Teri Sernett stood frozen in fear in the living room of the east St. Paul home.
Her patient, an elderly quadriplegic man she had just met, gasped for air, his throat blocked and his eyes rolled back. Nothing in Sernett’s one hour of training as a personal care attendant had prepared her for this.
Fearing the man was about to die, Sernett fumbled with a nearby suctioning machine. She had never used one, but she turned it on and inserted a long plastic tube deep into his throat.
“I was absolutely petrified,” she said. “I had a man’s life in my hands and had no idea of what to do.”
Each day, thousands of home-based caregivers such as Sernett are thrust into similar life-and-death situations with little training and virtually no direct supervision. They perform a dizzying array of complex medical tasks — from inserting feeding tubes and cleaning infections to monitoring intravenous fluids — that once were provided only in hospitals or nursing homes by medical professionals.
Many say they feel overwhelmed and unqualified as they struggle to help patients with serious illnesses and disabilities.
In Minnesota, where more than 100,000 care assistants serve some 36,000 vulnerable patients, all it takes to be certified as a home caregiver is a brief online quiz with questions such as, “When talking to a 911 operator, do not hang up. True or false?”
Of more than two dozen personal care attendants interviewed by the Star Tribune in the past two months, only one had received more than an hour’s training from their agencies. Many said they appealed to their agencies for more training and oversight but were told that state payments were too low to cover the expense.
Isolated and left to fend for themselves, many home caregivers say they have no choice but to violate rules designed to protect vulnerable adults. In interviews, unlicensed personal care attendants said they routinely sterilize wounds, administer powerful prescription drugs and even inject medications into patients’ veins — even though such tasks are prohibited under the state-funded personal care assistant program.
Often, their employers don’t know the risks they undertake because the caregivers are largely unsupervised.
The same pattern plays out across the country. Despite a decade of explosive growth in the $95 billion home-health industry, which is swelling to meet the demands of an aging population, there are no federal standards for the training, credentials and supervision of personal care attendants.
In Minnesota, state law requires personal care agencies to check directly on patients and their caregivers every four months. But some agencies neglect that law, letting years go by before visiting patients, according to some caregivers and county officials.
Personal care agencies are also required by law to employ a “qualified professional,” such as a registered nurse or licensed social worker, who can train and oversee caregivers.
But at larger agencies, these professionals sometimes oversee hundreds of patients, and their house visits often amount to cursory scans of patient care plans, caregivers say.
The Minnesota Department of Human Services, which oversees care for vulnerable populations, has one full-time staff member on its home care team dedicated to service quality, including patient safety, to oversee hundreds of care agencies.
This person is supported by six other staff who do ongoing quality reviews.
When mistakes happen, complaints to state and county agencies sometimes go unreported or unheeded, enabling negligent caregivers to avoid sanctions while moving from one home-health agency to the next, say county officials and caregivers.
“It’s like we don’t exist,” said Jennie Pechia, a personal care assistant from Cambridge. “You can be in a patient’s home for a year, providing life-and-death medical care, before a nurse even pops in to check on you.”