Judith Clinco: It’s time to regulate the Arizona home care industry

Judith Clinco: It’s time to regulate the Arizona home care industry

The following is the opinion and analysis of the writer.

Nursing homes have been in the news lately, and not in a good way: They’ve repeatedly emerged as hot spots of COVID-19 deaths. Another segment of the continuum of care might be even more impacted, but in Arizona, we have no way of knowing.

Nonmedical home-care agencies are licensed and regulated in 26 states, but not Arizona. It’s time we joined the majority.

To start a home-care agency, just register with the Arizona Corporation Commission and obtain a local business license. There’s no professional license. At no point will you have to demonstrate your fitness to do the job, and there’s no master list of agencies.

Nonmedical home-care is a vital segment of the caring professions, but it’s unique in its lack of state oversight. From hospitals to hospices, licensing and regulation ensures a baseline for quality. But not for home care, where caregivers provide support — cooking, transportation, help with hygiene, medication reminders and so on — for frail, at-risk, usually older clients.

And it’s a booming industry, all the more reason to get regulations in place now. According to the Bureau of Labor Statistics, openings for personal-care aides will expand by 70% this year. That’s about 650,000 new jobs.

Caregivers do their work out of sight, in the client’s own home. In my book, they’re front-line heroes. But the opportunities for spreading infections are abundant. Many clients need just a few hours of service per week, so caregivers often work with a number of clients. About one in 10 work for multiple agencies. One infected caregiver can spread illness widely. Typhoid Mary was a real person.

It’s easy, but dangerous, to assume a professional standard of care when you hire an agency. Many agencies vet their caregivers, provide skilled supervision, offer benefits and more. Some don’t, because they’re not required to.

Also not required, in most cases: training, even in life-and-death subjects like infection control, where ignorance of basic protocols can endanger the client, the client’s family and the caregiver. Some agencies — those contracted with the Arizona Long Term Care System — do provide limited training in infection control. Part of the state’s Medicaid program, ALTCS is a safety net for clients in deep poverty. But there’s no protection at all for clients who pay for services themselves.

Regulated industries have built-in lines of communication and accountability. During the pandemic, the medical director of the Pima County Health Department has been hosting weekly conference calls with community-based care providers. It’s a way to keep nursing homes, home health agencies and hospices current on important information such as testing for staff and clients, personal protective equipment availability and state policies.

Nonmedical home-care agencies are welcome too, but few take part, because there’s no way to know who they are or how to reach them.

Every home-care agency should be required to do at least as much as ALTCS. The Arizona chapter of the Home Care Association of America has tried, repeatedly, to find legislative support for regulating the industry. Those attempts have failed, repeatedly.

Maybe it’s too complicated. Or maybe regulation would reveal too many problems — as in, don’t ask the question if you can’t handle the answer. Or maybe the state just doesn’t care about a very vulnerable part of the population. If you think your elected representatives should show they do care, maybe it’s time to let them know how you feel.

Judith B. Clinco, R.N., B.S., is founder and president of Catalina In-Home Services Inc. in Tucson and founder of the CareGiver Training Institute.

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