Should Psychological Exams be Required for New Care Business Owners?

Tens of thousands of well-meaning entrepreneurs own adult day care, group home and private duty home care companies around the world and in every corner of America.  Thanks to these special people a number of citizens can age in place, not having to share a bedroom with 4 others in what can be the less dignified setting of a nursing home. Initially when these business operations commence the hours are long and the pay is short as the business model is being integrated into the community and built to serve its capacity.

In many states, including Michigan, new licensees in adult foster care must complete a Medical Clearance Form.  This form is to be taken to the licensee’s physician and there is at least one question that asks if there is a physical or mental impairment that could stand in the way of this person executing their duties as an adult foster care administrator or licensee.  Most doctors or their staffs who see it probably treat the form as somewhat routine, add the basic info, conduct the TB test, sign it and hand it back to the patient.

The question for society is:  “Is this enough?”  Probably not.

Imagine indignantly insisting that a healthy adult eat less than it takes to fill-up a baby.

In way too many group living/adult foster care environments we hear reports such as:

  1. Residents not being given adequate food.  In one case the owner screamed, “one sausage, one boiled egg, one piece of toast and no more.”  Imagine serving an adult an amount of food inadequate for a baby.  Would you treat a dog that way?
  2. Providers refusing to purchase necessities for staff such as latex gloves to use when rendering personal care.  (There is one report of staff using the rubber gloves they wash dishes wish to render personal care to a group home resident in Michigan and the resident’s family witnessing it)
  3. Owners of small group homes demeaning a resident in the presence of caseworkers and staff.  In some cases the owner even speaks negatively of the resident’s family which surely fits the widely accepted definition of verbal abuse.
  4. Owners and employees of group homes utilizing the identities of residents to order cable television service, credit cards and in some cases file false tax returns seeking illegitimate refunds
  5. Owners being aware of a specific amount of time an employee worked, but refusing to pay them for something as simple as the loss of or damage to a time card when others verified the presence of this person as does the documentation completed on the shift
Verbal abuse of a vulnerable adult is never appropriate!

While it would appear that some of this behavior is simply the accepted conduct of a person who does not have love in their hearts or who lacks moral integrity on every level, do you wonder if there might be more?  What if this person has been a victim of abuse themselves and as a result are completely inward turned when it comes to daily focus; psychologically unable to empathize with the needs of others?  Its a combination of extreme selfishness, self-hatred, greed and more.

Can you imagine rationing out food like that to a vulnerable adult?  Would they do their children that way?  Can you imagine engaging in a discussion about the extra cost of one more sausage?  Sure we may want to label them as scrooge and move on but often more is at play psychologically.  It could very well be that the right pre-licensing psychological examination could spot certain sociopathic tendencies or other deficiencies that could stand in the way of this person feeling empathy.  As a result they may not qualify to render care to or supervise care for others and we can protect many people.

A means of accomplishing this might include:

  1. Not allowing a Medical Clearance Form to be completed by the person’s personal physician.  Arrange for a qualified set of physicians to act on behalf of the licensing department who are not personally familiar with this patient.  After all the applicant’s personal physician may fear losing or offending them due to what could be a long-standing personal relationship.
  2. An approved set of questions and physical examination should be a part of the process.
  3. Do not allow the applicant to return the Medical Clearance Form with the physician’s comments.  Insist that the doctor mail it in themselves.

Care providers, especially those providing residential care should want to provide a life as nice as their own for those they serve.  They should craft a business model that allows them to do that.  However, if they are not bothered by this abusive behavior and what surely is neglect, it could very well be that catering to the needs of others for more than just money is not within their capabilities.

It does not matter how often we head to church or how loud we are during the testimony of others.  If we engage in or support any type of abuse or neglect of those who trust us to care for them and add fulfillment to their lives, we have dropped to the bottom of the garbage pile where that uneaten sausage would eventually belong.  What is your focus?

and share your thoughts.


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