Questions to Consider Asking a Home Health Care Agency

Questions to Ask a Home Health Care Agency

DISCLAIMER: I am NOT a lawyer or insurance professional. Please check the local laws and regulations in your state.

We've had a home health care aide for my child with special needs for roughly 10 months. We located an agency through a list of state -approved providers. However, some of the caregivers they sent were completely unsatisfactory. For instance, one casually mentioned during a family dinner that her own family had called child protective services on her several times.

Another time an frail woman who appeared to be about 70 showed up. I was afraid she'd fall and break a hip! I ended up making her tea and letting her watch TV until the end of her shift. In my opinion, she couldn't handle the physical challenge of working with a 125 pound, autistic and mobility impaired person.

I finally discovered that the agency (which was approved by my state Medicaid) hired through Craigslist. Applicants were required to pay for their own background checks, but were allowed to start assignments before providing the agency with the results.

The agency was hiring them as independent contractors. These individuals had no worker's compensation insurance. Several told me that they had no personal health insurance. What would have happened if they were hurt on the job in my house? Most likely we would have been sued.

When I contacted the home health care agency I asked about these issues (none of which they refuted.) I also asked if they had any general liability insurance in case my child was injured by one of the people they sent to our home. The answer was that the business was insured, but the coverage only extended to their physical place of business (the office.) If my child was hurt or abused by someone they sent over I would be free to sue the individual involved!

These practices put both my family and the caregiver at risk. I had to ask the state to help me locate a more suitable agency. Rest assured that I asked A LOT of questions before I agreed to a new agency!

So, as a precaution to others I've compiled the following list of questions.

If you have a home health care or home care worker in your home, consider asking the agency* the following questions:

Are the workers you send to my home employees or independent contractors? This is important because the agency isn’t paying payroll taxes on independent contractors – including worker’s compensation insurance.

If an independent contractor is hurt on the job in your home or driving on your business you can be sued for medical costs and lost wages. Do not rely on Homeowners Insurance coverage to protect you, unless the insurance carrier has confirmed coverage for this risk. Many insurance companies have specific riders that can be added – at a cost- to cover in-home caregivers

Does the agency have general liability insurance?
In the event that your child or family member is injured while being cared for by an employee of the agency does the agency have coverage to pay for related medical expenses? Ask to see the documentation.

Does the agency have theft insurance?
Have employees been bonded? In the unfortunate case of theft by a caregiver is there insurance coverage to help you recover financially?  Ask to see the documentation.

Has the applicant had a criminal background check, drug screen and employment (not personal) references contacted?
Just because caregiver is provided by an agency or registry doesn’t mean that adequate screening has occurred. A number of smaller agencies recruit though Craigslist. Applicants may or not have been interviewed in person. 

Is the worker First Aid/CPR certified?
Tell the agency what your specific needs are. Don't assume that the worker will know how to operate your equipment, assist with transfers, etc.

Ask things such as: Has the caregiver had any specialized training (familiarity with equipment/supplies, received training in a specific illness, etc.)?  Are they capable of meeting any lifting requirements?

Does the caregiver have adequate auto insurance coverage?
If not, and the caregiver gets in a car accident in the course of running errands on your behalf, then you may be held liable for the damages caused by the caregiver.

 *If you hire an in-home caregiver yourself ensure that you have similar coverage!

If you hire a home care worker privately, you are not required to provide workers compensation (unless they are being paid through a funded program such as CCSP/PSS in Georgia.)

Like any employer, you must abide by the applicable disclosure and authorization provisions if you elect to perform a background check. You should only have a background check conducted by a professional third party. Do not attempt to do it yourself. If you elect to have a background check done be sure to adhere to all legal requirements regarding privacy and disclosure.

If you are hiring the worker privately be sure to have clear job guidelines including specific lifting requirements and safety precautions.

If the worker is injured lifting your family member, slips in a wet bathroom, etc. are you prepared for the financial costs of covering their lost wages and medical costs? What if they sue you – do you have an umbrella policy on your homeowners insurance that will protect you?

What if you are robbed by them? Will your insurance cover the damages?

If they injure your family member are you equipped to handle the related medical costs?

Be sure the worker knows what is expected of them while on the job in your home and that you have made your home safe for both the caregiver and your family member.

DISCLAIMER: I am NOT a lawyer or insurance professional. Please check the local laws and regulations in your state.

Broken Hip, Broken Heart – A Cautionary Tale

This is a sad story, not the kind I like to write.

Recently, Amanda fell and broke her hip at school. Here’s the heart breaking part of the story from a mother’s perspective. This is the second time that Amanda has taken a serious fall at school that has ended in surgery. This second fall was both foreseeable and preventable had the Fulton County School System acquiesced to our request for dedicated paraprofessional to oversee Amanda’s safety four years ago. 

Amanda - bowling before the fall

Even more agonizing to me than the injury has been the Fulton County School System’s complete lack of regard for my child’s safety or concern for her recovery. The Fulton County Georgia Risk Manager was slow to return our calls, didn't provide us with contact information that we asked for and essentially ignored our repeated requests for information and reasonable accommodation following the accident. His stand was quite simply “you can’t sue the County.” Tragically, that’s true. It’s called sovereign immunity. Generally speaking it is the doctrine that the State cannot commit a legal wrong and is immune from civil suit. It’s a vestige of the old English law “you cannot sue the King.”

Doesn’t the State have any obligation to protect the health and welfare of the children attending public school? Most people assume that it does, however, that is not the case. Had the same event happened at a private school, negligence and liability would be fairly easy to prove. However, because Amanda attends public school it is irrelevant whether or not the school, County or State was negligent. You, the taxpayer and parent, have no right to pursue legal action against a State entity. In most states a parent would be able to sue the State’s insurer. However, Georgia is self-insured, meaning that there is no separate entity to assume liability and cover resulting damages.

Amanda following surgery June 2011

We all have certain expectations when we send our children to school, whether they are typical children or have special needs. Most of these expectations would seem reasonable to the common man. Is it unreasonable to expect that when you put your child on the school bus he or she will be taken to the school you were told they would be attending? Is it unreasonable to expect the school to call or otherwise notify a parent if the child is delivered to the wrong school? Is it further unreasonable to expect incidents such as a slip and fall to be promptly recorded and the parents notified in a timely manner?

If these expectations are all reasonable doesn’t it follow that it is reasonable for the School System to assume liability for the accident?

In this situation, the school’s actions both before and after the incident can certainly be called into question under the “reasonable person” concept of law. Here is what happened:

On June 7, 2011 somehow Amanda ended up at Centennial High School in Roswell, GA instead of Alpharetta Elementary School. We had been told that she would be continuing at Alpharetta Elementary for Extended School Year (ESY). She had her backpack with her, on the outside was a photo ID of our family with our names and contact information. No one called to let us know that she had been transported to the wrong school.

Apparently one teacher recognized her and they called Alpharetta Elementary School. Between the two schools it was decided to leave her at the high school for the remainder of the day. Neither school called us.

Sometime around 9:00 that morning Amanda fell. There was no visible bruising so the school continued to force her to walk, despite her complaints. Amanda is non-verbal so her complaints typically consist of grunts, moans and howls. She doesn’t cry.

Finally five hours later, the decision was made to call the Special Needs Nurse.  The nurse called me from her cell phone on her way to the high school. It was then that I learned where Amanda had been all day. I could immediately tell from her description of Amanda’s behavior that it was a serious injury. I called my husband, Kevin, and sent him directly to pick her up (of course, he too, wondered why she wasn’t at the elementary school.)

When Kevin got to the high school, there was no written accident report available, but the teachers described the incident to him. He took Amanda to her primary care physician where they x-rayed her right leg. While Kevin was waiting for the x-rays to be read the ESY coordinator from the Elementary School called me at home and said, laughing, “Do you know that Amanda’s been at the high school all day?’ “Yes, I do now, and I think she has a broken leg’” I shot back. The poor woman hadn’t been informed of the accident either.

Upon x-ray it was determined that Amanda had a femoral neck (hip) fracture. Kevin drove Amanda to the children’s hospital in downtown Atlanta and she was admitted for emergency surgery, roughly 11 hours after the fall.

The fracture was misaligned and required two surgical screws to hold it in place. During her recovery Amanda struggled to breath. Three days later it was discovered that the lower section of her right lung had collapsed, possibly due to the surgery, possibly due to her fall. She remained on oxygen for a week following the surgery. Due to the severity of the break she came home with a “No Weight Bearing” restriction. That meant no standing for transfers in and out of bed, a chair or her wheelchair.

More than two weeks after the accident we finally received a written accident report from the school. Right now her prognosis is good.  There is a possibility that due to the delay in reporting and treating the injury critical blood flow may have been interrupted to the bone. Osteonecrosis (bone death) occurs when part of the bone does not get blood and dies. It occurs in a small percentage of fractures of the neck of femur, because the blood supply is interrupted. If this sets in, Amanda may require a hip replacement. Naturally we don’t expect this to happen.

But, then again, we didn’t expect Amanda to have a second serious fall at school. The first fall occurred in May, 2007 during a “water day”. Her teacher called to tell me that Amanda had fallen and "fussed a little"; not to be surprised that there was a small bruise above her lip. She didn’t give me any other information about the accident - where it happened or how. When Amanda got home I noticed that she had broken a front tooth below the bruise. I immediately took her to the dentist and had it repaired.

Within days it became apparent that something had also happened to Amanda's back. The previous year Amanda had “growing rods” surgery to correct severe scoliosis. The plan was to lengthen the rods incrementally over the period of several years in order to avoid a complete spinal fusion. We were careful to put in her return to school documentation that a fall could result in a very serious injury to her.

Broken rod May 2007

We took her to her orthopedic surgeon who determined that the top of Amanda's right rod had completely dislodged from the bone. This required major surgery - a full spinal fusion years ahead of schedule. To the best of our knowledge the teacher didn’t call the nurse or file a report even though she knew Amanda had the potential for serious complications if she fell. We asked for, but never received, an accident report.

We wrote a letter to the school, explaining the circumstances of the accident and subsequent surgery. At the time we requested that Amanda be assigned a dedicated paraprofessional to ensure her safety. Our request was ignored. Had it been granted Amanda most likely would not have experienced this second fall and resulting complications.

Right now we are spinning our wheels – quite literally as Amanda is now in a wheelchair. We are concerned about how we can protect Amanda going forward when we are working with a nonresponsive school system.

I ask you, what would a reasonable person do in these circumstances?