Are We Expecting Too Much From Home Care Workers?

Sherrie CoomerPerhaps out of fear? 

Perhaps as a backlash to the bad press we regularly hear about nursing homes? 

The popularity of home-care continues to expand as many people view such arrangements as a viable alternative to the skilled nursing care provided in nursing homes.  For the the most part, these simply are not.

Unlike nursing homes which are medical facilities--- staffed by medical professionals, most home-based care is provided by staff who may not have the specialized training and credentialing of nursing home staff. 

That's not to say that home-care (and even home-health care) doesn't fill and important role in providing needed assistance to people who are not capable of living independently, but it is important to remember that there are limits to the type of care that these people can provide.

I was remined of the increased reliance that we are consistently putting upon home-care workers and agencies when I read about a home care worker who was caring for a stroke patient who was completely reliant upon the worker for assistance with all daily living activities--- grooming, bathing, administration of medications and transportation to doctors' appointments.

Unfortunately, at some point the home care worker stopped attending to her patients care needs and simply allowed the patient to deteriorate to the point that the patient was allowed to remain confined to a reclining chair.  Over the course of several months, the home care worker allowed the disabled patient to essentially sit in her own feces and urine because she was unable to move the patient without assistance.

Not surprisingly, the inattention to the patient's basic care needs resulted in the development of extensive decubitus ulcers--- and eventual death from a systemic infection known as sepsis.  According to the coroner examining the body, the wounds were so advanced in nature that maggots had infested the wounds.

Now, the home care worker faces involuntary manslaughter charges for her extended inattention to the patient's needs. 

As we await to see how the criminal matter progresses, I immediately began to consider why a single home care worker was allowed to single-handedly care for a patient with such obviously complex medical needs?  Though I know no more about this incident than what has been disclosed in news reports, I would home that authorities would consider investigating to see if she was part of an agency or placed via a service.

Sadly, situations like this can--- and do occur in a variety of different contexts-- nursing home, hospital or assisted living, but I feel as though situations such as this simply set the patient and caregiver up for imminent failure with perhaps a combination of unrealistic patient expectations and a caregiver simply overextending themselves.

Home Care Services

For patients and families considering a home-based care arrangement, it is important for families be realistic about their loved one's personal care and medical needs.  As opposed to assuming that all needs can be achieved, it is crucial to understand that there are limits to the type of care that can be realistically provided.

From a legal perspective, when a home care agency fails to uphold their end of the bargain, a cause of action may be pursued to recover damages related to their negligence or neglect.  In a civil lawsuit against these providers, damages can theoretically be recovered for all of the patients injuries and accompanying medical care.

Related Nursing Homes Abuse Blog entries:

Three Years And $23 Million Later, Jury Finds Home Care Nurse & Agency Responsible For Neglect Of Patient

At Fraud Trial Involving A Home Health Agency, The Real Losers Are The Patients Who Miss Out On Care

Three Years And $23 Million Later, Jury Finds Home Care Nurse & Agency Responsible For Neglect Of Patient

A home care-nurse and health care agency in Pennsylvania were found guilty of providing negligent care to a 55-year-old woman who required medical care for her Crohn's disease.  The medical malpractice lawsuit was premised upon the nurse's failure to report a catheter-related infection to the woman's doctor.  The infection progressed throughout the woman's body to the point that she required extensive hospital care and amputation of both legs.

The record verdict of $23.12 million intended to compensate the patient for past and future medical care, lost earning and and pain and suffering. 

Increased popularity of home health care

Perhaps as backlash against traditional nursing home care, the use of home-care nurses and doctors has become more popular today than ever.  While the option may be desirable for patients who need assistance with particular types of medical care, home-care providers must remember that many of their patients are especially vulnerable and completely reliant upon them for all aspects of their care.

While there may be geographic distance between the patient's home and the medical facility, nurses (and other medical staff) still have a duty both to provide the care as ordered by the individual's physician and to relay the patients condition back to the physician or clinic so that the person's condition can be monitored.

In the case of this recent verdict against this home-care nurse and agency, I am glad to see that the jury recognized that just because the care was provided in a home-based setting doesn't mean that these medical professionals should be held to any different standard than if the care had been provided in a nursing home or hospital setting.  As with other substantial verdicts, we can only hope that this will cause providers to pause and reevaluate the care they provide to their patients.

Related:

Jury awards Lehighton woman $23 million, September 17, 2011 by Riley Yates The Morning Call

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Expanded Home-Based Care for the Impaired Elderly- Solution or Pipe Dream? (.pdf) by BURTON D. DUNLOP, PHD

Never Event #4: Catheter Associated Urinary Tract Infections

At Fraud Trial Involving A Home Health Agency, The Real Losers Are The Patients Who Miss Out On Care

A fraud trial pending in Federal Court in Philadelphia is providing glimpse into the sad world of fraud amongst home health care agencies.  The trial involved four employees of MultiEthnic Behavior Services, Inc., a now defunct home health care agency, who were billing for home nursing services that they never provided.

The fraud was discovered following the death of 14-year-old Danieal Kelly, a girl suffering from cerebral palsy, that MultiEthnic was responsible for caring for.  An investigation into her death revealed that Danieal's case worker-- a MultiEthnic employee-- failed to provide medical care to her that they were charging for. 

According to Cindy Christian, co-director at Children's Hospital in Philadelphia, the home health agencies failure to provide care resulted in medical conditions that contributed to Danieal's death. Shortly before her death, Daniel suffered from extreme malnourishment and advanced bed sores. In describing the bed sores at the fraud trial, Christian described the bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers), 'they were the multiple and severe, the most severe they could be."

Testimony at the fraud trial further revealed that had the home health care workers chosen to visit Daniel's home, they would have been able to smell her bed sores because they wounds were so severe that the smell of rotting flesh was pronounced. 

Sadly, Daniel is probably one of many people who suffered because this home health care agency failed to do their job.  According to her caseworker, he fabricated 60% of his progress reports during his four years with the agency.  Further, he had no experience when he was hired and received no training from agency supervisors.

Read more about this trial involving a home health company here.

Related Nursing Homes abuse Blog Entries:

"Home Care Nursing" Doesn't Mean "No Care Nursing"

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

About Jonathan Rosenfeld

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Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities.   Jonathan has represented...

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