Selection of Elder Care Facilities and Caregivers

Many kinds of elder abuse can be prevented by the careful selection of a nursing home or long-term care facility, home health or home care agency, or home caregiver. You should visit any home, facility, or agency you are considering.

Ask the following questions about a nursing home or long-term care facility:

  • Are you Medicare and Medi-Cal certified?
  • Are you licensed?
  • Can I see the latest California Department of Public Health inspection report.
  • Do you conduct criminal background checks on all employees? What else is done to screen prospective employees?
  • Is your staff trained to recognize resident abuse and neglect?
  • Are there clear procedures to identify events or trends that might lead to abuse and neglect?
  • Are there clear procedures to investigate, report, and resolve complaints?
  • Are there policies and procedures to safeguard residents’ possessions?

Even if the home or facility has policies and procedures to safeguard residents' possessions, a resident or a family member should do the following:

  • Keep valuables and cash out of plain sight.
  • Keep a minimal amount of cash in your room.
  • Keep valuables in a safe and make sure a responsible family member also has access to it. Or leave them with a family member.
  • Lock your door when you leave your room.
  • Report a missing item to the administration. If it is not found report it to the SDPD.
  • Consider installing a camera in your room if you suspect a staff member is stealing.

Home health agencies are hired when the elder's doctor orders services requiring the skill of a medical professional. These agencies are licensed and regulated by the California Department of Health Services. Their staff members, i.e., nurses, nurse assistants, and home health aides, are also licensed. Make sure all these licenses are current and the agency is Medicare and Medi-Cal certified.

Ask the following questions about a home care agency. Note that unlike home health agencies, home care agencies are not required to be licensed.

  • Are your caregivers bonded and insured? Ask to see a copy of the bond to make sure it's current and the amount of the bond is at least $10,000.
  • Do you conduct criminal background checks on all caregivers? What else is done to screen them? Hired caregivers paid through County In-Home Supportive Services (IHSS) are background checked, but there is no such requirement for caregivers from private agencies, or for caregivers who work independently.
  • What training is provided to caregivers? How are they supervised?
  • Do you have a written policy against caregivers accepting loans, gifts, or any gratuities from an employer?
  • What are the names and phone numbers of a few former employers of the caregiver being considered for employment?

Do not rely completely on an agency regarding the trustworthiness of a caregiver. Conduct some checks on your own, e.g., with former employers, as you would in hiring privately.

In hiring a caregiver privately seek referrals from a trusted source first. If possible avoid using a “help wanted” ad. And do not respond to an ad by a person seeking employment as a caregiver. Interview all prospective caregivers. For your safety, do it in a public place, e.g., a coffee shop, not at your home. And don't give out your home address. Ask the applicant to do the following:

  • Fill out an employment application that asks for personal information, education, employment history, applicable licenses and certificates, personal references, etc.
  • Provide proof of citizenship or legal residency, a state-issued photo ID, and a Social Security card.
  • Provide his or her driver's license number and automobile insurance policy information if driving is involved.
  • Sign an authorization for a background investigation if you plan to check on personal information that it not a matter of public record, e.g., education, credit, and medical records. For the investigation you can hire a private investigator or do it yourself. You can find an investigator in San Diego on the California Association of Licensed Investigators website. The authorization form will be provided by the investigative agency. The investigator would check criminal, civil, and credit records, the applicant's driving history, the applicant's SSN, etc.

If you decide to do the investigation yourself you should first check the applicant's employment history and personal references. Then you should check the public records of criminal and civil court cases in San Diego County in the past 10 years. They are available at the following four locations:

Central District
330 W. Broadway
San Diego, CA 92101
(619) 615-6358

East County District
250 E. Main St.
El Cajon, CA 92020
(619) 441-4461

North County District
325 S. Melrose Dr.
Vista, CA 92083
(760) 726-9595

South County District
500 3rd Ave.
Chula Vista, CA 91910
(619) 691-4439

You should also call the San Diego County Courthouse at (619) 544-6401 to find out whether there are any outstanding San Diego County warrants on the applicant. All you need is his or her first and last name and birth date. Warrant information is available to the public and it's free. A search of outstanding San Diego County warrants can also be made on the County Sheriff's website. Just click on Warrant for Arrest. For records of cases and warrants in other counties you must contact the court clerks and sheriffs in those counties.

As an employer of an unlicensed person providing non-medical home care to an aged adult you can also get a California criminal history of the applicant from the Bureau of Criminal Identification and Information by asking the applicant to submit fingerprints to the California Department of Justice. This can be done electronically at any Live Scan site in the state. The locations of these sites are listed on the Office of the Attorney General's website.

For more information on these and other tips for hiring a home care worker go to the AARP website. This page also has links to checklists for selecting an in-home care agency and a nursing home.

After hiring a caregiver you need to be clear about what he or she can and cannot do. Some of the things that he or she cannot do include the following:

  • Deal with the elder's financial matters
  • Have access to the elder's incoming or outgoing mail
  • Have access to the elder's computer
  • Use the elder's credit or debit cards
  • Write checks on the elder's bank accounts
  • Borrow money from the elder

If the elder cannot handle his or her finances, you will have to do the following;

  • Have a trusted relative or friend, licensed professional fiduciary, or bank handle all accounts, pay bills, etc.
  • Lock up or remove from the home all financial records, checkbooks, credit cards, personal ID information, etc.
  • Do not allow the caregiver to have access to the elder's computer.
  • Supply a limited amount of cash for necessities and require receipts and an itemized accounting of all expenditures.

Some questions to answer in assessing the performance of a caregiver include the following:

  • Does the caregiver make it difficult for you to visit the elder alone?
  • Is the caregiver beginning to run the household?
  • Does the elder seem anxious or exhibit an unusual dependence on the caregiver?
  • Is the elder showing a sudden change in mood or behavior?