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Connecticut rushes to oversee the unregulated home care industry

Susan Ryder and their nursing assistant Arelis Estrella struggle to pull on a compression stocking onto Betty Bednarowski, 79.
Wong Maye-E
Susan Ryder and their nursing assistant Arelis Estrella struggle to pull on a compression stocking onto Betty Bednarowski, 79.

More than ever, Connecticut residents are looking to age at home. Can the state keep up with a growing home health care industry that has been unregulated so far?

WSHU’s Ebong Udoma spoke with CT Mirror’s Dave Altimari to discuss his article, “Home care providers: A growing but unregulated industry,” as part of the collaborative podcast Long Story Short.

WSHU: We've seen a shift away from nursing homes or long-term care facilities as more people prefer to age at home. But you say there might be a problem, because home care providers are not properly supervised by the state. And you give the example in your article about 92-year-old Ruth Hughes of Farmington who was ripped off by mother and daughter team home care providers Cynthia Williams and Sharonda Williams, could you tell us a little bit more about them and this particular instance here?

DA: Sure. So the home companion agency field is the only thing in healthcare that is not overseen by the Department of Public Health. It is the Department of Consumer Protection at the moment that is responsible for investigating them. And there's very little that is done to track who's working for these companies. The companies are supposed to do background checks, but they don't have to provide them to the state. In the case you're referencing, what happened was, I did a Freedom of Information request to get three years worth of DCP investigations. And there were over a half a dozen of them where a personal care aide stole the money from the client.

In the case that you're referring to, Ruth was in an assisted living facility. She had hired a company to have an aide come and stay with her a few hours a day. And about a month after the person had started working there, her conservator got a call from the bank asking about $27,000 worth of checks that had been written off Ruth’s checkbook. The conservator immediately knew that that wasn't the kind of money that Ruth would be spending and went to the Farmington police to do an investigation and they determined that the PCA, her name was Cynthia Williams, was basically writing checks to buy furniture for her apartment and had spent almost $27,000 writing all these checks. When the police started investigating, they realized there was a second client that she was also stealing from. They eventually arrested both the mother and daughter on larceny charges. And both of them ended up pleading guilty in Harford court.

WSHU: But that's just one example. And it's not just fraud we're talking about here. You have another example of an 86-year-old client in Waterbury whose home care assistant ended up overdosing in his apartment. And he was by himself.

DA: That was a South Windsor case. The Waterbury case was the one where when the man died, he was 89 years old, the PCA refused to let the family into the apartment claiming that they had a relationship and had to get the police involved and DCP and it took six-eight weeks for them to even get access to the father's stuff.

The case you're referring to occurred in South Windsor. A man suffering from dementia, normally him and his PCA would take a bus to a senior center. So the bus driver knew who he was and knew we always had a PCA with him. So when he showed up one morning without his PCA, they basically didn't let him on the bus and left him on the side of the road. The guy had no idea of how to get home. He was reported missing to the police. They eventually found him about an hour after he had been reported missing. And when they brought him back to the house, they found that his PCA had overdosed on heroin and died in the house. And the man had just walked out and walked to the bus station and then had walked around the neighborhood. Luckily the police found him relatively quickly.

WSHU: So what's been done about this? I mean, is the state doing something, are lawmakers looking into this?

DA: Yes, actually. As we were reporting on this series, the legislature formed a Home Companion Task Force to take a look at what DCP was doing, what was the oversight, and what could be done differently. And they have a bill that's passed out of committee that would transfer the responsibility of overseeing these facilities from DCP to DPH.

WSHU: The feeling is that DCP is too lenient, or DCP does not have the ability to properly regulate this industry? That it is better done by the Department of Public Health?

DA: DCP does not have the manpower, the number of home companion agencies has gone from 300 to 900 in just a few years. DCPS investigative unit is down to like three people, one supervisor and two investigators, so they just don't physically have the bodies to do investigations. The ones they do tend to focus more on things like companies that mis-advertise their services, and claim that they can do medical procedures like clean wounds or change IVs, when they're really not supposed to do that kind of stuff. They focus more on that than they do on who's working in these places.

And DCP does tend to basically issue relatively small fines when they do find a company has done something wrong. And their argument there is that unlike with nursing homes, where DPH can put a receiver in and can take over a nursing home. DCP can't do that. So if they closed down a home companion agency because somebody was stealing from a client, they would close the whole agency down. All the people who are getting services through that agency are going to be left in the lurch.

WSHU: But do you also say here that the Department of Public Health is saying that they're not prepared to take this on right away.

DA: They also are down a lot of people who've retired. their unit that investigates nursing homes would probably be the unit that would take this over. And I think what the public health commissioner told the committee and I'm sure what she will tell the full legislature is that if you want us to do that, we're going to need a significant increase in funding so that we can hire investigators specifically to deal with this type of agency.

WSHU: I saw something you mentioned in the article, about a billion dollars is needed to spend on regulating this industry in the near future?

DA: Three things going on. Number one, the state is already putting more money into home health care, they have sped up a process that had already started before COVID. And the majority, ultimately, roughly 75% of Medicaid money that the state gets will probably go to home health care rather than nursing homes. The other problem is just like nursing homes and hospitals, home health care agencies are having a difficult time finding employees. It's not a great paying job. It's not easy work. And so that's a big issue. So we'd have more people looking for home health care, less people working in the field. How do you address that? Talking about needing to increase salaries perhaps or come up with better benefits or better pay packages to get people into the field?

WSHU: A lot of personal care aides have joined a union, SEIU 1199. Would that help, the fact that it's been unionized now, would that help in trying to regulate this industry?

DA: One of the problems with the whole agency is it is a very confusing thing to navigate. The PCA’s you're referring to as members of the union, they actually are licensed by the Department of Public Health already, so they can provide a higher level of care than what the home companions can. The home companions are someone who is going to come over, cook your meals, wash your clothes, and do your banking for you. They're not caring for your wounds. So that's a different level, the PCAs that are unionized are paid more than home companion agencies. The problem with the PCA is that there's again, there's not enough of them and the system that the state has set up, it's very hard to find. It's basically a paper booklet that they put out that has names of PCAs and the list is old. The state needs to do a better job of developing online websites. And right now, they don't have that and it's a very difficult field to navigate.

WSHU: Something interesting in your article, a couple of years ago, Senator Saud Anwar tried to put forward legislation that would have required a drug test for home companions, but there was a lot of pushback from the home companion agencies. What was the reason for that?

DA: That was after the South Windsor case where the aide overdosed in the house, there were a couple things that they were proposing there. The one that did get passed was a requirement that a federal background check be done on every employee that an HCA hires, the problem there is that the state still doesn't require the agencies to turn that over to the state. So DCP has no idea who is working at any of these places, and whether they've had a proper background check done.

What you're referring to is after the aid overdosed in the South Windsor case, they wanted to pass legislation to make it a requirement to pass a drug test and get a job. And the pushback on that was the cost of the tests. HCA didn't want to pick up the cost of having to pay for drug testing for everyone that they hired. And ultimately, that did not make it into the bill.

WSHU: So is the state going to be able to grapple with this, as you know, you say here, the projections are that by 2040, there'll be a 30% increase in the number of people who are deciding to age at home, who will need this care. So it's a growing population. It's a growing need. And we seem to be very far behind where we need to be as far as regulating that industry.

DA: I think we're very far behind on regulating it, but also on funding healthcare, in general, but in particular elderly care services. And that's a question the legislature is, I believe, this session for the first time is really wrestling with. I'm curious to see what gets passed this session, what kind of funding comes with some of these bills that are currently being discussed. Because that's ultimately going to say, what happens here.

How much money is the state willing to put into what is going to be a growing problem? The number that you were talking about, the projections are faster than even the state originally projected with this and where this. I think Connecticut is the sixth oldest state in the country right now, and getting older. So this is a problem that's only gonna get worse unless it gets addressed. And I think we'll see how it plays out. But I think this is the first time I do think the legislature sees that this is a major issue going forward, and seems willing to possibly put more money into it.

As WSHU Public Radio’s award-winning senior political reporter, Ebong Udoma draws on his extensive tenure to delve deep into state politics during a major election year.
Molly is a reporter covering Connecticut. She also produces Long Story Short, a podcast exploring public policy issues across Connecticut.