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Who is minding the people who are minding our elders?

An absence of data on non-medical home-care providers means there’s almost no way to measure quality of care

September 05, 2013

  • UCLA Center for Health Policy Research

    ​Almost no data exists to measure the quality of care provided by the rapidly growing industry of private home care providers serving an expanding population of the elderly and disabled, according to a new policy brief and related report by the UCLA Center for Health Policy Research.

    In addition to the state's In-Home Supportive Services (IHSS) program, there are currently three types of providers of support services to the elderly and disabled in California. Home Health Agencies can provide medical services in addition to giving other types of support while the other two – Home Care Agencies and individual caregivers – provide housekeeping and other non-medical support.

    Yet unlike Home Health Agencies and IHSS providers, providers in the other two groups are not subject to regulations such as licensing, certification or background checks.

    “We have little to no information on the quality of care provided by many people who are taking care of some of the most vulnerable members of our society,” said Nadereh Pourat, the UCLA center’s director of research and author of the study. “Regulations within the private home care industry might help establish standards for caregiving that can ensure patient safety and quality of care.”

    Growing demand, growing industry
    The number of people in California who are at least 85 years old is expected to triple by 2050, to nearly 2.4 million residents. Many will have disabilities and require personal care services, causing one group of providers – home health aides and private aides – to become the second- and sixth-fastest growing occupations in the state between 2010 and 2050, growing by 52.4 percent and 42.6 percent, respectively.

    Since 1998, there has been a 94 percent growth in the number of providers of services for the elderly and persons with disabilities, a caregiving group that includes Home Care Agencies (HCAs) as well as senior centers and adult day health care centers.

    In addition, there has been a related growth in the number of employees who provide non-medical support to the elderly and disabled. Since 1998 the number of employees of Home Care Agencies as well as senior centers and adult day health care centers grew by 160 percent. The number of individual providers of non-medical services for the elderly and persons with disabilities grew by 199 percent over the same period. 

    An examination of income and insurance coverage of those with disabilities indicates that many Californians are likely to turn to these private caregivers, who can get the job simply by answering an ad.

    “Your grandmother might hire someone through an ad without any idea about their possible criminal background,” Pourat said. “Safeguards such as background checks could help prevent that.”

    Little to no regulation
    In California, overall regulation of home care providers is inconsistent. Home Health Agencies, which provide health services in addition to personal care, must be licensed and undergo certification and IHSS providers must also undergo background checks. Meanwhile, home care agencies that offer only personal care are required to only have a business license. Most private caregivers receive no oversight.
    Establishing licensure and basic safety standards for all home care providers would help standardize care across the state, the report concluded.  Regulation could also result in another important benefit – public data that could be studied to better understand the quality of care provided by home care agencies.
    The policy brief was funded by the Service Employee International Union, Union of Long Term Care Workers.

    The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.
    SEIU, United Long Term Care Workers (ULTCW): California’s leading long term care organization dedicated to providing and protecting quality care for some of our most vulnerable residents.