When Chris Sergio hired someone to take care of his elderly mother on the three days a week his father was undergoing dialysis treatment, he thought he was taking the necessary precautions.
He turned to Old Colony Elder Services, a nonprofit organization that provides elder care services to 23 cities and towns, which gave him a list of three agencies. He chose Home Instead Senior Care of East Bridgewater, a well-established company with a good reputation both locally and nationally, according to Diana L. DiGiorgi, executive director of Old Colony.
Home Instead sent Debra Blair Belcher, a home care aide, to provide non-medical assistance to Sergio’s mother, who suffers from dementia.
Belcher seemed like a perfect fit until Sergio’s parents noticed that their wedding rings and pieces of silverware were missing from their Middleboro home.
“I was furious with her for taking advantage of a person with dementia, and she did it on a weekly basis,” said Sergio, who said thousands of dollars worth of jewelry and flatware was stolen.
Belcher, who was charged under her maiden name Debra Blair, was found guilty of larceny from a person older than 60–years-old in Wareham District Court last year. Later, in Brockton District Court she was convicted of similar charges after other clients in Abington, East Bridgewater and Brockton brought similar complaints. She was to serve one year behind bars and is now out on probation until June 2013.
The Belcher case illustrates the risks the elderly face in an era when an increasingly aging population would rather live at home with an infirmity than move into a nursing home.
Massachusetts is one of a handful of states in the nation that does not license or regulate the burgeoning private-pay home care industry, the New England Center for Investigative Reporting has found. These are agencies that do not work under either a federal or state contract, but provide assistance like companionship, housekeeping and cooking to families that shoulder the costs alone.
When reimbursed by Medicare and Medicaid, home health agencies fall under federal regulation and state oversight. But these account for only a third of the estimated 400 home care agencies doing business in Massachusetts.
Although reports about elder abuse and theft are lodged with both the Department of Public Health and the Executive Office of Elder Affairs, no single agency in state government is tracking either the total number of complaints involving private-pay home care workers or the type of complaints, the NECIR investigation also found.
“In a state that licenses hairdressers, you would think that they would want more oversight of the people who take care of the elderly in their homes,” said Timothy Burgers, associate director for the Home Care Alliance, a statewide home care trade association that is drafting a bill for the 2013 legislative session.
The Home Care Alliance, which represents both Medicare-certified home health care and unregulated direct pay agencies, would like to see one state agency dedicated to the oversight of the industry. It also wants the state to set minimum standards for employee qualifications, training and supervision. A similar bill that the Alliance supported in 2007 died in committee.
The state currently treats private-pay agencies in Massachusetts as businesses akin to employment agencies and requires them to do a criminal background check on each person they hire. But that inquiry is limited to Massachusetts’ records. Unlike other states, Massachusetts does not require a check of federal criminal records or of records in states where the employee may have previously lived.
How much of a problem this unregulated industry poses is difficult to quantify.
Barnstable County Assistant District Attorney Sharon Thibeault, who is in charge of the elderly abuse unit, says the crime is growing along with the aging population.
“It’s not an epidemic, but this is a crime we definitely see. We usually have at least one crime pending,” Thibeault said.
In Chicopee, where police arrested home health aide Rose Sorrell last February and charged her with stealing $90,000 from a 93-year old client, Chicopee Police Capt. Thomas Charette says he sees a growing problem.
“When I was working patrol, we booked an awful lot of people who worked for one of these agencies. I can think of 10 cases off the top of my head where a health care worker ripped off either medication or a credit card,” Charette said.
Sorrell was indicted in Hampden County Superior Court and is awaiting trial.
Both Charette and Thibeault say the crimes committed by home-care workers are “under-reported,” in part because elderly victims are embarrassed to admit they were abused.
Thibeault says she has seen a slightly higher rate of abuse, neglect or theft among private-pay caregivers than those from regulated home health agencies, but she adds that often the abuser is the elder victim’s own family member.
This observation is borne out by national statistics. MetLife Insurance, in partnership with researchers at the Virginia Polytechnic Institute and the University of Kentucky, monitored the National Center on Elder Abuse’s newsfeed for three months period in 2010.
During that period, family, friends, neighbors and caregivers committed 34 percent of reported financial crimes against the elderly. Slightly more than 20 percent of them were paid caregivers, according to detailed statistics provided by Shalana N. Morris, MetLife spokeswoman.
James Fuccione, director of legislative and public affairs for the Home Care Alliance, said cases involving thieves like Blair may grab headlines but are still rare.
He said it is the “changing landscape,” of home health care, which includes huge growth in the aging population and a greater demand from people who want to stay at home, that requires his organization to be proactive.
Lisa Gurgone, executive director of the Massachusetts Council of Home Care Aides, another industry trade association, said most agency caregivers are hardworking, dedicated and underpaid and that many live near the poverty line. She says the bigger problem facing home care in the state is a growing underground of “mom and pop” operations that spring up overnight and pay their help under the table as well as the many individuals who advertise their services on Craig’s List.
Gurgone said these small operators and independents may not be bonded or insured, allowing them to charge less, but leaving an unhappy consumer without protection. Gurgone added that those firms also put downward pressure on wages for the entire industry.
As for the Sergio case, the national Home Instead parent company terminated its agreement with its East Bridgewater franchise, which is now closed, due to “multiple lapses in judgment,” said Dan Wieberg, company spokesman. Those lapses included sending Debra Blair Belcher to the Sergio family after having received complaints from a Brockton family that she was stealing. Wieberg said that the agency was bonded and that all victims were compensated for their losses.
But Chris Sergio still feels that his family was violated.
“My mother will ask where something is and we have to tell her again it was stolen. She has to relive it again and again,” he said.
Sergio believes it’s time for the Legislature to regulate the private-pay home care industry to give families greater peace of mind.
The elderly “are people who can easily be taken advantage of,” he said. “You shouldn’t have to deal with this in your golden years.”
The New England Center for Investigative Reporting is a nonprofit investigative reporting newsroom based at Boston University and supported in part by media outlets that include The Eagle-Tribune.