What A Background Check May Not Show About Your CNA

Amanda has had a caregiver for nearly two years. Finding the right person is extremely difficult. First you need to determine whether you are hiring the person directly or using an agency. 

The ideal situation is to hire someone you know or someone who has been referred by a friend or neighbor. It isn't always possible. If you use an agency you will have a stranger in your home. I've been fascinated (appalled?) by the stories some of caregivers provided by agencies have shared with me.

All of the caregivers we've had have passed a mandatory background check so you'd think their pasts and personal lives would be free and clear. Think again.

Laws vary on checking criminal history depending on your state. Some states don't allow questions about arrests or convictions beyond a certain point in the past. Others only allow consideration of criminal history for certain positions.

Most states allow a check for felony convictions in the past three years. A felony is a crime which carries a jail term of more than 12 months. So, a clear background check only confirms that the person hasn't been convicted of something like assault resulting in injury or with a weapon, a theft of over $500, sale of illegal drugs or rape.

Here's the catch.  The words felony and conviction. People can plea bargain a felony charge down to a misdemeanor in exchange for cooperating with the authorities. 

How do I know this? A caregiver told me that she had been to jail for selling drugs and carrying a concealed weapon, but the charges had been reduced because she had provided information about other dealers. 

There is also the issue of associates. One caregiver complained to me about how hard it was for her and her boyfriend to find a place to live. Why? Because he was convicted of statutory rape and had restrictions about living within certain distances of schools, parks, etc.  

Another caregiver told me that she had lost custody of her own children in her divorce because she was living with a convicted sex offender. 

Others told me about minor arrest records for offenses like driving under the influence of alcohol. Traffic violations often show up on a background check as they are public information. The agency knew about these but didn't disclose the information to me. This is critical as aides may need to transport Amanda to doctors and therapist appointments. What if one of them had been driving drunk with Amanda in the car?

In addition to potentially dangerous situations I've had many aides who just have a terrible work ethic. I've had aides show up late,  fall asleep on the couch during the day, bring their kids and their pets -- one even took a shower while she was supposed to be caring for my daughter. I've had aides ask to take home my extra set of dishes, buy them expensive gifts or order takeout food for them. I've had caregivers spend hours on their phones or IPads; others who have refused to do parts of the job like getting Amanda off the bus if it was cold or raining.

Check out these general guidelines from MSN HealthyLiving. 

"Keep in mind that aides are employees; don't try to make them your friends. "People are so happy to have help that they often treat the employee like a friend, and that creates problems down the line," says Dollar. If your employee thinks of herself as your pal, she may be more likely to take liberties... The bottom line: keep it professional."  

A personal assistant or caregiver is a difficult position to fill because it doesn't pay much better than minimum wage jobs. Sadly, these are the working poor.  Many are living hand to mouth. Even though they are working they are often on food stamps and other forms of public assistance. I give them credit for working and trying to support themselves and their families. I often feel very bad for their personal circumstances. 

On the other hand, their poor decision making skills make me uncomfortable having them in my home caring for my disabled child. Amanda can't speak.  If someone steals something, shows up drunk or mistreats her there is no way she can tell me. 

I don't know the secret to finding a good caregiver, but I've certainly had plenty of experience with bad caregivers!

Preparing Your Home for a Home Health Care Provider

Preparing Your Home for a  Home Health Care Provider

When you decide to employ a home health aide there are a number of changes that you need to consider - both in your home and in your lifestyle. What will it be like having another person in your home for hours or even days at a time? If you are a private person it may feel like an invasion. On the other hand, for some folks its welcome companionship - someone they can rely on to visit  daily.

You need to make your home as safe as possible for both your family member and their caregiver. Remove objects that may be easily broken. Prevent tripping by removing small rugs, runners, electrical and phone cords from pathways. Place non-skid adhesive strips to non-carpeted stairs. Make sure that your home is well lit - especially stairs and hallways.

You may need to purchase items that you don't already have. Things you should have include, but aren't limited to:

• smoke detectors
• carbon monoxide detector
• nonslip bath rugs
• nonslip stickers or mat in the bathtub or shower
• grab bars by the toilet and in the shower/tub
• flame resistant potholders
• fire extinguisher

Having help when you have a family member with a disability can be a blessing. Another set of hands to help with care giving and household tasks can seem like a dream come true at first.

However, anyone who has employed a home care worker knows that the honeymoon period wears off.  My initial reaction was to treat the person like a member of the family while they were in our home.  I did this in part because I saw my parents struggle with the aides who cared from my mother.

My parents were very private people. They were brought up in a different era. The combination of these factors meant that they didn't want their live in aide dining with them. There was one fundamental problem with this idea- they only had one table. There was no where to sit and eat in the kitchen. Those poor women had to stand in the kitchen to eat their meals.

My parents wanted their aide to be "on call" but essentially out of sight. That meant that they were relegated to spending large parts of the day in their room or on the back deck, waiting for my parents to page them. Being a home health aide is a difficult, physically demanding job. The pay is poor and there are often no benefits. Adding social isolation must have made the job so much harder.

My mother was a little confused toward the end and some of her aides took advantage of her. While I was visiting one afternoon I saw her "tip" the aide five dollars three times for filing her nails that day. After my mom passed way small pieces of jewelry and other items were missing. I think that if my parents had been even a little more tolerant these small abuses might never have occurred.

On the other hand, I've learned that without some boundaries people may also take advantage of your good-nature. My daughter's aide is generally included in everything we do. She eats with us, hangs out in the living room and watches TV with us, etc .

In the past I've been so casual that people forgot they worked for us. Some have wanted to watch graphic crimes dramas with my daughter in the room. I didn't realize that one woman was using my laptop for online shopping until I went to several websites and the "Your Store" zip was set to her town. We've had aides show up with their children and their dogs.  One showed up before a job interview so she could use our shower!

In addition to making sure your aide knows what you want done, be clear about what NOT to do as well. While I don't want to create a feeling of distrust I do want to maintain a semblance of privacy in my home.  Some of these suggestions may make you feel ridiculous, but consider the alternatives. Be specific about any areas that are for family-only. I would rather hang a sign on my door than find someone up to their elbows in my underwear drawer. Let the person know if they are welcome to watch your TV (and what shows you would prefer they not watch), use your computer, etc. Here are a few tips based on my experience:

• If you don't want your aide to pry into your bedroom, master bathroom or office, you need to clearly post a "PRIVATE" sign on the door.
• Password protect your computers and cell phones. Lock file cabinets. Consider blocking unwanted content on your TV.
• Label dresser drawers, kitchen cabinets, etc. to prevent "I was just looking for..." If everyone knows where to find necessary items there is no reason to look elsewhere. Most people will respect your privacy, but there is always one person that wants to go through your pantry or medicine cabinet.
• If you have cherished heirlooms or valuables, move them out of sight or store them safely somewhere else. A spilled drink can accidentally ruin an antique table that looks "second hand"to an aide.

Be sure to interview any person or agency carefully before you hire them!



For more information on home safety for the elderly or individuals with special needs please go to http://www.ces.ncsu.edu/depts/fcs/pdfs/FCS-461.pdf

How to Write Instructions for your Home Health Aide

Home Health Aide Daily Care Plan & Instructions

When we first had a home health aide for my daughter the job seemed obvious to me. Not so to the various care workers who were assigned to her. Truthfully a home health care aide or companion typically has very little to do. A live-in aide can retire to his/her room and read or watch TV until you need their help. A part-time aide is in an awkward position because there isn't much to fill the time. I don't mind if the aides read, text or use their laptops - provided they meet my daughter's basic needs in a timely manner.

Do your homework when you hire an aide. It turns out that most people will only do exactly what is asked of them - no more, no less. For instance, with an elderly parent if you ask the caregiver to make a pot of coffee it is very possible that they will only make coffee on the day that you make that request. If your parent wants a pot of coffee made every morning with breakfast that needs to be specified. You need to prepare your home when you have someone working in it so they can find the things they need.

Review the instructions on equipment and procedures. Make sure that the aide has the written instructions available for any unique equipment like a lift. WATCH them perform complex tasks at least once to make sure that they are being thorough and safe. Don't trust that "showering" means the same thing to everyone. Some people may spray your family member down quickly, others may sit them in the shower and walk away for 10 minutes. Be specific about your expectations.

Review and provide instructions for all medications that the patient requires. Don't forget non-routine medications. For instance, if the person has an Epi Pen make sure the aide knows where it is and how to use it.

If you expect the person to prepare meals or snacks, make sure that they know where the ingredients are as well as what food preferences or allergies the person may have. When in doubt, provide a printed recipe including the location of all ingredients. Decide if the person will be eating with your family member and provide adequate quantities of food (obviously live-ins expect meals).

While it seemed ridiculous at first, I learned to provide a detailed list of each task that I wanted done every day.  Each task is described including the timing (after school, at dinner),  tools to be used (special cup, broom, etc.)  and the frequency (daily, weekly, etc.). I also include check boxes so the person can keep track of what has been completed each day.

The last section of my daily list includes safety instructions. Make sure that you have your address written down in the event of an emergency. You'd be amazed at how many people simply follow their GPS and have no idea where they are. If you are not going to be there at all times include your contact information on this page as well.

Here is an example of a daily care plan for a 4-hour after school shift for our daughter. Your plan may be more detailed depending on medical needs and the extent of home care tasks you expect.


Daily Home Care Plan for __________________      Date:  _____________

Tasks include, but are not limited to:

Personal Care

         Meet & get her off school bus using wheelchair

         Change clothing if wet or dirty immediately after school

         Toilet or/change Depends every 2 hours   

o   Completed  at     time _____________       time _____________   

o    Check  Depends immediately after school. Change after shower & before bed

o   Thrown wet/dirty Depend in kitchen trash can

         Provide afternoon snack (prepared in frig) Complete at time _____________   

         Assist with ambulation around house (maintain contact guard at all times)

         Assist with TV remote, computer, etc.

         Shower daily    Completed at time _____________   

         Brush hair daily after shower

         Wash hair on Wednesdays   Completed date _____________   

         Assist with feeding during meals & snacks

o   Cut food into bite sized pieces for finger feeding

o   Assist with use of spoon or fork (may need to feed her)

o   Place dirty dishes, cups and utensils in the sink

         Provide companionship & supervision at all times

     Maintain safe environment while parents are away or otherwise occupied.

Home Care

         Make bed daily    Completed at time _____________   

         Fold & put away laundry as needed (2-3 times a week)

         Dust & vacuum bedroom on Mondays (weekly)  Date _____________   

o   Use Swiffer dusters and Shark carpet sweeper

         Clean bathroom on Fridays (weekly)    Date _____________   

o   Use disinfecting wipes to wipe down toilet & bathtub

o   Lift no slip mat and place on shower chair to air dry

Safety    I can be reached at 555-555-1234

Never allow her to walk around the house alone – be with her at all times.

Watch for choking while eating and drinking.

In the event of a clonic/tonic seizure (grand mal):

1.    Ensure her safety - roll her to her side, if possible

2.    Call 911 The address here is 123 Main Street Anywhere,ST

3.    Administer medication per instructions on label (outer pocket of blue backpack)

For insights on the aide's perspective please go to http://newoldage.blogs.nytimes.com/2009/01/21/advice-from-a-home-health-aide/

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.