Not all home care aides regulated by the state

Thursday, March 29, 2012
LaDonna McNulty places a barrette in Pauleta Johnson's hair Wednesday. McNulty is a home health aide with the Visiting Nurse Association of Southeast Missouri. (Laura Simon)

After infested bedsores were found covering much of an 79-year-old Cape Girardeau woman last fall, her live-in caregiver faced criminal charges in connection with her death.

Authorities believe substandard care provided by Sherrie Coomer, 53, of Patton, Mo., contributed to the woman's death from a sepsis infection.

This week, Coomer pleaded guilty to a charge of second-degree involuntary manslaughter, said Cape Girardeau County assistant prosecutor Angel Woodruff. Coomer will be sentenced April 23 and faces from one year in the county jail to up to four years in state prison.

According to court records, Coomer was paid by the victim to stay with her 24 hours a day, seven days a week and perform daily tasks such as grooming and bathing.

Home health companies that provide similar services for patients on Medicare and Medicaid must meet strict licensing and training requirements, but private-duty home care providers like Coomer are not regulated by the state.

"A similar incident in southwest Missouri many years ago prompted the legislators to take a look at possibly mandating licensure, but there was such a huge outcry from these individuals and their clients that they did not push any further," said Teresa McCulloch, CEO of the Visiting Nurse Association of Southeast Missouri.

Hiring an individual privately, rather than through a home health company, may be less expensive, but that's because they don't face the same regulations for criminal background checks, drug screening or training that licensed companies do, said McCulloch, who is a member of the Missouri Home Health Advisory Council and a board member of the Missouri Council for In Home Services.

According to the U.S. Bureau of Labor Statistics, home health aides who work for a certified home health provider earned a mean hourly wage of $10.49 in 2011, while personal aides earned a mean hourly wage of $9.88.

Home health aides with licensed companies are required to have 20 hours of classroom training and then go through an supervised field training program, McCulloch said.

Aides are trained about elder abuse, neglect and exploitation as well as how to spot skin ulcers, like the ones that became infected in Coomer's patient.

The number of elder abuse cases reported is increasing each year, according to the Missouri Department of Health and Senior Services. Initial reports of elder abuse, neglect and financial exploitation have risen from 12,177 in 2006 to 17,718 in 2010.

Along with proper training, supervision is also important in ensuring the safety of clients, McCulloch said.

Medicare and Medicaid require a supervisor to visit aides to observe them working and also requires a supervisor to visit patients when no aides are there in case they don't feel comfortable talking in front of them.

"When you hire a home care aide privately, the client or their family needs to be sure they know what they are getting and they need to provide the supervision for their family member. As the saying goes ... let the buyer beware," McCulloch said.

Home health care spending is on the rise in the U.S. as the baby boomer generation ages.

In 2010, U.S. spending on home health care services increased 6.2 percent from the previous year for a total of $70.2 billion, according to the National Health Expenditure report released in January by the Centers for Medicare and Medicaid Services. Home health spending increased at a greater rate than spending on hospital care, physician services, prescription drugs or nursing facilities.

When it comes to selecting a private home health aide, Mary Schantz, executive director of the Missouri Alliance for Home Care, compares the process to parents selecting their first baby sitter.

"I tell families to ask all kinds of questions and don't be afraid to drop in unexpected and surprise them and see what's going on," Schantz said. For those without family nearby, she suggests they ask a neighbor or friend to come over when their home health worker is there.

There are advantages to using a home health company over someone who is working on their own, she said. "When you hire somebody off the street, even if they turn out to be a great worker, the chances are they are going to have days when they're sick or their children are sick and they can't show up for work," Schantz said. "A health care company offers backup. You know we'll send an equally qualified person in their place."

Another advantage of using a company is that it can send more staff when, for example, it would be difficult for one person to get a patient out of bed, Schantz said.

There is often a fine line whether home care or a nursing facility is the best choice for a patient, Schantz and McCulloch said.


Pertinent address:

45 S Mount Auburn Road, Cape Girardeau, MO

Map of pertinent addresses

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