Connecticut’s Elder Care Reckoning
The aging population is expanding, but support systems are struggling
Part four: The challenges facing the home care industry
More people are aging at home, but the state provides little oversight of a growing industry of home care providers
Editor’s Note: This is the final report in a four-part series about Connecticut’s aging population and the challenges in finding ways to care for people.
Today: More people are aging in place. But the state’s home care industry operates with little oversight.
When the bank manager called Irene Loretto and told her that her 92-year-old friend Ruth Hughes, who suffered from dementia and lived in a Farmington assisted living facility, tried to cash $27,000 worth of checks and bought a $3,000 bedroom set, she knew something was amiss.
Loretto, who had been granted power of attorney for her friend, immediately called Farmington police because she knew Hughes would not have spent that much money.
During a seven-month investigation, Farmington police discovered that Hughes’ home care aide had not only stolen her identity but also that of another client living at a nursing home in Farmington and had cashed at least 20 of her clients’ checks, totaling nearly $40,000, according to police reports.
They charged a mother-daughter team of Cynthia Williams and Sharonda Williams with first-degree larceny and forgery, among other charges, according to court documents and news reports. Both women eventually pleaded guilty in Hartford Superior Court and received suspended jail sentences.
Loretto was shocked to learn from Farmington police that Cynthia Williams had a previous conviction for fourth-degree larceny in 2017 after an arrest by Hartford police. She called Williams’ employer, Brightstar Care, and asked why they had hired someone with a criminal record to work with older adults and people with disabilities. Brightstar did not respond to several requests for comment from the CT Mirror.
“I asked them, ‘Didn’t you check her background at all before assigning her to work with a 92-year-old woman?’” Loretto said. “They told me they did and didn’t find anything. Well, they didn’t look too hard. It was my mistake to assume that they checked people out.”
Cases like Hughes’ are an example of the challenges policymakers face as they attempt to “right size” the state’s elder care services by pivoting from long-term care facilities to expanding options for people to receive care at home. By 2040, state leaders expect a nearly 30% increase in the number of long-term care residents on Medicaid who remain in their homes, and they’ve committed more than $1 billion annually to that cause.
The shift has exposed a home care industry that operates with little oversight, is hard for consumers to navigate, and has a dire shortage of chronically underpaid workers.
One element of the sprawling home care industry is homemaker companion agencies (HCAs), which are overseen by the state Department of Consumer Protection. Unlike nursing home employees and home health aides, who must be licensed by the state Department of Public Health, there is no licensing process for HCA workers. Instead, homemaker companion agencies must register annually with DCP.
Managers at the companies are required to conduct criminal background checks on prospective employees but aren’t required to share that information with DCP, which does not track who works at the more than 900 HCAs registered with the state.
The result is an industry that some elder care experts refer to as the “wild west,” because there is little oversight, unlike long-term care facilities, which are heavily regulated by the state Department of Public Health.
The CT Mirror reviewed more than 75 complaints against homemaker companion agencies filed with the consumer protection department between 2018 and 2020 and discovered at least half a dozen cases in which HCA employees were arrested for allegedly stealing from their clients, more than a dozen findings by DCP investigators of agencies that routinely mis-advertised the services they provided, and seven complaints of clients being left alone for hours at a time.
The complaints against the companion agencies are varied and troubling.
There’s the 2019 Shelton case where a personal care aide was accused of stealing more than $20,000 from her 83-year-old client. There’s the Waterbury family who couldn’t get their father’s aide to leave after he died in March 2018 because she claimed she had been in a relationship with the 88-year-old stroke victim. There’s the East Hartford man with dementia who tried to board a bus while wandering the neighborhood after his live-in aide overdosed on heroin. And there’s the Cromwell woman who realized her aide had rented and furnished an apartment using her stolen checkbook.
The Mirror’s review of the DCP investigations found that many either led to small fines of less than $5,000 or an employee being fired.
DCP spokeswoman Kaitlyn Krasselt acknowledged that the agency has never denied a homemaker companion business’s registration and has never revoked a business’s registration following an investigation.
“It’s not the goal to close them down,” Krasselt said. “It is to bring them into compliance so that families aren’t left without the care that they rely on.”
She said state statutes don’t allow DCP to take over a company like DPH can do with a nursing home by placing it in receivership.
Sen. Patricia Billie Miller said DCP is too lenient on the agencies.
“The way it stands now, you can basically get a certificate … and I think there are potentially bad actors out there that would harm our seniors or take advantage of our older adults,” said Miller, a Democrat from Stamford.
“This is an industry that needs to be looked at a lot more closely, because we’re an aging population. I think there needs to be some policies and regulations in place to protect them,” she said.
Kicked to the curb
The voice mail message left on the morning of June 12, 2019, stunned Alma Hernandez.
Her 86-year-old father, who has dementia, tried to get on a bus in South Windsor without his caregiver and was escorted off because he didn’t have a ticket, the bus company representative said. Hernandez said her father and his home care aide rode the bus to go to a community center several times a week, so the drivers were familiar with him and knew he shouldn’t travel alone.
“They left him alone on the sidewalk, so where was he? And where was his live-in aide that was supposed to be with him?” Hernandez said.
She called the police, who soon found her father wandering around the neighborhood. When police took him home, they discovered his aide comatose in the apartment. Hernandez said the aide died on the way to the hospital of a suspected overdose and that police found drugs in the apartment.
Police told her the home care aide had previous drug convictions, Hernandez said, so she called Companions Forever to ask why they hadn’t drug-tested their employee, given his history. Hernandez said in her complaint to DCP that Companions Forever told her they weren’t required to perform drug tests and that they had no knowledge of their employee’s previous drug charges. Companions Forever did not respond to requests for comment from the CT Mirror.
“I wonder how many people assume that they require people to get drug tested before they put them with their loved ones or don’t know what type of background check, if any, they even do,” Hernandez said.
So Hernandez decided to act.
She contacted state Sen. Saud Anwar, D-South Windsor, and asked him to sponsor legislation that would require homemaker companion agencies to test prospective employees for drugs. She also asked him to submit a bill making bus drivers mandatory reporters if they see abuse or neglect.
“My father got on that bus every day to go to the senior center, and he always had his aide with him, so they knew him and should have realized something wasn’t right that he was by himself and not kicked him to the curb,” she said.
The mandatory reporter bill passed in 2021, but drug testing legislation died after the HCAs told lawmakers it would be too expensive, given their high employee turnover. They also objected to legislation that would have required them to pay for an FBI background check for every employee, arguing it wasn’t cost effective, but legislators passed it anyway.
The updated law included a requirement that HCAs perform national background checks and “recommended” they hire an outside company that specializes in doing them. Previously, DCP did not place parameters on what type of background search agencies did.
DCP officials acknowledged they have no idea whether the HCAs are actually performing the background checks unless they get a complaint or randomly audit the company.
During that same legislative session, lawmakers — recognizing the oversight problems in the rapidly growing homemaker companion sector — established a task force to study and recommend long-term solutions.
Miller, a former co-chair of the Aging Committee, helped pass legislation establishing the Homemaker Companion Task Force that began meeting last September.
The task force recently submitted a 26-page report to the Aging Committee, which used it as the basis of a bill that went to a public hearing in February and drew more than 40 comments, nearly all of which were favorable.
The task force’s most significant recommendation — transferring oversight of HCAs from consumer protection to the public health department by July 1, 2024 — was adopted and approved by the Aging Committee despite concerns raised by officials from both agencies.
The bill also requires the DCP commissioner to revoke a certificate of registration if an agency violates certain provisions three times in one calendar year, to create a guide that details how to file a complaint against a homemaker-companion agency, and to develop a plan to implement mandatory training standards for agency employees.
But in written testimony submitted for the public hearing, DPH Commissioner Manisha Juthani said her agency would need more time before assuming oversight of the HCAs. The commissioner requested an extra year for the takeover and said DPH’s approach to regulating the HCAs would be different from consumer protection’s.
“A significant information transfer between DCP and DPH would be required to fully understand the scope of the registration and monitoring process already in place,” Juthani wrote. “Additionally, given the differences in responsibility and subject matter expertise at DCP and DPH, the process that DPH would use to regulate and monitor the Homemaker Companion Agencies would be different from what DCP currently monitors. While DCP’s focus lies more in monitoring business practices, DPH would focus on the health and safety of the services provided by Homemaker Companion Agencies.”
One of the task force members was Leslie O’Brien, a legislative liaison for the consumer protection department, who acknowledged the growing homemaker companion industry is overwhelming the department.
“We’re really struggling at DCP to figure out how to manage the massive growth in this industry with what the statutory constraints are, while recognizing that the most important thing is protecting consumers and ensuring public health and safety,” O’Brien said during a presentation to the Homemaker Task Force.
“The confusion about the different spectrum of services provided under the home care umbrella is a huge issue,” she added. “It’s confusing for people who work for the state, so think about how confusing it is for consumers. So I think the real challenge as a state is: Does it make sense the way this is all happening right now, all chopped up, among state agencies?”
Several HCA owners testified in favor of the bill, particularly the need for more training and transparency by all HCAs.
“The demand for in-home care has never been greater. Not only is their home where they want this care to occur, but this is the most cost-efficient setting,” said Guy Tomasso, owner of Lifetime Care in Guilford.
“This bill will ensure that all registered homemaker companion agencies will be held to the same standards,” he said. “As providers of this care, we must be accountable to those who have placed their trust [in us] and have peace of mind.”
Tomasso specifically mentioned mandated training programs and several important upgrades, such as “person centered care plans.”
Task force co-chairwoman Anne Foley was a state employee 15 years ago when the original language for registration for HCAs was established, she said.
“We didn’t have any kind of oversight at all over homemaker companion agencies, and we decided that we needed some kind of structure in order to protect the consumers and clients of these services,” Foley said.
“But, clearly, 15 years is a long time, and things have changed demographically, things have changed structurally, and I think it’s just really the right time to relook at the entire system,” she added.
The biggest change is the sheer number of HCAs, which have tripled, while the size of the DCP unit that handles complaints and conducts audits has shrunk, according to DCP officials.
Over the last 10 years, the number of HCAs has grown from 308 to 903, and “we’re still dealing with minimal staffing and in statutory and regulatory frameworks that are much different from when this started,” Foley added.
Home care options vary
With the state placing more money and emphasis on keeping people out of nursing homes, there are several options available for aging in place, according to Tracy Wodatch, the president of the Connecticut Association for Healthcare at Home.
The highest level of care would be by a licensed home health care professional. Wodatch said this is someone who has the ability to administer medications, including shots if necessary, and would be needed by anyone with long-term health concerns. Consumers must have an order from a health care provider to access these services.
The field includes everyone from registered nurses to physical therapists to speech therapists. They are licensed by the Department of Public Health and must follow strict regulations, Wodatch said.
“The other level of care is what we would call long-term services and supports,” she said. “Somebody doesn’t really have a medical diagnosis, maybe they have some dementia, they can’t live alone, but they’re certainly able to get up and about, they might not remember to take their medications, they might not remember to take a shower or eat. So they really need a support system in there to help them with a structured day.”
At this level, she said, residents on state Medicaid waivers can hire a personal care aide, or PCA, to help them with daily tasks.
Many PCAs are represented by SEIU 1199 New England. Their numbers have grown from fewer than 6,000 in 2012 to about 11,000 now.
The PCAs are listed in a binder of printed pages created by the contractor hired by the state Department of Social Services to handle payroll, but the information that is available is often outdated, and there is no searchable online database.
“A lot of it is through word of mouth. I’ve seen people posting for PCAs on grocery store bulletin boards. I’ve heard of people posting for them on Craigslist. It’s all over the map,” said Diedre Murch, home care director with SEIU 1199 New England, the state’s largest health care workers union, which represents many of the PCAs.
PCAs are not licensed by the state, and while they are not authorized to dispense medications or provide medical services, such as wound care, many end up doing just that, Murch said.
“We often think of home care as kind of like the wild, wild west,” Murch said. “There’s a lot of gray area in home care. Technically they’re not doing medical tasks, but it’s not uncommon to have a PCA talk about removing suctioning tubes.”
“There are certainly a pretty large number of caregivers who provide some pretty advanced care to people with very complex medical needs,” she added.
The third level of care is what Wodatch refers to as “agency-based, long-term services and supports.” Those are usually provided by a homemaker companion agency, she said.
All homemaker companion agencies must be registered with DCP, but their workers are not licensed by the state.
Just over one-third of the HCAs participate in a state-funded Medicaid waiver program called the Connecticut Home Care Program for Elders. Those agencies are subject to some additional quality checks and audits from a fiscal intermediary hired by the state.
The different state agencies involved, varying licensing requirements and a dearth of accurate information make the system difficult to navigate, advocates say, especially for consumers facing family emergencies.
“A lot of people come into needing home care services at a moment of crisis in their life and find it really confusing to understand. If there’s a problem, do I call DPH? Do I call DCP? And it feels very unclear,” said Anna Doroghazi, associate state director of advocacy and outreach for the AARP in Connecticut.
“It’s a very, very disjointed consumer experience,” Doroghazi said. “I get a lot of very upset, very surprised calls from consumers who are saying, ‘I didn’t realize there were different standards for background checks between my homemaker companion and my personal care aide like, why, why is this happening? How do I fix this?’”
‘Keeping my father hostage’
Constantine Milonas was frustrated having to deal with multiple agencies when he discovered his father’s personal care aide had moved into his apartment and wouldn’t leave.
Milonas said he was stunned when he walked into the emergency room at St. Mary’s Hospital in March of 2018 to see the woman who had been hired as his father’s PCA telling doctors they were married.
“I was shocked when the doctor told me that ‘Ms. Milonas’ had informed them she was in a romantic relationship with my father, so they should inform her of all medical decisions,” he said.
Her name was Kelly Jennine Peters, and she had been hired through a company called Quality Home Care to be a personal care aide for 79-year-old James Milonas, who had suffered a stroke a few years before.
James Milonas died a few weeks after he was brought to St. Mary’s, but the family’s troubles with Peters were far from over, according to the complaint the family’s attorney filed with the state. The aide refused to allow them into the apartment or turn over the keys, the attorney wrote, and said she had moved in when they became a couple.
Milonas said he tried multiple times to gain entry to his father’s apartment and get the keys back but was unsuccessful. He then hired attorney Mary Alice Loughlin, and she filed complaints with the HCA, state Office of Elderly Protective Services and, finally, DCP.
“There was nothing I could do. I had the power of attorney for my father, and I couldn’t even get into his apartment, and I couldn’t get anybody to help me out,” Milonas said.
Eventually, Loughlin, with the assistance of Waterbury police, did get the family into the apartment and removed some of the father’s possessions.
DCP opened an investigation in the spring of 2018 and found that the agency fired Peters before the state could fully investigate.
Quality Home Care could not be reached for comment. But the DCP investigative file contains a letter that Quality Home Care President Miguel Rosado wrote to Peters informing her that she “was no longer employed by Quality Home Care effective immediately.”
“As you know, you never have been and are not now authorized to occupy the residence of James Milonas,” Rosado wrote. “You were not assigned to any oversight position and have never been entitled to occupy the residence.”
Rosado ended the letter warning Peters “she was not permitted by the Milonas family from attending the wake, funeral of graveside service.”
Peters could not be reached for comment.
When DCP finished its investigation in October 2019, the company was ordered to use specific language in employee contracts having them certify they don’t have criminal records.
“The state doesn’t have the resources to adequately inspect, oversee and police the home care field,” said Loughlin, the family’s attorney. “We don’t know what happened to this woman who took over this man’s house, but neither does the state, and she could be doing it all over again elsewhere and they wouldn’t know.”
DCP’s Director of Investigations Pamela Brown, who oversees the agency’s investigative units, said in an interview with the CT Mirror that the agency randomly audits about two HCAs a month. The department has one supervisor and two investigators dedicated to investigating complaints against HCAs.
Brown said in 2019 there were 81 complaints filed with DCP; the number rose to 120 in 2020 and fell back to 73 in 2021, with 64 complaints in 2022.
A review of these complaints shows that many are either billing issues, false advertising allegations against a company, or accusations that a personal care aide has left someone home alone.
“Advertising is one of our larger issues, where as someone may say they offer home health services when they’re actually a homemaker companion, or they claim they offer a higher level of service for dementia care or Alzheimer’s care when their staff hasn’t been trained in those areas,” Brown said.
Complaints of fraud or abuse are passed onto law enforcement agencies or, in cases of just fraud, to the banks involved. Given the number of complaints compared to the number of staff, the agency has no choice but to pass on many investigations.
“We can always use more staff there. I mean, this is a growing issue,” Brown said. “Investigating these complaints is going to take time, especially when you are dealing with someone's finances.”
She acknowledged the state relies on the agencies to police themselves because the state just doesn’t have the manpower to do so.
“There are over 900 home companion agencies registered in Connecticut right now. Some of these individuals are working in someone’s home either 24 hours a day, or 12 hours a day, and I believe if we had more supervision site visits from these agencies themselves, that would prevent a lot of the problems,” Brown said.
Brown also testified before the task force and emphasized the department’s concern that many HCAs are falsely advertising services they cannot provide.
'I figured, what the heck'
Regina Stankaitis, 69, knew she was going to need some assistance at her Cromwell home after surgery and decided to contact “Care Giving by Kathy” — the homemaker companion agency recommended by her doctor’s secretary.
But Sally Douglas lasted barely a week as her aide before Stankaitis, feeling threatened by her new aide, asked her to leave. It wasn’t until about a month later, when her bank contacted her about a $4,000 check for a paint job at an apartment in Rocky Hill, that she realized something was wrong. Police later determined Douglas was living in the apartment.
She went to her bureau and discovered that the checkbook she kept hidden in her underwear drawer was missing. She called her sister, and they filed a complaint with the Cromwell police.
“I figured if someone from the doctor’s office was recommending them, then I figured what the heck, they must be OK,” Stankaitis said. “But boy, was I wrong.”
The police investigation showed that Douglas, who only worked for the agency for one week, also had used Stankaitis’ credit card to purchase about $2,300 worth of furniture for the Rocky Hill apartment. Police also discovered that Douglas had a previous criminal record that included assault, criminal trespassing and threatening, and had been charged with third-degree larceny only a few months before she became Stankaitis’ personal care aide.
Care Giver by Kathy Business Manager Ciara Lundell said she couldn’t discuss an employee but noted, "Sally Douglas was only an employee here from Aug. 10 to Aug. 18th.”
Police charged Douglas in March 2022 with third-degree larceny and second-degree identity theft. Her case is still pending in Middlesex Superior Court, and Stankaitis has attended all 14 court dates, with the next one scheduled for May 4. Attempts to reach Douglas’ attorney, Richard Silverstein of New Haven, were unsuccessful.
“I want to see this through and make sure she is held accountable so she can’t do this to anyone else,” Stankaitis said.
ABOUT THIS PROJECT
Part 4: More people are aging in place. But the state’s home care industry operates with little oversight.
Reporting: Dave Altimari, Jenna Carlesso
Photography: Yehyun Kim
Data visualization: Katy Golvala
Editing: Elizabeth Hamilton, Stephen Busemeyer, Keila Torres Ocasio
Social media: Gabby DeBenedictis, Nicole McIsaac
Web development: Kyle Constable