Courtesy of Godoy Medical Forensics
For elderly and disabled persons to live independently in their home, they often seek aid from family or hired assistants. Sometimes this involves live-in caregivers, and other times, the caregiver comes in for a few hours at a time. The support provided typically involves the activities of daily living (ADL), such as cleaning, cooking, and bathing. At higher levels, care may involve assistance with medical tasks, such as injections for diabetics or dressing changes for wounds. Unless the caregiver is an independently hired nurse, the medical aspects of care are very limited.
Most states provide support to eligible applicants based on age or disability. For example, the program in California is through the Department of Social Services and is called In-Home Supportive Services (IHSS). Under this program, a non-medical person will come into the home of the recipient and assist them with common household duties, such as cooking, cleaning, and shopping. There are some mild “paramedical” tasks that may be authorized, such as checking blood sugar or giving injections, but training is required before they can be provided. California’s list of non-medical authorized tasks can be reviewed here and information on paramedical services is here. For more information on your state, a keyword search online is necessary. Family members may apply to become IHSS providers for reimbursement by the state.
Whether training is required for the IHSS provider varies from state to state. If you take a moment to peruse the training content, you will see that it requires a high level of reading comprehension and much of it is in legal jargon/penal codes. I am sure the IHSS providers are of a wide variety of educational backgrounds but my sense is that most of them are not going to be able to read and understand a penal code. Even the definition of neglect and self-neglect under “Types of Abuse and Neglect” is at a 14-15th grade reading level. There are YouTube videos on how to fill out your timesheet, but none on any of the tasks expected, or on abuse or neglect.
So what is the responsibility of IHSS caregivers when it comes to abuse and/or neglect? Obviously, they should be reporting anything they see that is suspicious of abuse or neglect. Whether or not it is mandated will vary from state to state. In California, caregivers are mandatory reporters. Family members not under the umbrella of the IHSS program are not mandatory reporters, but under social etiquette, they should report any suspicions they have. Whether they are aware of how to report is an issue of training and education. In most cases, they will rely on medical providers to guide them when the patient is taken in to the doctor or hospital.