Disabled, elderly or blind recipients of help may be at risk of fraud or abuse, report says
Home care providers who care for clients to whom they are not related should be fingerprinted, the county civil grand jury advises.
Jurors said funding problems have placed some recipients of in-home care at risk by limiting oversight.
“Once a client is on the program, oversight of caregivers is limited,” grand jurors wrote in a report released two weeks ago. “The risks of fraud or abuse ... are real.”
The investigative report is advisory only. In it, jurors spent most of their time praising the program for bringing much-needed and effective help to 1,778 disabled, elderly, blind and otherwise vulnerable county residents.
Under In-Home Supportive Services, eligible people hire caregivers to help with cooking, cleaning, working through the medical bureaucracy to make appointments, and doing other chores they are unable to handle on their own. In this county, 60 percent of those being served are disabled children or adults younger than 65.
Slightly fewer than half of those hired are relatives or friends.
Caregivers spend an average of 94 hours a month providing care, for $10 an hour. The federal government pays half the cost, the state one-third and the county 17 percent.
With in-home services, the elderly and others are able to remain in their homes, which helps them physically and psychologically, and saves taxpayers money, the grand jury wrote.
Without In-Home Supportive Services, “many, if not most ... would be in nursing homes or similar institutional facilities at public expense,” the grand jury wrote.
While the program is well-run, and relatives and friends provide much of the care, financial cutbacks, including state cuts in February, have shrunk the oversight of caregivers traditionally provided by social workers.
“County oversight is minimal,” grand jurors wrote.
“Is the caregiver coming to work late, or leaving work early? Is he or she performing or being paid for tasks not performed? Suppose the caregiver is a substance-abusing adult child living with an elderly parent-client, how would the county ever find out care was unsatisfactory?” the report asks.
That situation is only going to get worse, according to Lee Collins, director of the county Department of Human Services.
“Imagine Lucy Ricardo on the assembly line, and you’ll have a good idea of where we’re headed,” Collins wrote in an e-mail to The Tribune.
“The governor has targeted IHSS for additional cuts as part of his slash and burn on the budget,” Collins wrote.
“His proposal would reduce caregivers to minimum wage, and would eliminate services to all but the most severely impaired,” Collins wrote.
The county and the caregivers’ union, the United Domestic Workers of America, are still negotiating a new contract. Both sides “acknowledge that the parameters within which we can negotiate are largely dependent upon state action,” Collins wrote.
“It’s a great program, and we appreciate that the grand jury saw that,” Collins added.
The grand jury also alluded to caregivers who have been fired for stealing medicine and taking loans from clients, as well as to some clients who have cheated the system by faking disabilities. Those cases were rare, grand jurors said.
Nonetheless, to improve oversight, grand jurors recommended that caregivers who are not relatives be fingerprinted.
Grand jurors indicated they would like to see all caregivers fingerprinted, but noted that neither the state nor county government would pay for that.
Under the law, the Board of Supervisors and Department of Social Services must file a reply to the grand jury report in Superior Court by Aug. 18.
http://www.sanluisobispo.com/news/local/story/732679.html
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