ArticlesHealthHealthcare Deregulation

What deregulation of home health means for patients?

“I’ve been in home health for about 32 years, and there’s been a lot of changes in the regulations over that time. Generally, we think changes in regulations are sort of the political knee jerk to something bad happened and now we’re going to do this to fix the problem. Probably the best example recently for that is, we all remember the people in a nursing home in Fort Lauderdale that died during the hurricane because they didn’t have generators and they got dehydrated and whatever.

So now, there is a regulation that says all nursing homes have to have a certain sized generator for every so many patients, and that’s an example of how regulations are generally changed in our industry. However, in home health several years ago, probably 2007-2008, something like that, there was a substantial deregulation and it was supposed to be a way to level the playing field so that agencies, registries, homemaker companion companies, all played by the same rules, and what it did was it essentially got rid of everything that was unique to one of those entities.

So, that it didn’t require to do all the things that we think are important to do to protect the patient. Background screening. We used to get a printout of what the criminal offenses were that, that person had committed and we had a whole list that we had to compare those offenses to see if any of them were disqualifying offenses, and so part of the deregulation was they set up a background clearing house for all facilities to do their background checks through, but we don’t get any detail any longer. So, we do a second level of background screening not through the agency for healthcare administrations background screening department, because we think there are times that there are criminal offenses that are not disqualifying events according to our regulating body.

For example, you could have been arrested and convicted a bunch of times for things that legally they call petty theft, shoplifting, that kind of thing, and it’s not a disqualifying offense. I don’t know about anybody else, but I don’t want somebody that is a convicted shoplifter taking care of my patients. I don’t want to have to worry that every time the patient, who may have Dementia, misplaces something, is it because the patient misplaces it or because the employee stole it? And that’s perfectly okay under the regulations. There’s no requirement any longer for a certain amount of experience.

The regulations actually allow me to train people to be home health aids, and put them right to work with no experience. While I do occasionally do a class to train home health aids, I don’t hire people that haven’t ever provided patient care. I choose people that have worked in a nursing home and maybe don’t have a CNA certificate in Florida. So, they have the experience, they just don’t have the academic credentials in Florida, and so I may train them myself, rather than make them go to a formal class, but it’s just that kind of thing that, why should we put our vulnerable, elderly, frail patients at risk because the state wanted to level the playing field.

There are definitely some issues that go along with that deregulation. Just this week, I saw on the news where a local company had an employee that went in and stole a patient’s credit card and used it to buy a whole bunch of stuff. A cruise, I don’t know what all, and that really doesn’t matter, but you have to wonder if they had done the kind of second stage background screening that we do, if they wouldn’t have picked that up, and their statement that they gave to the media was that they had already fired her, but it still didn’t protect the patient. She had the patient’s information. She had been there. She knew where the patient kept their credit card. It still didn’t protect her, just that they had already fired her, and she had a clean background screen.

No system is 100%, but that might have been able to be prevented had they continued to get the kind of information that we used to get before deregulation. Well, before, and I a think it was 2007-2007 kind of time, but that might not be right, but it’s been 10 years, probably. We were still required to do a background screen. We could choose who we wanted to use to do that through, and we got a report that said the person has been arrested, but not charged, or arrested and plead guilty, or had a criminal trial and spent time in jail, whatever. We got all the detail, almost what they refer to on TV as like a rap sheet, and we also had a list of disqualifying criminal offenses, and we would compare those two and make the decision.

These things disqualify him. We can’t hire him, based on the state’s regulations, but we could also make a hiring decision based on other charges that were not disqualifying offenses according to the regulators. Now, we don’t get that detail. So, there are some gaps in what we can find out about the person, unless we go above and beyond. We’re required to try and check references, but if you can’t get references there’s no regulatory edict that says we can’t hire them, but we don’t hire people without good references, and it’s commonplace these days for people to, if you call Publix, they give you a 800 number to call, and they want to charge you for reference.

Nice little side scam, if you can get it, I guess, and so from a regulatory perspective, not being able to get a reference is not a reason not to hire somebody, but I want to hear from people that this person has actually worked for. The regulations used to require that everybody have a statement of good health. That was abolished. We still do it. Same with, there’s nothing that says we have to verify driver’s license or auto insurance, but some assignments involve taking the patient to and from the doctor, or the grocery store, or the therapist. I want to know they have a valid driver’s license without a lot of tickets and especially for tickets for things like DUI and that kind of thing.

I want to know their insurance is valid, because there is a lot of uninsured drivers out there. We verify every single piece of information we can figure out how to verify on a person. We check their social security card as real, and believe it or not there’s a lot of fakes out there. We verify that their credentials are real, and the state doesn’t require any of that. I had a situation, this has probably been five years or so ago that this applicant came in to apply for work, and she had a manila folder with all of her credentials, and she just looked familiar to me, but the name didn’t ring a bell.

So, we started searching back through her records, and I whole other set of credentials. Driver’s license, green card, social security card, CNA and HHA certificate, CPR, all of the required things in another name. So, I went out and said, “Which one of these is really you,” and the rest of my staff said, “You know, you’re trying to get yourself beat up, because she is three times your size, and looks like she could have a major attitude,” but you know, I don’t need people that have multiple aliases and how do you get all of those documents in a completely different name if there isn’t something suspicious going on? And when I looked further into our records, she had worked for us under the first set at documents at one time, and we fired her.

So, if all of that checking and double checking doesn’t take place, things can slip through the cracks.”

Anita Roberrson RN
Director of Nursing | Aging Life Care Manager