In 2018, more than 120 personal care attendants — paid by the state to help people with disabilities eat, dress, or use the bathroom — were registered sex offenders, a state watchdog found. Thousands more had open criminal cases. Some had even faced murder charges.
Yet, state officials, who pay $1 billion to these workers each year, don’t require background checks for them. In fact, the state’s Medicaid program, known as MassHealth, has so little information about these 50,000 workers, it doesn’t even know their names, according to a new report.
The findings, released with little publicity in late February by Massachusetts Inspector General Glenn A. Cunha, describe a widely-used program that helps low-income residents with disabilities and chronic illness live independent lives ― but also that “significantly limits" officials’ ability to root out fraud and abuse.
The review found that nearly 12,000 attendants, or 24 percent, had a criminal record from the last 10 years, and 2,066 had at least one pending criminal charge. The report said that 991 had faced at least one sex crime charge in the past, and 63 had faced murder charges, including six in the last decade.
Checking the workers against sex offender records, Cunha’s office found 122 sex offenders, including 41 who are considered Level 3, meaning they have a high risk of re-offending and pose a high degree of danger to the public.
“These findings require MassHealth to weigh the risks and benefits of its current practice of not conducting background checks on" personal care workers, the report states.
The 2018 data highlight the challenge of running a program that is structured so it’s controlled by the people who need the services. MassHealth members are responsible for hiring their own attendants, based on their individual needs and preferences, and the state pays the cost.
Personal care attendants help MassHealth members perform daily tasks, from preparing meals to bathing to housekeeping. The job has few prerequisites, beyond a minimum age of 14 1/2 years, and requires no formal training outside of a one-time, three-hour orientation for new hires. Family members often serve as attendants for their loved ones.
Vendors hired by the state to help run the program provide individuals with information about how to request background checks, but performing them is not mandated. And state officials do “not provide any additional support or education” about requesting criminal records, nor do they conduct any routine follow-up after an attendant is hired, Cunha’s office found.
“MassHealth is unaware of the most basic information regarding an entire group . . . it is paying hundreds of millions of dollars,” the 32-page report states. “MassHealth has no way to know if a member has conducted any kind of background check on a prospective PCA."
MassHealth officials said they are working with the inspector general’s office and the disability community to address the concerns raised in the report.
The unique nature of the program means that all hiring decisions, including the decision to do a background check, is left to the consumer, MassHealth spokeswoman Jessica Lyons said in an e-mail. She said MassHealth "provides consumers with the tools to make safe and informed choices about who they hire, including educational materials and trainings on the importance of background checks.”
Though the inspector general asserted that MassHealth doesn’t know the names of PCAs, MassHealth officials said they can request the names at any time by contacting the agencies that manage billing for the program.
The program’s approach to background checks is very different from others run by the state, according to Cunha’s office, which performed its own review of nearly 50,000 attendants from 2018.
Cunha’s office did not make him available for an interview, but in a statement it called background checks for attendants a “complex, multi-faceted issue” that it intends to work on with MassHealth.
Indeed, the program has its nuances. Advocates say that consumer control is crucial, and that people with disabilities should not have to cede the control to state officials. Instead, they said, the state should make it easier for individuals to request background checks.
It can cost up to $50 to request a person’s Criminal Offender Record Information, or CORI, and getting results can take anywhere from a few minutes, if submitted online, to two weeks.
Bill Henning, executive director of the Boston Center for Independent Living, a nonprofit that serves people with disabilities, said that while the safety of MassHealth members is critical, he’s worried that too many state requirements around hiring could hamstring the program.
“Would you want somebody who might be in a compromised situation to hire a sex offender? Absolutely not,” he said. “Do what you can to do to make it safer — but the element of the consumer control is really what drives the success.”
Paul Spooner, who has personally used attendants for several decades, said it would “fundamentally alter” the program if MassHealth began conducting background checks.
Consumer control is key, Spooner said, because it allows him to hire attendants with whom he is comfortable to come to his home at the times that work for his schedule.
“It allows me to live in the community, work in the community, contribute to the community, pay my taxes,” said Spooner, who works as executive director of the MetroWest Center for Independent Living, which provides services for people with disabilities.
The personal attendants program has come under increasing scrutiny in recent years. State Auditor Suzanne Bump said last year her office intended to ramp up focus on attendants after fraud cases involving them doubled in three years. The 300 cases in 2018 resulted in about $1.4 million in fraud, and Bump said her office identified another 297 cases in 2019, totaling nearly $900,000.
A 2018 Globe investigation found that dozens of personal care attendants and other types of workers hired to care for elderly, sick, and disabled people at home have faced allegations that they abused or neglected their clients.
One personal care attendant had faced 15 criminal charges before a New Bedford woman hired her. Months later, she was charged with larceny and credit card fraud after the woman accused her of running up $20,000 in bank withdrawals and unauthorized credit card charges.
The case was dismissed a year and a half later, after the alleged victim said she didn’t have the nerve to go through with testifying.
Home health aides — a different category of workers — also assist people with daily activities such as eating and bathing. But unlike PCAs, home health aides also provide some medical care and typically work for private agencies, not directly for the people they serve.
Rebecca Gutman, vice president of the union representing personal care attendants, said the inspector general’s report “highlights areas to strengthen the program, including deterring some people from becoming a personal care attendant if they know their background will be screened for criminal activity.''
"The health care workers of [United Healthcare Workers East] have always been supportive of free consumer-initiated background checks,” she said in a statement.