Criminal Checks of Home Health Aides Planned

The Clinton administration proposed Wednesday that private agencies receiving Medicare funds be required to conduct criminal background checks before hiring home care workers.

Some scandals involving physical abuse and thefts committed by health aides who care for house-bound elderly and disabled persons led to the proposal.

“Home health care aides care for our most fragile and vulnerable citizens,” said Health and Human Services Secretary Donna Shalala as she announced the push for the first major change in home health care rules since the program began in 1973.

She added: “We must make sure that those whom we trust to care for our senior and disabled citizens are beyond reproach.”

Home health care is the fastest-growing portion of the Medicare program, accounting for $18 billion of total Medicare outlays of roughly $200 billion last year.

Home care is available to any Medicare beneficiary who has a medical condition needing skilled nursing care on an intermittent basis, or physical therapy, speech therapy or occupational therapy. Examples could include someone with a catheter, a person recovering from a broken arm or leg, or a recovering stroke victim needing speech therapy and physical therapy.

Those who qualify for these skilled services provided by a nurse or physical therapist also become eligible for care by home health aides. These are personnel who provide help with the basic activities of daily living: getting in and out of bed, using the toilet, bathing, dressing and eating.

Currently, nursing homes that receive federal funds are required to check state registries to see if workers have criminal records or have been fired for misconduct. The proposed rule would require similar investigations for employees of the 9,000 agencies certified to supply home health aides under the Medicare program.

Advocates for the elderly were enthusiastic about the proposal.

“We feel this kind of thing is long overdue,” said Mary Ellen Bliss, a member of the federal affairs health group at the American Assn. of Retired Persons.

The industry’s major trade group said the proposed rule is acceptable.

“We think it’s a good thing,” said a spokeswoman for the National Assn. for Home Care. “A lot of agencies already do this,” she said. “Our first concern is the patient and the quality of care.”

In addition to the background checks for criminal records, the administration also is proposing a new record-keeping system to “monitor patients’ conditions and satisfaction,” HHS announced.

A home health agency would be required to prepare a plan of care and an evaluation of a patient’s needs within 48 hours of getting a patient referral. And reports of patient and family satisfaction levels with the care would be issued periodically.

“In the near future, we want to compare treatment outcomes and patient satisfaction at individual agencies to national data,” said Bruce Vladeck of the Health Care Financing Administration, which runs Medicare.

The agency will take public comments on the proposed rules for 90 days before issuing a final version.