas with high caseloads, she said, the state has been urging counties to hire.\u003c/p>\n\u003cp>“We do want to see cases become better balanced,” she said. “We do want to see [clients] assessed every year.”\u003c/p>\n\u003cp>During their visits county workers focus much more on possible fraud than on quality of care, statistics suggest. From 2008 through 2012, workers in the five most populous California counties -- Los Angeles, San Diego, Orange, Riverside and San Bernardino -- reported 960 cases of fraudulent overpayment to caregivers. During that same period, the workers reported a total of 32 “critical events” –- potential neglect, abuse or self-harm.\u003c/p>\n\u003cp>The state has another limited quality assurance program that aims to ensure clients are safe and that county workers are following proper procedures. Inspectors conduct “desk reviews” of case files and other documents, along with a very small number of home visits. In 2013, just 3.8 percent of IHSS cases were reviewed under the program.\u003c/p>\n\u003cp>Since last summer, more desk reviews and unannounced visits are taking place, Carroll said.\u003c/p>\n\u003cp>Case workers – and caregivers-- are required by law to report suspected abuse or neglect. But IHSS officials and family members mostly depend on another state agency, Adult Protective Services, to investigate those concerns.\u003c/p>\n\u003cp>This agency is also spread thin and has limited powers, according to state records and interviews. Even if workers suspect abuse or neglect, they generally can’t remove an adult from the home without his or her permission.\u003c/p>\n\u003cp>“We cannot force anybody to accept our services,” said Stacey Lindberg, program manager of Adult Protective Services in Orange County. “It is heartbreaking.”\u003c/p>\n\u003cp>\u003cstrong>Suffering In Seclusion \u003c/strong>\u003c/p>\n\u003cp>The result, in some cases, is prolonged abuse and neglect by IHSS caregivers. Examples can be found in court records throughout the state.\u003c/p>\n\u003cp>In Fresno, a 26-year-old woman, disabled by a severe spine condition, hired her brother and his wife as IHSS caregivers. Police and prosecutors say the couple, Joe and Denise Roman, didn't turn her in bed, and her tissue broke down so much that metal rods in her spine became exposed. She died and the caregivers were convicted in 2011 of abusing her.\u003c/p>\n\u003cp>In Lake Isabella, Kern County, Joseph McCoy was a paid caregiver over many years for his 90-year-old grandmother, who raised him. McCoy left her unattended, and officials discovered her stuck to her sheets with gruesome bedsores in a fly-infested room, according to prosecutors. She died shortly afterward. McCoy was convicted in 2012 of elder abuse.\u003c/p>\n\u003cp>“This was a really, really horrible case,” said Michelle Domino, Kern County deputy district attorney. “She had clearly been left neglected for some time.”\u003c/p>\n\u003cp>In Yolanda Farrell’s case, relatives say they are stunned that Linda Maureen Raye even was able to become a paid caregiver for her mother. Farrell was unable to walk and had very limited use of her arms as a result of a bout with polio years earlier. Maureen Raye had longstanding emotional problems, her brother Terrence said. She’d tried to take care of her mother in the past but always found herself overwhelmed. “My mom would always try to believe that she was better,” he said.\u003c/p>\n\u003cp>Maureen “went behind our backs and convinced my mom that she would be better off being taken care of in a private residence with her,” Terrence Raye said. Later, he said, Maureen Raye told him that she needed the IHSS funds as well as Farrell’s Social Security money.\u003c/p>\n\u003cp>Terrence Raye said she wouldn’t allow him to visit his mom, or even talk to her, so he called police and adult protection authorities. They interviewed his mother in Maureen Raye’s presence, he said, and told him they found nothing wrong.\u003c/p>\n\u003cp>The last time he saw Farrell was at Riverside Community Hospital, where she had arrived sickened from ulcers that went to the bone.\u003c/p>\n\u003cp>“My mom was old enough and in bad [enough] health never to recover,” he said.\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Data analyst Ronald Campbell contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23329/lack-of-oversight-for-in-home-caregivers-can-lead-to-neglect-and-death","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_459","stateofhealth_474"],"featImg":"stateofhealth_23331","label":"stateofhealth"},"stateofhealth_19591":{"type":"posts","id":"stateofhealth_19591","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19591","score":null,"sort":[1403136661000]},"guestAuthors":[],"slug":"california-caregivers-sue-their-employer-kindred-healthcare-for-wage-violations","title":"California Caregivers Sue Their Employer for Wage Violations","publishDate":1403136661,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19592\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Ginger-Hina.jpg\">\u003cimg class=\"size-large wp-image-19592\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Ginger-Hina-640x374.jpg\" alt=\"Plaintiff Ginger Rogers with one of her attorneys, Hina Shaw, reviewing the complaint that was filed today against Kindred Healthcare and affiliates. (Photo: Sara Feldman)\" width=\"640\" height=\"374\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Plaintiff Ginger Rogers (right) with one of her attorneys, Hina Shaw, reviewing the complaint that was filed today against Kindred Healthcare and affiliates. (Photo: Sara Feldman)\u003c/figcaption>\u003c/figure>\n\u003cp>Professional caregivers filed a class action lawsuit in California Wednesday on behalf of hundreds of workers throughout the state. They say their employer, Kindred Healthcare and its affiliates, shorted them on wages, overtime, and breaks.\u003c/p>\n\u003cp>Ginger Rogers, a caregiver with 25 years experience, says Kindred Healthcare hired her in 2012 to look after a patient at a skilled nursing facility in Castro Valley, outside San Francisco. She says she asked her supervisor if she could leave her patient's bedside to take a lunch break. The supervisor told her no, adding that coffee breaks weren't allowed either, according to the complaint filed in Alameda Superior Court today.\u003c/p>\n\u003cp>“That’s illegal,” says Hina Shah, co-director of the Women’s Employment Rights Clinic at Golden Gate University, who is representing Rogers and the other plaintiffs. “The law mandates two 10-minute breaks and a 30-minute meal break for every five hours of work. But more importantly, the type of work that these caregivers are doing is physically and mentally demanding, and to require someone to work 12-hour shifts without any kind of break is very detrimental to their health and is onerous.”\u003c!--more-->\u003c/p>\n\u003cp>The lawsuit also alleges the way these workers get paid violates the law, too. Shah says Kindred Healthcare pays its caregivers a flat sum for a 12-hour shift or a 24-hour shift. For some workers, that comes out to $5.83 an hour, “well below the minimum wage,” Shah says.\u003c/p>\n\u003cp>She added that these pay policies also denied workers overtime pay they were entitled to. Caregivers who work in nursing homes or assisted living facilities in California are entitled to time-and-a-half pay for every hour worked more than 8 in a day, and more than 40 in a week. But when Emma Delores Hawkins asked her supervisor for overtime pay, the supervisor responded, “We don’t have overtime.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kindred Healthcare did not respond to requests for comment. The company is based in Kentucky and is one of the largest employers of direct care workers across the country. This is not the first labor lawsuit filed against the company –- nurses and other health workers have sued Kindred in the past for alleged wage and hour violations.\u003c/p>\n\u003cp>Wednesday’s lawsuit was filed on behalf of several hundred current and former caregivers who worked for Kindred Healthcare in California. They are represented by Shah’s clinic, the Legal Aid Society–Employment Law Center, and the Oakland law firm Lewis, Feinberg, Lee, Renaker & Jackson.\u003c/p>\n\u003cp>Shah says she and the other plaintiffs’ attorneys hope the lawsuit will set a new industry-wide standard for the way caregivers are compensated across the country.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We really hope this will send a signal,” she says.”Quality care really cannot come at the expense of these employees' basic rights to be paid for all hours worked.”\u003c/p>\n\n","blocks":[],"excerpt":"Caregivers across California filed a class action lawsuit against their employer, Kindred Healthcare.","status":"publish","parent":0,"modified":1403211391,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":526},"headData":{"title":"California Caregivers Sue Their Employer for Wage Violations | KQED","description":"Caregivers across California filed a class action lawsuit against their employer, Kindred Healthcare.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Caregivers Sue Their Employer for Wage Violations","datePublished":"2014-06-19T00:11:01.000Z","dateModified":"2014-06-19T20:56:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19591 http://blogs.kqed.org/stateofhealth/?p=19591","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/06/18/california-caregivers-sue-their-employer-kindred-healthcare-for-wage-violations/","disqusTitle":"California Caregivers Sue Their Employer for Wage Violations","path":"/stateofhealth/19591/california-caregivers-sue-their-employer-kindred-healthcare-for-wage-violations","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19592\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Ginger-Hina.jpg\">\u003cimg class=\"size-large wp-image-19592\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Ginger-Hina-640x374.jpg\" alt=\"Plaintiff Ginger Rogers with one of her attorneys, Hina Shaw, reviewing the complaint that was filed today against Kindred Healthcare and affiliates. (Photo: Sara Feldman)\" width=\"640\" height=\"374\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Plaintiff Ginger Rogers (right) with one of her attorneys, Hina Shaw, reviewing the complaint that was filed today against Kindred Healthcare and affiliates. (Photo: Sara Feldman)\u003c/figcaption>\u003c/figure>\n\u003cp>Professional caregivers filed a class action lawsuit in California Wednesday on behalf of hundreds of workers throughout the state. They say their employer, Kindred Healthcare and its affiliates, shorted them on wages, overtime, and breaks.\u003c/p>\n\u003cp>Ginger Rogers, a caregiver with 25 years experience, says Kindred Healthcare hired her in 2012 to look after a patient at a skilled nursing facility in Castro Valley, outside San Francisco. She says she asked her supervisor if she could leave her patient's bedside to take a lunch break. The supervisor told her no, adding that coffee breaks weren't allowed either, according to the complaint filed in Alameda Superior Court today.\u003c/p>\n\u003cp>“That’s illegal,” says Hina Shah, co-director of the Women’s Employment Rights Clinic at Golden Gate University, who is representing Rogers and the other plaintiffs. “The law mandates two 10-minute breaks and a 30-minute meal break for every five hours of work. But more importantly, the type of work that these caregivers are doing is physically and mentally demanding, and to require someone to work 12-hour shifts without any kind of break is very detrimental to their health and is onerous.”\u003c!--more-->\u003c/p>\n\u003cp>The lawsuit also alleges the way these workers get paid violates the law, too. Shah says Kindred Healthcare pays its caregivers a flat sum for a 12-hour shift or a 24-hour shift. For some workers, that comes out to $5.83 an hour, “well below the minimum wage,” Shah says.\u003c/p>\n\u003cp>She added that these pay policies also denied workers overtime pay they were entitled to. Caregivers who work in nursing homes or assisted living facilities in California are entitled to time-and-a-half pay for every hour worked more than 8 in a day, and more than 40 in a week. But when Emma Delores Hawkins asked her supervisor for overtime pay, the supervisor responded, “We don’t have overtime.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kindred Healthcare did not respond to requests for comment. The company is based in Kentucky and is one of the largest employers of direct care workers across the country. This is not the first labor lawsuit filed against the company –- nurses and other health workers have sued Kindred in the past for alleged wage and hour violations.\u003c/p>\n\u003cp>Wednesday’s lawsuit was filed on behalf of several hundred current and former caregivers who worked for Kindred Healthcare in California. They are represented by Shah’s clinic, the Legal Aid Society–Employment Law Center, and the Oakland law firm Lewis, Feinberg, Lee, Renaker & Jackson.\u003c/p>\n\u003cp>Shah says she and the other plaintiffs’ attorneys hope the lawsuit will set a new industry-wide standard for the way caregivers are compensated across the country.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We really hope this will send a signal,” she says.”Quality care really cannot come at the expense of these employees' basic rights to be paid for all hours worked.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19591/california-caregivers-sue-their-employer-kindred-healthcare-for-wage-violations","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_459"],"featImg":"stateofhealth_19592","label":"stateofhealth"},"stateofhealth_11137":{"type":"posts","id":"stateofhealth_11137","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"11137","score":null,"sort":[1362688033000]},"guestAuthors":[],"slug":"support-for-caregiver-and-patient-new-ucla-program-for-alzheimers-and-dementia-care","title":"Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care","publishDate":1362688033,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By Stephanie O'Neill, \u003ca href=\"http://www.scpr.org/news/2012/07/25/33450/ucla-launches-new-comprehensive-alzheimers-and-dem/\" target=\"_blank\">KPCC\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6652\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/loneliness-is-bad-for-the-elderly/oldpersoncanegeneric/\" rel=\"attachment wp-att-6652\">\u003cimg class=\"size-medium wp-image-6652\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/OldPersonCaneGeneric-300x199.jpg\" alt=\"There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\u003c/p>\n\u003cp>“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”\u003c/p>\n\u003cp>The going is slow and precarious as Martha Kerr, who is recovering from a cracked vertebra in her neck, inches along the corridor guiding the walker for her mom. Her caregiver, Virginia, walks behind her with the wheelchair that will be used to transport Martha after the journey to the elevator is complete.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors.\"\u003c/aside>\n\u003cp>This particular morning is a good one for the elder Ms. Kerr. She's in good spirits, and she recognizes her daughter. On other days she's more irritable, and she sometimes confuses Linda for her own mother. A series of strokes have left her with dementia. Today, the trek to the elevator lasts about five minutes and is the first leg in the Kerrs' commute to the Santa Monica-UCLA Medical Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They're heading to the hospital to get help and become among the first to enroll in UCLA’s Alzheimer’s and Dementia Care Program. Funded by philanthropic dollars and a federal innovations grant, the program is designed to help patients and family caregivers deal with dementia.\u003c!--more-->\u003c/p>\n\u003cp>Linda says she welcomes any assistance offered by the program. For more than a decade, she's played the lead role in caring for her mother. While a full-time caregiver now assists her mother, Linda's days nevertheless remain consumed by providing care for her mom — with her remaining time spent with her husband or on her career as voice actress and audiobook narrator.\u003c/p>\n\u003cp>“I have no free time,\" she says. \"No free time. You know how people say, 'One day at a time'? A day is way too long. I take it an hour at a time. Sometimes, just this moment at a time.”\u003c/p>\n\u003cp>That’s a refrain shared by many who care for people with Alzheimer's and dementia. In California, more than 500,000 people are now afflicted with Alzheimer's alone. By 2030, that number is expected to climb to 1.1 million, according to \u003ca href=\"http://cadc.ucsf.edu/cadc/emergingcrisis\" target=\"_blank\">statewide projections\u003c/a>. Experts say that will place an even larger strain on family caregivers.\u003c/p>\n\u003cp>“The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors,\" says Dr. David Reuben, chief of UCLA Geriatric Medicine and head of the new dementia program, which is offering enrollment to all medical center patients diagnosed with dementia. Those who participate will get an individualized care program tailored both for them and for their caregiver.\u003c/p>\n\u003cp>\"We see a lot of caregiver burnout,\" Reuben says. \"Once the burnout has happened, it’s almost impossible to try to retrieve people. That means a lot is riding on these caregivers, and they have to be supported.\"\u003c/p>\n\u003cp>In addition to providing coordinated medical care for patients, the program is offering caregivers around-the-clock access to geriatric experts for help with sudden behavior changes and other unique challenges posed by dementia.\u003c/p>\n\u003cp>The program also features caregiver support groups, called \u003ca href=\"http://www.geronet.ucla.edu/patients/dementia-support/beyond-alzheimers?831a6a7603aca2da33e5c8f97a3f7b84=fwsmrdfv\">Beyond Alzheimer's\u003c/a> that are organized by Patti Davis.\u003c/p>\n\u003cp>Davis is the daughter of former president Ronald Reagan — one of the world’s most famous Alzheimer’s patients. She says support groups are especially important for family members dealing with Alzheimer's disease and other dementia because they affect families unlike any other disease.\u003c/p>\n\u003cp>\"It’s a death before dying,\" Davis says. \"You’re losing everything that is familiar about that person in stages that are very unpredictable and you have no idea what’s going be lost next or when. You only know that it will happen.\"\u003c/p>\n\u003cp>That’s a pretty accurate depiction of the journey Linda Kerr has traveled with her mother since 2001. The several strokes Martha has suffered have changed her personality and require medication to quell episodes of belligerence. But the drugs sometimes affect Martha’s coordination, as happened on a recent outing that Linda says devolved from a fun experience into another exhausting episode.\u003c/p>\n\u003cp>“It was like she had another major stroke,\" says Linda. \"Her brain went dead; she couldn’t walk right. She almost fell on us, and she still gets agitated.”\u003c/p>\n\u003cp>Martha’s drug prescriptions were among the topics of discussion at her dementia care enrollment meeting, which began with a medical technician checking her vital signs.\u003c/p>\n\u003cp>The female tech started by explaining to Martha everything she was doing. “I need one finger in here. It’s for your oxygen and pulse, OK?\" she said as she held up the finger-mounted pulse oximeter. She then checked Martha's weight.\u003c/p>\n\u003cp>The brief physical was followed by an assessment meeting between the Kerrs and geriatric nurse practitioner Leslie Evertson, who manages the dementia care program.\u003c/p>\n\u003cp>“The first thing I do is get a good overview picture of what’s going on with Ms. Kerr and the family and try to narrow down some goals that we can hope to attain — what would make their quality of life easier,\" she says.\u003c/p>\n\u003cp>After about an hour, the Kerrs left the closed-door meeting with Martha enrolled in the program and with a prescription for Linda as well: to attend a support group. But the time constraints imposed by her mother’s illness right now make that step unlikely, she says.\u003c/p>\n\u003cp>“I wish I had more time to go,\" Linda says. \"If I have a day, I’m here with my mom giving the caregiver a break. So I have to choose, you know, it’s like it’s better off I’m here.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That sentiment underscores a paradox that may likely pose one of the biggest challenges for the UCLA program as it expands into what organizers hope will be a model for dementia care nationwide.\u003c/p>\n\n","blocks":[],"excerpt":"It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\r\n\r\n“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”","status":"publish","parent":0,"modified":1362792862,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1063},"headData":{"title":"Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care | KQED","description":"It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\r\n\r\n“Be careful, Ma," she gently cautions as her mother takes tentative steps forward. "C’mon, get closer to the walker — you’re walking too far away.”","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care","datePublished":"2013-03-07T20:27:13.000Z","dateModified":"2013-03-09T01:34:22.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11137 http://blogs.kqed.org/stateofhealth/?p=11137","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/03/07/support-for-caregiver-and-patient-new-ucla-program-for-alzheimers-and-dementia-care/","disqusTitle":"Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care","path":"/stateofhealth/11137/support-for-caregiver-and-patient-new-ucla-program-for-alzheimers-and-dementia-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Stephanie O'Neill, \u003ca href=\"http://www.scpr.org/news/2012/07/25/33450/ucla-launches-new-comprehensive-alzheimers-and-dem/\" target=\"_blank\">KPCC\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6652\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/loneliness-is-bad-for-the-elderly/oldpersoncanegeneric/\" rel=\"attachment wp-att-6652\">\u003cimg class=\"size-medium wp-image-6652\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/OldPersonCaneGeneric-300x199.jpg\" alt=\"There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\u003c/p>\n\u003cp>“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”\u003c/p>\n\u003cp>The going is slow and precarious as Martha Kerr, who is recovering from a cracked vertebra in her neck, inches along the corridor guiding the walker for her mom. Her caregiver, Virginia, walks behind her with the wheelchair that will be used to transport Martha after the journey to the elevator is complete.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors.\"\u003c/aside>\n\u003cp>This particular morning is a good one for the elder Ms. Kerr. She's in good spirits, and she recognizes her daughter. On other days she's more irritable, and she sometimes confuses Linda for her own mother. A series of strokes have left her with dementia. Today, the trek to the elevator lasts about five minutes and is the first leg in the Kerrs' commute to the Santa Monica-UCLA Medical Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They're heading to the hospital to get help and become among the first to enroll in UCLA’s Alzheimer’s and Dementia Care Program. Funded by philanthropic dollars and a federal innovations grant, the program is designed to help patients and family caregivers deal with dementia.\u003c!--more-->\u003c/p>\n\u003cp>Linda says she welcomes any assistance offered by the program. For more than a decade, she's played the lead role in caring for her mother. While a full-time caregiver now assists her mother, Linda's days nevertheless remain consumed by providing care for her mom — with her remaining time spent with her husband or on her career as voice actress and audiobook narrator.\u003c/p>\n\u003cp>“I have no free time,\" she says. \"No free time. You know how people say, 'One day at a time'? A day is way too long. I take it an hour at a time. Sometimes, just this moment at a time.”\u003c/p>\n\u003cp>That’s a refrain shared by many who care for people with Alzheimer's and dementia. In California, more than 500,000 people are now afflicted with Alzheimer's alone. By 2030, that number is expected to climb to 1.1 million, according to \u003ca href=\"http://cadc.ucsf.edu/cadc/emergingcrisis\" target=\"_blank\">statewide projections\u003c/a>. Experts say that will place an even larger strain on family caregivers.\u003c/p>\n\u003cp>“The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors,\" says Dr. David Reuben, chief of UCLA Geriatric Medicine and head of the new dementia program, which is offering enrollment to all medical center patients diagnosed with dementia. Those who participate will get an individualized care program tailored both for them and for their caregiver.\u003c/p>\n\u003cp>\"We see a lot of caregiver burnout,\" Reuben says. \"Once the burnout has happened, it’s almost impossible to try to retrieve people. That means a lot is riding on these caregivers, and they have to be supported.\"\u003c/p>\n\u003cp>In addition to providing coordinated medical care for patients, the program is offering caregivers around-the-clock access to geriatric experts for help with sudden behavior changes and other unique challenges posed by dementia.\u003c/p>\n\u003cp>The program also features caregiver support groups, called \u003ca href=\"http://www.geronet.ucla.edu/patients/dementia-support/beyond-alzheimers?831a6a7603aca2da33e5c8f97a3f7b84=fwsmrdfv\">Beyond Alzheimer's\u003c/a> that are organized by Patti Davis.\u003c/p>\n\u003cp>Davis is the daughter of former president Ronald Reagan — one of the world’s most famous Alzheimer’s patients. She says support groups are especially important for family members dealing with Alzheimer's disease and other dementia because they affect families unlike any other disease.\u003c/p>\n\u003cp>\"It’s a death before dying,\" Davis says. \"You’re losing everything that is familiar about that person in stages that are very unpredictable and you have no idea what’s going be lost next or when. You only know that it will happen.\"\u003c/p>\n\u003cp>That’s a pretty accurate depiction of the journey Linda Kerr has traveled with her mother since 2001. The several strokes Martha has suffered have changed her personality and require medication to quell episodes of belligerence. But the drugs sometimes affect Martha’s coordination, as happened on a recent outing that Linda says devolved from a fun experience into another exhausting episode.\u003c/p>\n\u003cp>“It was like she had another major stroke,\" says Linda. \"Her brain went dead; she couldn’t walk right. She almost fell on us, and she still gets agitated.”\u003c/p>\n\u003cp>Martha’s drug prescriptions were among the topics of discussion at her dementia care enrollment meeting, which began with a medical technician checking her vital signs.\u003c/p>\n\u003cp>The female tech started by explaining to Martha everything she was doing. “I need one finger in here. It’s for your oxygen and pulse, OK?\" she said as she held up the finger-mounted pulse oximeter. She then checked Martha's weight.\u003c/p>\n\u003cp>The brief physical was followed by an assessment meeting between the Kerrs and geriatric nurse practitioner Leslie Evertson, who manages the dementia care program.\u003c/p>\n\u003cp>“The first thing I do is get a good overview picture of what’s going on with Ms. Kerr and the family and try to narrow down some goals that we can hope to attain — what would make their quality of life easier,\" she says.\u003c/p>\n\u003cp>After about an hour, the Kerrs left the closed-door meeting with Martha enrolled in the program and with a prescription for Linda as well: to attend a support group. But the time constraints imposed by her mother’s illness right now make that step unlikely, she says.\u003c/p>\n\u003cp>“I wish I had more time to go,\" Linda says. \"If I have a day, I’m here with my mom giving the caregiver a break. So I have to choose, you know, it’s like it’s better off I’m here.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That sentiment underscores a paradox that may likely pose one of the biggest challenges for the UCLA program as it expands into what organizers hope will be a model for dementia care nationwide.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/11137/support-for-caregiver-and-patient-new-ucla-program-for-alzheimers-and-dementia-care","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_459","stateofhealth_461"],"featImg":"stateofhealth_6652","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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