Jerry Parson lay motionless on the bedroom floor, pain shooting through his back. The screams of his companion, Joyce, pierced the morning silence of their Bloomington apartment.
They were helpless.
A personal care attendant they had hired to move Parson from his bed to his wheelchair each day had failed to show up for work. Frantic calls to her employer, a company called Crystal Care Home Health Services, had gone unanswered.
Parson, 55, suffers from multiple sclerosis and has virtually no movement in his limbs. When Joyce tried to move him, her legs buckled and he crashed to the floor.
“I felt hurt and abandoned,’’ Parson said.
Crystal Care, one of the largest home health care companies in Minnesota, was on the brink of collapse and had stopped paying its employees. Many had quit going to work, leaving their sick and bedridden patients at home for weeks with limited or no care. Even as state officials learned of the crisis, no one alerted Parson.
The slow demise of Crystal Care, which finally shut its doors in March, reflects the grave and widespread problems that shadow the home health care industry as it grows explosively in Minnesota and across the country.
Home health care companies now deploy an army of more than 100,000 personal care assistants in Minnesota, serving thousands of frail and ailing patients. But they operate without the kind of oversight that is routinely given to licensed care facilities such as nursing homes, and their workers are often low paid and poorly trained. Despite the industry’s rapid growth, most states have no minimum training requirements for personal care attendants in their programs. Minnesota requires only that they take a 25-question, multiple-choice exam that can be completed in just a few minutes.
The industry is also wracked by instability. Of the roughly 800 companies that employed personal care assistants in Minnesota in 2009, one-third have since closed their doors, according to a state database analyzed by the Star Tribune. State records also show that more than 100 home care companies have had more than $350,000 in unpaid-wages claims in the past five years.
Yet unlike a nursing home, a home health care company is not required to secure substitute care for clients when it goes out of business. Companies can close and leave patients in suddenly dire straits — and Crystal Care is just the latest in a series of recent failures that have destabilized the lives of vulnerable and chronically ill people across the nation.
“The lack of oversight is a catastrophe,” said Dr. Robert Kane, chairman of long-term care and aging at the University Minnesota’s School of Public Health. “But the catastrophe has gone largely unnoticed because it’s happening in thousands of individual, isolated homes.”
Crystal Care’s co-founders, Sally Knutson and Jeanette Mefford, said they worked 80-hour weeks to help clients as the agency began foundering last year. Still, Knutson acknowledged that the process “was not as smooth as we wanted it to be,” and that some patients may have gone without care.
“It was a major, major loss,” said Mefford, who cried as she described the company’s demise.
Consumer advocates acknowledge that the home care industry serves a vital function, helping people live more independent lives outside of institutions and keeping them closer to their families and community. Many agencies, they say, provide first-rate care.
But they also warn that what happened with Crystal Care could happen anywhere, anytime.
Federal and state regulation is so light that “no one who is getting personal [health] care at home is really safe,’’ according to Dr. Charlene Harrington, a nursing professor at the University of California at San Francisco and a former director at the Center for Personal Assistance Services (PAS) in San Francisco.
Rapid growth, troubling signs
When Crystal Care’s finances began unraveling last year, authorities in Minnesota appeared ill-equipped to respond. Three state agencies knew that its employees were not getting paid, records show, but no single regulator notified Crystal Care’s 1,000 clients that the company was failing. A state ombudsman also declined to meet with the company’s alarmed employees.