Abuses by home caregivers revealed in a new state report — including a woman left dying on a toilet and improper care that resulted in an amputated foot — are prodding lawmakers to seek more oversight of the industry.
Legislation filed this week would require agencies providing nursing, physical therapy and basic caregiving in patients’ homes to be licensed by the state.
Colorado is one of just five states that do not license home health care providers, and the state health department says the inability to set minimum standards of care and perform inspections is resulting in increasing instances of deficiencies.
A not-yet-released report from the Department of Public Health and Environment, obtained by The Denver Post, cites some of the most egregious examples of neglect reported in the past three years:
• A Colorado Springs patient’s foot was amputated after a home care provider applied an ointment to pins holding a fractured ankle together without asking the patient’s doctor. The caregiver neglected to tell the doctor the ankle area had become infected, and by the time the patient went to the doctor, it was too late to save the foot.
• An Englewood personal care provider arrived to find a patient with multiple sclerosis slumped over on a toilet and was unable to rouse her. The caregiver called her agency for advice, and her manager told her the patient “slept a lot” and to leave her alone. When the care provider returned the next day, the woman’s skin was blue. She was dead. The state is still investigating.
• An Aurora patient with bipolar disorder was found dead of an overdose after telling her home care agency she was losing her home and car and no longer needed their services. The agency failed to tell the patient’s physician or social worker.
The report also details instances of commingled prescription drugs, a patient who lost 20 pounds under home care and a failure to report the sexual molestation allegations of a bed-bound client.
While nurses, doctors and other health care professionals are licensed by the state, home health care providers frequently use aides with no medical training to help patients with household chores and personal hygiene needs. Those aides are unlicensed.
Under current law, the state health department has no authority to check on privately funded home care agencies. If an agency receives federal money through Medicaid or Medicare, the state inspects it every three years.
But it has no authority to punish an agency. The federal government can strip an agency of Medicaid or Medicare funding, but the agency can keep operating with private funds.
Senate Bill 153 would bring home care agencies under state oversight similar to nursing homes, and assisted-living and hospice centers.
“We see this as a significant gap in protection of the public,” said Dr. Ned Calonge, the state’s chief medical officer. “You want to have someone you can trust to be in the home.”
If the bill becomes law, the state health department would make surprise inspections of home care agencies, including those with no public funding. Sanctions for deficient care would range from citations — available to the public on the department’s website — to de-licensure.
“The time has come,” said Sen. Betty Boyd, a Lakewood Democrat sponsoring the bill. The lack of regulation now “makes it difficult to assign some kind of responsibility,” she said.
The number of federally funded home health agencies in Colorado, the only agencies the state keeps track of, increased from 129 in 2004 to 140 in June 2007. The number of deficiencies found during that period has nearly doubled, according to the state report.
The Home Care Association of Colorado, representing about 90 agencies, is cautiously supporting the legislation. The group is concerned that fees and potentially burdensome paperwork could overwhelm small businesses.
Still, “licensure is probably long overdue for home care agencies,” said Ellen Caruso, the association’s executive director.
Caruso said she was “baffled” by some of the deficiencies cited in the department’s report but said problems are not rampant.
The home care industry in Colorado includes about 65,000 clients and 10,000 employees who make 3 million visits a year, she said.
“We think agencies that are not taking care of vulnerable people should have their hands slapped or worse,” Caruso said.
Several privately funded agencies were seeking state regulation before the legislation was drafted.
“Without standards, we believe that Colorado seniors are at a greater risk of harm,” said Bill Dahlquist, who owns Home Instead Senior Care agencies in Denver and Lakewood.
People 60 and older are predicted to be one in five Coloradans by 2020, Dahlquist said.
“A lot of those folks are going to want to stay in their own home,” he said. “The challenge for our state will be to try to figure out how to do it.”
Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com
