In Connecticut, easy for problem CNAs to slip through system
WASHINGTON — Certified nurse aides, or CNAs, are on the front lines of health and elder care, spending the most time with patients. They are also among the least monitored and least regulated health care professionals, and are paid the least.
The state of Connecticut has 37,700 licensed CNAs, but does not require drug trusts and leaves background checks to the health care facilities and home health agencies that employ them. But those companies practice different levels of oversight on their employees, and there is virtually no oversight of CNAs who do “freelance” work with patients in their homes.
A 72-year-old woman in the town of Washington hired one of those freelancers recently as she was recovering from debilitating back surgery.
According to police, the woman’s CNA, Candy Sutay, and Sutay’s boyfriend, Bryan Gamelin, stole $71,000 of the woman’s jewelry and silverware to finance their heroin addictions. Sutay, while providing care, went through eight bags of heroin a day, according to police.
While Connecticut mandates that agencies who provide at home help or companion care subject their employees to “comprehensive” background checks, if a home care worker — a nurse, a nurse’s aid, or just an assistant — works without an agency, they aren’t subjected to any testing, or checks.
Like Sutay, those folks fly under the radar.
Sutay and Gamelin, both 44, were arrested July 23, and subsequently charged with two felonies each: first-degree larceny and first-degree conspiracy to commit larceny, for what police said was a months-long theft of gold, silver, gems and silverware.
And while they await trial, their case raises the question: Who monitors home care aides — the folks that work most closely with our most vulnerable populations?
The answer: health care agencies — to varying degrees. And if a home care assistant is hired by a private person, like Sutay was by the woman in Washington ... no one.
The state does not keep track of where CNAs work, or how many work with an agency, which leaves a list of people that are certified by the state to perform nursing-home-like work, who are not background checked, or drug tested.
The state Department of Public Health doesn’t have any drug testing requirements for licensure, regardless of profession, said Maura Downes, a DPH spokesperson.
The CNA registry is intended to be used by nursing homes, who often employ CNAs to provide residents with assistance in tasks such as bathing, dressing, eating, and teeth brushing.
A CNA is like a nurse, but with with less training and education, Downes said. To be a CNA in Connecticut, one must complete 100 hours of instruction in a state-approved nursing program. To stay current on the registry, a CNA must have worked eight hours of direct personal care over the two years before they are re-certified.
Agencies don’t have to drug test. And while they have to do background checks, according to the Department of Consumer Protection, each agency does background checks differently, agency owners said.
Some agencies do federal checks, some statewide, some just local.
“It just depends on how much you want to spend on it,” said Gary Ferrone, owner of home care provider Fairfield Family Care. Ferrone’s background checks are some of the toughest in the business, he said. His company checks applicants’ criminal, civil, sex offender, DMV, and credit histories, he said, adding that he only considers hiring one person out of every six that apply.
But not all agencies are as tough, he added.
“They’re unhireable to me, but they may go to another agency with lower standards,” Ferrone said. Other agency managers, hiring directors and owners agreed with Ferrone. While agencies function as the safeguard between caretakers and those who need care, the hiring process often comes down to a home care agency’s “moral code”, they said, adding that less background checking is cheaper than more.
And even if Connecticut’s hundreds of health care agencies all pass on an applicant, a CNA can still work freelance — and can remain on the statewide registry — as long as their two-year certification is up-to-date.
In the Washington woman’s case, Sutay’s two-year certification had lapsed in 2015. It is unclear, in court records, if the woman knew.
The registry does have one safeguard, according to the Department of Public Health. If a CNA has stolen things, abused residents, or neglected residents, that finding accompanies their name on the list, which would make them unhirable by a certified nursing home.
They can still work freelance if they can find a person to hire them.
The people doing the hiring are usually vulnerable people — the elderly or disabled. And it can be hard for them to check an assistant’s background, or even their standing on the list.
Although police said Sutay told them that she’d been using heroin for 20 years, she has no “findings” against her on the registry.
According to the state, CNAs are kept on the registry — even if they’ve had “findings” against them or their certification has lapsed — so nursing homes know who they are hiring, and know who to avoid.
Across the country, some municipalities mandate background checks or drug testing, said Genevieve Gipson, the director of the National Network of Career Nursing Assistants. But, while some local governments try to provide oversight of home care workers, Gipson said, state laws regulating CNAs more strictly are rare.
“We really need to be helping consumers recognize that there’s a responsibility there,” Gipson said. “The way, too often, they find out there is a problem is after there’s a problem.”
The state does not track how many CNAs are employed by an agency or nursing home, and are therefore background checked or drug tested (depending on the company they work for).
Connecticut is not an outlier, said Abby Marquand, the director of policy research at the Paraprofessional Healthcare Institute. In most states, any privately-hired health care assistant is only subject to background testing if their employer decides so.
“When it comes to vulnerable people, it’s a difficult thing to navigate,” Marquand said. “The onus is really on the individual hiring.”
And the CNA registry — while it is a list of people the state says are trained to provide care — is not necessarily there for the public, she said. It’s mostly there for nursing homes and agencies, she said, adding that those agencies in turn provide the oversight.
But for private hires, the transaction — and oversight — is more like the hiring of a babysitter than that of a regulated health care professional. So no matter how trained a hire may be, and even if they specialize in elder care, like CNAs do, no government agency tests them, or checks their background.
State Rep. Matt Ritter, D-Hartford, co-chairman of the legislative Public Health Committee, said the issue raises questions, but it would be hard to determine if there are clear answers.
While the people who need home care are vulnerable, Ritter said, he’s not sure if it’s the state’s place to check on care providers, adding that it really depends on if the CNA registry is actually used by the public.
If the public uses the registry, it’s “disconcerting,” he said. But if the registry is only used by agencies, who then provide the oversight, there may be a different role for state to play, he said.
“I could go both ways on it,” he said.
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