News Scrapbook 1984

An Ailing System of Health Care By SA DY BANKS d CAROLMcGRAW, Tim I Staff Writer

18 Part I/Wednesday, July 25, 1984 CARE: Ailing County Health-Provider System Continued from Pare 1

deaf-and-blind elderly employer. Nadine Pensis had cleaned, shopped, and cared for 70-year-old Wilma White for six months after White got her name from a county registry. When White was evicted from her apartment. Pensis moved the woman into her Glassel! Park home. But White was removed from the home after she told pohce that Pensis had struck her and refu ed to allow her to leave. Pohce al o removed from Pensis' care an 85- year-old woman who they say hvcd in a metal shed behind Pensis' home. (Felony charges have been filed against Pensis and her broth- er, Michael Pensis, alleging that they mistreated the women. They have denied the charges. ) According to some in the pro- gram, problems are not uncommon at the hands of the untrained and unsupervised attendants. Some tell stones of workers physically abusing them. stealing everything Crom household items to their life's savings, eating them out of house and home, runrung uf) long-distance phone bills, enter- taining strangers at all hours of the day and night, leaving them unat- tended at crucial times, reporting to work drunk. or not showing up at all. "People put up with awful things to remain at home," said Florence Moore, director of the New York- based National Homecaring Coun- cil, which accredits home health companies. Moore is among a number of cntics calling for changes in the way the government monitors the homemaker care system-changes that would make worker training mandatory and require closer su- pervision or client-worker rela- tionships. Unlike some counties, which re- quire' attendants to complete train - ing courses, Los Angeles County has no qualifications for-home care workers in the Sl28-million pro- gram and depends on clients to hire their own help. In Los Angeles and 25 other California counties, in- cluding Orange, home attendants are considered "independent pro- viders" and are supervised by the clients. but paid by the county, largely from state and federal funds.

without a home aide, she would be forced Into an institution. "I should have done something about it at the start," she said, "but I was afraid of going into a home." She now Jives in an El Monte board.and-care home. Others put up with some abu. e because they know how difficult it 1s to find, and keep, household workers. Turnover 1s rampant, with almost one-quarter of the clients in the state going through four or more providers a y ar, according to state figures. Because the aides provide such personal care as bathing and dress- ing their charges, "It's emotionally difficult to go through new workers all the time," said Linda Kmpps, 32, president of the state's In-Home Support Services consumer adviso- ry committee and a severely disa- bled woman who needs around-the-clock care. "It's like having your family disrupted," The Downey resident said she had six different attendants last year, and two, so far, this year. "You put up with a lot because it's so hard to get good workers, and hard to keep lookmg for them," she said. & Most of the elderly and disablea rely on newspaper advertisements to find help. Others depend on the county registry, which lists 4,000 homemaker aides, but does not vouch for their qualifications. The people who work in the In-Horne Supportive Services pro- gram have their own complaints. Many are middle-age women, who receive little respect for their work, said Hadley Hall, executive director of the Visiting Nurse Assn. of San Francisco. "They pay street sweepers $24,000 a year, they pay chefs unbelievable pay, they pay laundry workers $9 union wages, but)lorne- rnakers who have much more re- sponsibility are supposed to do it for love," Hall said. Efforts to Improve the program so far have made little headway. The National Homecaring Council has called for a national home-care policy to boost funding, upgrade employment benefits and improve training for aides. The California Legislature,

Home Care Services One of the largest programs of its type in the nation, California's In Home Supportive Services program provides non-medical home care to the aged blind and disabled. It has been hailed as a godsend to many invalids, but is drawing criticism for lack of control over the quality of care. • Origin: The program was begun in the 1970s when federal funds became available to the states through the Social Security Act. • Who paya: The federal government now pays 75% of the cost, with the state and counties picking up the rest of the bill. • Growth: In 10 years. the California program has grown from $78.6 million to $287 million annually. Los Angeles County's program, which aids 44,000 people, is the state's largest. Because the homemaker program has grown so rapidly and because the federal government does not require states to report how they allocate their block grant funds, there are no solid statistics on its size nationwide. • Comparative Coate: Because the program helps the elderly and disabled stay out of institutions, officials say that It has saved taxpayers millions of dollars. In California. for example, the average cost of nursing home care is about $60 a day; hospital care costs an average o~ $750 a day, health officials say. Homemaker aides are paid an average of $3.50 an hour, with the typical client requiring about 15 hours of care a week.

stopped paymg their aides for two weeks, the workers would have to "If you've got a good worker, you certainly aren't gomg to let them go. And they are working, they usually end up at your bedside at the hospital, or doing things around the house that need doing," she In comparison to private compa- mes, Los Angeles County social workers. who have a minimum of 216 cases each, maintain little con- tact with their clients, except for once-a-year visits to check the number of hours of weekly care needed by the client. Social work- ers try to resolve complaints, but unless there 1s evidence of serious abuse, "We leave it up to the client to terminate the provider," Nurse Workers who abuse their em- ployers may be removed from the county's referral list, but that does not stop them from finding home- chore work through other means. "I don't think, considering the number of cases we have, that there is a great deal of abuse of clients by providers," Nurse said. "It is not easy to provide services for some of these people. There will often be conflicts, but the social worker is often able to talk to one or both and straighten out the Until January, Los Angeles County did not keep track of the number of complaints of abuse reported by clients, so it is difficult to determine how prevalent such abuse is. "We're just now trying to gather data to get an idea of the extent of the problem," Nurse said. getanotherJob. said. explained. problems." A state law that went into effect this year requires social workers to report suspected abuse of the eld- erly to county officials. Statistics from January to May show about 150 of the 3,600 complaints of adult abuse in Los Angeles involved In-Home Supportive Services cas- es. The complaints ranged from physical, sexual and psychological abuse to failure to provide adequate food, clothing and shelter. However, health-care officials say many abuses may go unreP9rt- ed because clients are often reluc- tant to complain about the people SomeTolerateAbuse

hkely to do extra things for them But, because no one is watching over the 44.000 people served by the program, the arrangement of- fers the potential for eXploitation of the vulnerable and frail. "I had some years where I had a dozen different workers," said Tad Tanaka, a college counselor and quadriplegic who lives in Para- mount. "Some tore the place up, some got drunk. A good friend of mine hired a guy who, one night, left him in bed and stole his car and didn't come back. I've heard of somewhoevenbeatthe1rclients." Independent providers in Los Angeles are paid $3.45 an hour-IO cents above the rnmimum wage. Private agencies in California pay slightly better-typically between $3.50 and $5 an hour, according to without pay," Most Are Part-Timers Most home aides work part-time, though some have more than one chent and put in a 40-hour week between them, while others are live-rn attendants, on duty 24.. hours a day. The maximum granr available to a severely disabled person in Los Angeles is 991 a month, so those with live-in at- tendants wind up paying them less than half the minimum wage. In Los Angeles, workers record their hours, have the time sheets signed by their employers, then mail them to the county. Officials make no effort to verify the hours "In the independent-provider program, they usually hire a friend or relative, so you tell me who's going to squeal (about unworked hours)," said Charles D. Hoffman, reg10nal manager for Upjohn, which has a $4.2-million contract to provide most of the home-care services in San Diego County. Private companies like his keep track of workers' hours and main- lain regular contact with clients to check on their care, he said. His agency also makes surprise visits to check on the workers and main- tains a 24-hour hot line for clients worked. Msemaji.

•

reme mple In - home care has been a godsend for nany, who express unstinting pnusc for work rs who allow them to mamtam measure of ndepend • nee. But It has been a nightmare for others, particularly m places hkc Los Angeles, where the county exerci es v1rtually no control over the quality of care, 'Charles Manson could escape from prison today and tomorrow be m ome elderly per on·~ home und r the gui e of a home attend- nt." aid Ken MscmaJ1, president of the Domestic Workers Union of Amenca in San Diego. which rep- r s nts home attendants in nine California counties. Th potential for abuse was suggested recently when a home attendant was arrested and charged with mistreating her Please 1ee CARE, Pare 18

Mix of Providers Sixteen other counties, including San Bernardino, San Diego and San Francisco, use some independent providers, but subcontract out part of their program to private home- care agencies, which hire, train and s erv1se attendants. Sixteen smaller counties use county em- ployees to supplement independent providers. The independent-provider sys- tem works to the advantage of manv elderly and disabled, who are able to hire friends and relatives to care for them. In many of those cases, the payments go to family members who Jive with the client but who could not otherwise afford to stay home and provide care without being paid. According to a 1980 statewide study, 41.5% of clients used In-Home Supportive Services to hire friends or relatives. "That method provides emotion- al support to the client and gives them control over their situation," said Marti Nurse, Los Angeles County welfare administrator. "They get somebody who has a personal interest in them, who"s

llosAngeles 6rtmes long run the contracting system would be less expensive because a poorly monitored independent- provider system allows clients to continue to receive care long after their health has improved, and allows workers to collect for hours not worked. "The problem is you have a situation that encourages people to cheat and be irresponsible," said Msemaji of the domestic workers union. "And there's no way for anybody to complain without jeop- ardizing their own interests. In a very large way, ~verybody is ex- ploited." Even Nurse, the head of the county program, believes contract- ing might be a more efficient way of providing care. "Services would get provided quicker because fhe workers are more professional," she said. "They get in, get the job done, they're out. They're paid at a higher rate, so while it's more per hour, each case gets fewer hours. The county also has more control over who's doing the work." Linda Knipps summed up the dilemma faced y those needing home care: "I can't live with them," she said, "but I'd die without them."

meanwhile, has tightened ehgibili- ty standards and cut the amount of care others received in a bid to hold down costs. Lawmakers have also resisted attempts to make care providers county employees with Civil Service protection. "The boys in Sacramento play the game that the little, disabled lady of 90 is (capable of being) the employer," Hall said. "What kind of fiction is that?" The contracting system, on the other hand, is not without its potential for abuse because there is virtually no regulation of the pri- vate agencies. Contracting would remove much of the burden from cuents by providing trained workers and tighter supervision, but some say it would also cost the county more because of administrative overhead and higher employee pay. For example, San Diego County's con- tract with Upjohn costs $6.30 an hour compared with the $3.45 an hour Los Angeles County pays its workers. Because counties are re- quired to serve everyone who is eligible for the program, higher costs would likely mean cutting the number of hours of care. But some critics argue that in the

to report problems.

One Los Angeles woman, who asked that her name not be used, said that she lies about the hours her homemaker works whenever she is hospitalized, which is often. The care worker is supposed to be laid off while the client is in the and others as well, said that if they hospital. However, this woman,

they depend upon.

For example, White says she was hit and bullied over six months by her attendant, but she did not tell anyone because she knew that

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