Audit: Oregon in-home care program needs improvements

According to an audit released Wednesday by the Oregon Secretary of State’s Office, the Department of Human Services Aging and People with Disabilities program should take immediate action to improve the safety and well-being of participants in the Consumer-Employed Provider program.

Auditors examined the policies and practices APD uses to ensure CEP clients’ needs are met. The findings are outlined in a report entitled: “Consumer-Employed Provider Program Needs Immediate Action to Ensure In-Home Care Consumers Receive Required Care and Services.” http://sos.oregon.gov/audits/documents/2017-23.pdf

Oregon leads the nation in maximizing clients’ independence and choice in long-term care services. The CEP program offers aging adults and people with physical disabilities, who otherwise would be eligible to receive care in nursing facilities, the opportunity to safely remain in their homes. This choice comes with additional requirements. Clients in the CEP program are responsible for hiring, training, supervising, and dismissing their home care workers.

“As Oregon’s aging population grows, it is important that we stand ready to meet the critical needs of vulnerable members of our senior population,” said Secretary of State Dennis Richardson.

The audit found that shortcomings in vital components of the program may put clients’ health and well-being at risk. These shortcomings include the following:

— Some clients are not able or willing to successfully manage their homecare workers. As an example, a client experiencing memory issues from Alzheimer’s may be unable to confirm that a homecare worker is completing necessary tasks.
— APD does not ensure that homecare workers are prepared to provide the care and assistance clients need. For example, homecare workers are not required to be trained to meet a client’s specific needs.
— Excessive workloads prohibit case managers from contacting clients as frequently as required and from monitoring the critical services clients should be receiving. According to the auditors’ file reviews, roughly one third of CEP clients in 2016 did not receive all of their monthly required case manager monitoring contacts.
— Data collection and utilization practices make it difficult to adequately evaluate CEP program performance and the safety of clients. For instance, APD does not track the percentage of CEP clients who are abused, neglected, or victims of fraud.

Without addressing these issues, the integrity of the program, as well as the clients it serves, may suffer. Clients may be at greater risk of fraud, neglect, or abuse.

Drawing on current program policies and examples from other states and similar programs, the audit recommends APD consistently follow existing monitoring policies, address case managers’ excessive workloads, and provide more support to clients and homecare workers.

“We can and must do better to ensure the safety and well-being of these vulnerable Oregonians,” said Secretary Richardson.

Read the full audit on the Secretary of State website or highlights on the Audits Division blog.