Finding a Care-Giver Can Be Risky Business for Elderly : Aging: Cost of in-home help often is a hurdle. Experts say lack of state regulations opens door to crime, abuse.

When 86-year-old Eleanor Siegman’s health began to fail and she needed personal care at home to stay out of a nursing facility, her daughter thought she had found the perfect person for the job.

The live-in care-giver she chose was a certified nursing assistant who seemed trustworthy and compassionate and was recommended by her mother’s rabbi.

“I don’t think you want a better recommendation than that,” said Siegman’s daughter, a mental health professional who asked not to be identified.

But within a year, the care-giver and an accomplice had taken Siegman--a widow who lives on the Westside--for $500,000 in cash, jewelry and clothing, according to the district attorney’s office. In addition, the nursing assistant, who has been charged with grand theft, was receiving $1,250 a week for her services.

What happened to Siegman is a graphic example of the sometimes tragic quandary facing California’s ever-increasing elderly population: How to obtain safe and adequate assistance in their own homes as they become unable to care for themselves.

The long-term help they need with everyday tasks such as housework, cooking, bathing and shopping can be the difference between remaining at home or being forced into a nursing facility.

The necessity for such help often develops quickly and few know where to turn. While many look to their own families, others must hire strangers.

Largely unregulated by government agencies, in-home care can be crushingly expensive or even dangerous for the elderly, who sometimes are abused, neglected or financially exploited.

Ardith V. Javan, prosecutor in charge of the district attorney’s elder abuse section, says that three-quarters of the cases handled by her office involve care-givers, including professional aides, relatives and friends. An increasing number of the crimes, which range from overcharges for services to theft of homes and gross neglect, are being reported each year, Javan said.

“It’s widespread--we can’t take every case,” Javan said of her two-prosecutor section. “But at least in Los Angeles County it’s recognized as an important assignment.”

Javan and her partner, Deputy Dist. Atty. Cynthia Zuzga, work on 40 cases at a time and report a 92% success rate of those they prosecute.

Those familiar with in-home care stress that most people who do such work are generally honest and diligent and often go beyond the call of duty in performing difficult, sometimes thankless tasks. The emotional and physical toll is often high, especially for relatives.

While some care-givers move in, most only work several hours a day. Either way, the results can sometimes be tragic, especially if the client has money.

“Temptation is a terrible illness,” said Jon Jeffries, a referral officer with the Los Angeles Department of Aging. “And if somebody sees money, sometimes the whole complexion of values change.”

Arcadia police, for example, are investigating a case in which the nephew-by-marriage of an elderly widow moved into her home on the pretense of helping her with her affairs. He coerced the 84-year-old woman into giving him control over her bank accounts and took more than $100,000, authorities claim.

Police became involved after the woman was taken to a hospital, where doctors discovered severe bruises and bedsores. Police believe the woman was beaten by a hired caretaker, who was brought into the home to give additional help.

Obtaining help from a friend can also be dangerous.

Jewel Hayes slowly won the friendship of a lonely 80-year-old Hollywood woman. Hayes began visiting the woman, taking her fruit and finally moved in as her care-giver, he later admitted in a statement to police.

“I soon realized I met Jesus,” he told police. “She could give you everything but eternal life. She has all that money.”

When Hayes was arrested in 1991, he had pillaged the woman’s bank accounts of nearly $20,000 and was trying to cash checks worth $80,000 to clean out her funds, according to police.

Hayes--who had been in and out of prison for burglary, receiving stolen property and vehicle theft--thought the law couldn’t touch him because the woman had signed the checks. But he eventually pleaded guilty to grand theft.

Anyone, even an ex-convict, can legally work as a care-giver. Because background checks aren’t required for care-givers, the elderly have no way of knowing when they hire those with prison records.

“Getting home care is a very risky business,” warned Jeffries of the Los Angeles Department of Aging. ‘You just don’t know what you’re going to end up with and it’s pretty chancy.”

Such help can be obtained from agencies, lists provided by social workers, newspaper ads, bulletin boards at senior centers or word of mouth. Workers are generally low paid--making $4.25 to $9 an hour--which often leads to rapid turnover.

State law requires no licenses, certification or training for care-givers or the agencies that provide them.

Badly needed regulations would help protect the elderly from exploitation and abuse, experts say. State investigators, agency operators and trade associations are seeking reforms.

“You don’t need anything to start arranging home care for people except a phone and some names, and that’s scary,” said Joan Baier Garland, administrator of the BWA Home Health Agency in Culver City.

Garland is a board member of the California Assn. for Health Services at Home, which is pushing for state-funded criminal background checks on all in-home care-givers. Garland’s organization also wants to establish a low-cost voluntary process to set accreditation standards for agencies, some of which already have established regulations of their own.

Calls for reform have also come from the state Little Hoover Commission, which has investigated long-term care for the elderly.

Because of the lack of screening, criminals are sometimes paid with public funds as care-givers, the commission found in a 1991 study entitled “Unsafe in Their Own Homes.”

“Frail elderly people . . . may be preyed upon by criminals in their own homes and subject to abuse, neglect and indignity,” the commission found.

As an example, the study cited an Inyo County case involving a publicly paid in-home aide who had a history of assault and mental problems. The woman was ultimately sentenced to prison for attempting to murder the elderly man she was caring for.

The commission has no statewide figures on aides who have criminal pasts, but its report cited a study by Santa Clara County officials in 1988-89 that found 11% of potential care-givers in a pilot project there had police records.

Even relatives who provide care should be required to meet state-set standards if they are paid by public funds, as many are, said Jeannine L. English, executive director of the commission.

Public funds--from federal, state and local sources--provide nearly $1 billion a year for in-home care of the poor in California through the In-Home Supportive Services program. While 186,000 mostly elderly people are served, critics say the program is seriously flawed.

Round-the-clock care, for instance, is not provided no matter how poor the health of a client might be. The program provides a maximum of 283 hours of care per month, which sometimes forces the very frail into nursing facilities.

Most recipients must find their own aides with minimal assistance from county social service workers. If requested, Los Angeles County officials will supply recipients with names of interested people, who only have to show their drivers’ licenses as identification to get on a list.

There is no pre-employment screening, reference check, criminal background check or even testing for contagious diseases such as tuberculosis and hepatitis for care-givers paid through this program.

County social workers are required to make home calls on recipients only once a year. What they find can be frightening.

During an annual check last June, one Los Angeles County social worker discovered that a mentally impaired recipient in her 60s was being held a virtual prisoner in squalid conditions by her publicly paid care-giver. The man used a power of attorney to sell the woman’s childhood home without her knowledge, according to county records.

Asked to investigate, Glenda Stovall, a social worker with the county Adult Protective Services, found that the woman was so weak and her fingernails so long that she could not open the door to the small rented room in which she was kept.

Stovall’s report gives a stark snapshot of what she found: “No clothing, no hygiene supplies, scant food, helpless, hopeless. Blouse unbuttoned with breasts exposed, hair uncombed and unwashed, finger and toe nails grossly long and dirty. Sitting posture was one of resignation and despair, as was attitude.”

The woman’s home had been sold by the care-giver for $90,000, although she had received none of the money, Stovall discovered.

The woman now lives in a board and care facility at public expense. But she still dreams of going home. “I would just be happier being at home with my old neighbors and a puppy dog,” she said.

Police are investigating, but the care-giver, about whom little is known, has reportedly left the country.

County officials who administer the program for the poor insist that such cases are not common.

“I think you’re hearing about the exception,” said Kitty Cooper, county program manager for In-Home Supportive Services. “Remember, we are serving 73,000 recipients in L.A. County--and successfully.”

Under state regulations, Cooper said, the recipient--not the county--is the actual employer of the care-giver and is responsible for such precautions as reference checks and disease screening.

As for the lack of 24-hour care, Cooper said family members should pitch in because public funds are stretched too thin. “The heart and soul of it is that we do care very much for our clients and do what we can within the parameters of the program to meet their needs,” she said.

Still, changes are being considered.

The state Department of Social Services was required by recent legislation to develop a plan by next January for doing criminal background checks on care-givers paid with public funds.

The Los Angeles County Board of Supervisors voted last week to hire a consultant to study the program and make recommendations on how to improve it.

Most of the state’s elderly do not qualify for such help because they are not poor enough for public aid and not affluent enough to hire professional care-givers.

Sybil Peterson, a 92-year-old widow, is legally blind and her pension is so small that she qualifies for a low-income apartment in Santa Monica. Even so, she is considered too well-off to receive a publicly paid care-giver.

Peterson is able to stay out of a nursing home only because of a part-time housekeeper paid by WISE Senior Services, a nonprofit organization in Santa Monica.

“It would take me two days to do what she does in two hours,” said the slender, soft-spoken woman who can see only vague images. “I’d want to die before I went into a nursing home.”

WISE, which pays aides about $8 an hour, asks recipients to contribute what they can to the salaries. The organization is one of several in the county that provide such part-time help, but the need far outstrips the grant money available.

Many elderly Californians who do not qualify for public assistance turn to private for-profit agencies. But this can be extremely expensive. Rates in the Los Angeles area range from $9 to $18 per hour and $70 to $160 a day.

Paying the tab for such care is a major problem for many, even though they have worked hard all their lives and set aside some savings.

James Lechlitner, for instance, is walking a tightrope. The 92-year-old widower can afford several hours of aid a week. If he eventually needs more, he’ll have to move to a residential care facility.

Lechlitner, who can only barely hear, has lived in his Van Nuys home since he and his wife bought it new in 1953--and that’s where he wants to stay. He has a modest balance in his bank account and lives on pensions from the Southern Pacific Gas Co., where he worked as an engineer’s assistant, and Social Security.

Since he has no children, a niece arranged for his in-home care. Kathy Parks chose the CliniShare agency in Chatsworth because the company says it emphasizes careful screening and supervision of its employees and insures them against theft and other misconduct.

An aide, who is certified in home health and as a nursing assistant, visits Lechlitner for four hours twice a week. She checks his vital signs, cooks meals that he can warm up later and takes him shopping. The cost is $120 per week, an amount Lechlitner can pay because he has few other expenses.

“If he keeps on with two days a week, he can stay, but if he needs any more care, it would be too costly,” said his niece.

Even the relatively affluent can be reduced to poverty when they face paying for in-home care.

Diane Robinson’s aunt was left financially comfortable when her husband died a couple of years ago. But the 85-year-old woman developed Alzheimer’s disease and requires round-the-clock aid in her home.

Robinson, a police officer in Inglewood, says her aunt receives good care through a private agency, but the cost is $52,000 per year. Her aunt’s funds, she says, will be used up in about two more years.

And then?

“She doesn’t want to go to a nursing home--she says she’ll die first,” said Robinson.

“They worked hard all their lives,” she said of her aunt’s generation, “and this is where their money goes.”

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Getting Good Help

There is no sure-fire way to obtain high-quality, in-home aid, but senior citizens can take steps to protect themselves and improve their chances of getting good help, say experts in gerontology, social work and law enforcement. Here are some of their suggestions:

* PLAN AHEAD: Locate a trusted relative or friend--preferably more than one so there are checks and balances--to handle your affairs if you become mentally impaired.

* SEEK HELP: Talk to someone you trust in selecting a care-giver.

* REFERRALS: If you go to a referral agency, ask how long it has been in business and insist on references from other clients or senior citizen organizations. Ask how the agency screens employees and monitors workers and whether it provides substitute aides when necessary. Ask about the qualifications and training of workers. Ask whether the agency insures aides against accidents or misconduct. Find out exactly how much you will be charged and how much the worker will be paid.

* ADVERTISEMENTS: Be careful when seeking help through a newspaper want ad; exploiters look for such ads. Don’t list your phone number or address in an ad; have applicants send resumes, including references and experience, to a post office box.

* INTERVIEWS: Conduct in-depth interviews with prospective care-givers. Insist on references and don’t be afraid to ask detailed or personal questions. Have a person you trust sit in. Check references carefully. Get the phone number, address, driver’s license and Social Security numbers of the prospective aide. Discuss details of salary.

* WAGES: Don’t pay wages in advance and don’t lend money to or borrow it from the care-giver.

* DUTIES: Be sure the prospective care-giver understands exactly what tasks are to be performed. Managers at senior citizen centers or home-care agencies can help determine your needs.

* CHECKING: Have a trusted friend or relative make frequent, unscheduled visits to check on your care.

* DEPENDENCE: Beware of becoming overly dependent on the care-giver and don’t be afraid to fire an aide who is not doing a satisfactory job.

* PLAN: Have a backup plan to cover emergencies, days the aide is off and holidays.

* CAUTIONS: Beware of prospective aides who ask questions about your finances. Also, get to know personnel at your bank so they will be able to spot a stranger handling your finances and will be more likely to notice unusual activity in connection with your account. Check out money management programs at your local senior center.

* HELP: If you are victimized, call the Elder Abuse Hotline: (800) 992-1660.