A Truely Frightening Story, How Can this Happen?

By James Miley

Early Sunday morning, around 7:15 AM, I experienced that eerie feeling that forms when your phone rings at a time when you normally don’t receive calls. I looked at my phone and saw that it was my partner, Peter. I answered trying to quickly come up with an appropriate greeting to this unexpected buzz.

Before I could get a word out, Pete said, in a rather solemn tone, “Have you seen the paper”? My reply was, “which one”? Spending my entire life in the twin cities, I have formed the habit of reading both the Saint Paul Pioneer Press and the Minneapolis Star Tribune on weekends. He jumped in; “the Tribune”! “No, I’m still reading the Saint Paul paper, why”? I asked.
“Check-out the front page, you won’t believe it”, he said with a tone of disbelief. “Read it, and call me back!”

I went to the door to retrieve the other paper. As I bent down to pick it up, I could make out a sub-headline reading, “inside the personal care industry” That eerie feeling, quickly turned to incredulity. I was shocked to see the name of the company, Crystal Care Home Health. A company known throughout state as a leader in the in-home care health sector. Both my partner and I have attended a number of seminars and/or conferences concerning issues related to in-home care in which one of the principal partners was a keynote speaker or subject-matter-expert for a number of topics including; regulation, human resources, nursing techniques, training, and so on.

I was stunned. I’ve met both of the owners, but really spent more time with one of the two. She, is well educated and very knowledgeable about the issues facing in-home health, from the perspectives of both the provider and the patient. She’s known throughout the in-home care industry in our area as a go-to person in regards to regulatory surveys conducted by the state health departments auditing in-home care agencies.

The opening paragraph was horrific. It described a patient, “lying motionless on the floor, pain shooting from his back. The screams of his companion, pierced the morning silence of their Bloomington apartment.”
“They were helpless.”

The next few paragraph were worse. The article listed the duties the patient hired Crystal Care to manage, and went on to describe the patients current condition, multiple sclerosis, with “virtually no movement in his limbs”. “I feel hurt and abandon” the patients is quoted as saying. Hurt and abandoned? My feeling is that he was certainly was taking the ‘high road’ when detailing his emotional upheaval.

The story went on to point out the rapid growth of the in-home care industry in Minnesota and some of the problems explosive growth can bring. It detailed the minimal training requirements for caregivers as well as the instability of the industry as a whole. Citing the closure of one-third of the nearly 800 in-home care companies since 2009. It went to note that in-home care, unlike the nursing home industry, has no requirement to secure substitute care for a client if it goes out of business. I’m sure anyone reading this understands the impact that inaction will cause.

“The lack of oversight is a catastrophe,” said Dr. Robert Kane, chairman of long-term care and aging at the University of Minnesota’s School of Public Health. “But the catastrophe has gone largely unnoticed because it’s happening in thousands of individual, isolated homes.”
“Consumer advocates acknowledge that the in-home care industry serves a vital function, helping people live more independent lives outside institutions and keeping them closer to their families and community. Many agencies, they say, provide first-rate care.

The piece went on to point out that “this episode was symptomatic of problems that have emerged during a decade of explosive growth in the industry. In Minnesota, public spending on personal care assistants in clients’ homes has soared from $117 million in 2003 to $618 million last year, and more than 36,000 Minnesotans now receive such care.”

The author also noted, “in the midst of that growth, billing irregularities and fraud have become chronic. Nationwide, 20 percent of all Medicaid claims submitted by personal care service providers were found to be faulty – either because providers had no record that the services were actually provided or the caregivers lacked proper qualifications. ….. in a single year, the U. S. Department of Health and Human Services found the total of wrongful payments exceeded $700 million.”

“In Minnesota, personal care assistance accounts for less than 10 percent of total Medicaid spending, but alleged personal care fraud accounts for 37 percent of state investigator’s time, according to Minnesota’s Department of Human Services. Personal care fraud also accounts for more than half of the state attorney general’s Medicaid investigations.

The story exposes more episodes of the company’s failure to meet their clients’ needs, describing another patients’ experience. In this case, the patient is described as a “Korean War veteran, who calls himself “fiercely independent,” he thought he could fend well enough on his own until another aide arrived.

Days slipped by without a caregiver showing up. Then weeks. Then months. He stopped showering, washing his clothes and changing his bed sheets. And he frequently forgot to take the small pink pills, kept in a plastic tray above the kitchen sink, that prevented the buildup of fluid in his lungs…… he was afraid to call public officials for help, fearing they might discover his frail state and send him to a nursing home….”

This article is a wake-up call to everyone that is dealing a parent, spouse, child, loved one or friend, in need of specialized care, but wanting to continue living independently.

The article is very well written, and meticulously researched. My comments only cover a portion of the problems identified in the report. I will comment further on the other issues raised in a later blog.

It points out errors made by the company’s owners, and it also brings to light the need for better regulatory supervision within the in-home care industry as a whole. In this particular case, I’m having trouble finding fault with the state ombudsman or the states Human Services Department due to the nature of the company’s closure. After their September meeting, the DHS prepared letters to be sent to Crystal Care’s clients advising then of the company’s plans to close. Because Crystal Care changed their filing status to Chapter 11 bankruptcy, or reorganization. I’m not sure how any overseer would conclude that the company would then close down in the rapid manner as with Crystal Care.

I would support, and I’m sure most other reputable in-home care providers would also support stronger regulatory oversight for companies offering in-home care that require all of us to create contingency plans that outline their process to cover the care expectations of their clients in the case of closure.

The training requirements for personal care attendants by the state may seem lax. However, each company should be continually training caregivers in the most advanced care techniques that fit their client’s needs. And we all know, our client’s needs will change over time. Some more rapidly than others.

This story exposes the risks our loved ones face when choosing an in-home care provider. In most cases, people in need of our services have go with their ‘gut feeling’ as to how well the company will perform before the service starts. My advice: ask a lot of questions. Even the uncomfortable ones. Ask them if they have a contingency plan in effect in the case of a sudden shut-down!

In-home care is a wonderful service that allows client’s to continue living in the comfort and familiarity of their own home at an affordable price point, preserving their dignity and independence.

(This article was written by Chris Serres for the Star Tribune, on 6/22/2014