Papa, a health tech startup that offers companionship services to older adults, has invested in new security protocols and stepped-up background checks for home caregivers as the safety of elderly seniors has come into question.
The startup, launched in 2018 with a reported valuation of $1.4 billion, works with payers to tackle loneliness among seniors through companionship and support. The company matches seniors with younger caregivers, called Papa Pals, who socialize and help out with in-home tasks as well as shopping, transportation and assistance with prescriptions. Papa works with Medicare Advantage and Medicaid health plans, and a number of large employer-sponsored programs also offer it as an eldercare benefit.
A recent media report claims that a lack of training and oversight as part of this gig economy solution is putting a vulnerable population at risk.
In an article published May 30, Bloomberg Businessweek reported that a review of more than 1,200 confidential complaint reports logged by Papa over the past four years uncovered dozens of allegations of sexual harassment and assault of both seniors and their caregivers as well as allegations of unlawful imprisonment. These incidents are among a broader range of issues including theft and dissatisfaction with the service’s quality, Bloomberg reported.
One alleged incident led to a criminal complaint filed in Minnesota against one of the company's "pals" based on claims of assaulting a 70-year-old Papa client. That individual is facing charges of criminal sexual conduct, kidnapping and assault with a dangerous weapon, Bloomberg News reported.
In an email interview with Fierce Healthcare staff writer Annie Burky in June, a Papa spokesperson said, "Unfortunately, whenever you connect people in person, there is a chance that safety incidents can happen. Any such incident is unacceptable and we’re deeply saddened when this occurs. While there is no way to completely eliminate that chance, we want to make sure we are doing every single thing we can for the people involved and always work to identify whether we could have done anything to prevent it."
Papa contends its background checks "go beyond the industry standard." Every prospective Papa Pal receives a thorough, three-party review before to being matched with a client and then annually thereafter. This vetting process includes a manual review of the raw data from over 1,300 municipal, state, federal and international databases by specially qualified individuals in addition to analysis by the background check vendor’s software, to avoid potential configuration issues, the spokesperson told Burky.
In areas where courthouses do not have digitized records, an individual is sent in person to check the clerk of court’s paper files to better ensure accuracy and remove blind spots, according to the company. Papa also monitors visits in real time using geolocation technology and continuously monitors feedback from Papa Pals and members about visits.
The company contends it has a "strong safety track record."
"Trust and safety is at the center of our operations and mission and incidents have been incredibly rare," the spokesperson said.
Of the more than 1.6 million visits Papa conducted with members, including both in person and virtual, 0.1% of in-person visits have contained a member-reported safety complaint and 0.3% of visits have contained a Pal-reported safety complaint, the company told Fierce Healthcare Thursday.
Papa says its safety record is dramatically better than traditional home healthcare settings. "Per the U.S. Center for Disease Control, as many as 41% of traditional home healthcare workers have reported sexual harassment," the company spokesperson told Burky.
Since last summer, the company reports it significantly invested in additional caregiver training and education, more than doubling its touch points with "pals." This training now includes a dedicated safety briefing, educating caregivers on safety guidelines and guidance on how to respond in case of an emergency. It also launched Papa Pal Central, a new one-stop-shop content hub with safety and other educational information.
In February 2023, before the Bloomberg article was published, the startup began an end-to-end review of its security, safety and background screening policies and procedures for both members and Papa Pals. For this review, the company tapped an outside trust and safety expert, Robert Chesnut, whose 30 years of experience spans the U.S Department of Justice, eBay and Airbnb, the spokesperson said.
The company exclusively shared with Fierce Healthcare on Thursday a road map for new safety and security measures, policies and protocols that it has implemented or plans to roll out over the next three to six months.
Among the changes, Papa plans to bring in external trust and safety advisers and uplevel its internal trust and safety organization. The company also will invest in more required training for its Papa Pal caregivers, step up its Papa Pal screening and onboarding processes and develop additional in-visit and post-visit safety features, according to the road map provided to Fierce Healthcare.
The company instituted a new background checks process for Papa Pals earlier this year, before the safety review, and contends that its current background checks "go above the industry standard." These checks include a Social Security number trace; sex offender registry; motor vehicle records; local, county and national criminal records; federal courthouse criminal; and Global Watchlist. Papa says it also screens monthly against the Office of Inspector General’s List of Excluded Individuals/Entities.
The startup also conducts a manual background check review, which includes a specialist review of the raw data from government databases and courthouses, as a supplement to the automated review.
After the safety review, the company implemented new policies that now make more of the voluntary training currently offered mandatory. This additional mandatory training will include sexual and other workplace harassment, responding to emergency situations and cultural competency during onboarding as well as ongoing contextual training, the company said.
Papa also is implementing new in-visit and post-visit safety features including more secure communication channels, such as number anonymization and additional identity verification tools to ensure the right Papa Pal is seeing the right member.
The company also stepped up efforts to improve its emergency response, including a dedicated and highly visible emergency button in the Papa app and making it easier for clients to report visit problems within the app.
The company highlighted safety and security measures it already had in place before the review, including required training for pals. Since Papa's founding, caregivers have been required to complete Centers for Medicaid & Medicare Services (CMS) fraud, waste and abuse training and HIPAA and sensitive handling of personal information training as well as general compliance training. Pals also have been required to complete safety training on the types of tasks Papa Pals can and can’t help with, support available via the Care Team and pay prior to gaining access to member visits on the Papa Pal platform.
Papa also formalized its visit standards, which are the expectations for Papa Pal behavior before, during and after a visit to ensure a safe and enjoyable experience for everyone involved.
The changes were announced the same day U.S. Senate Committee on Aging Chairman Bob Casey, D-Pennsylvania, posted online a letter he sent to Papa CEO Andrew Parker requesting information about its background check system.
“With the increasing demand for home care services to enable older adults and people with disabilities to live at home, service providers must ensure they are offering their clients the opportunity to live safely. Similarly, care workers deserve to be treated with dignity. The allegations of abuse by both Papa care workers and clients, as well as the lack of training and oversight to prevent and address future problems, raise deep concerns,” Casey wrote in the letter.
In the letter, Casey asked Papa to provide a range of information, including its recent complaints, safety procedures and the adequacy of its vetting process.
Insurers had to submit their plans to CMS by the first week of June detailing the benefits they plan to offer their members in this fall's open enrollment. CMS then approves those offerings. A CMS spokesperson told Bloomberg the agency has been “reviewing complaints and grievances that allegedly involve Papa.” Most complaints revolve around customer service, but CMS said it’s also aware of the allegations and “serious concerns” described by Bloomberg Businessweek.
Papa's spokesperson said the company actively cooperates with its clients and CMS to "uphold the highest quality standards for members and Papa Pals, and will continue to do so."
Americans ages 65 and older are expected to mushroom over the next four decades with 1 in 9 stating that aging at home is a top priority.
The gig workers who visit Papa enrollees do everything from assist in light housework to grocery shopping, technology navigation or transportation to doctors’ appointments.
The overwhelming majority of members report a positive experience with the Papa service—rating Pals 4.75 stars out of 5, on average, the company claims.
Beyond assisting seniors with mundane daily chores, Papa also rolled out a Social Care Navigation service to uncover and address social drivers of health that may otherwise be missed. The program has assisted with things such as getting members on SNAP benefits, ensuring members maintain their Medicaid coverage and preventing low-income members from being evicted, according to the spokesperson in an email to Burky.
"As the gap between those who need care and those who have access continues to widen, our role will become even more important. This isn’t to say there haven’t been bumps along our journey—but we’re continuing to learn and improve along the way," the spokesperson said.
Big-name investors including SoftBank and Tiger Global Management have backed Papa, and the startup has raised $240 million to date. A $150 million series D round in 2021 boosted its valuation to $1.4 billion, according to the startup.
Beyond traditional home health services, there are other startups targeting eldercare, and investors are pouring money into the market. Approximately 10,000 American adults are turning 65-plus each day. About half of older adults have at least one unmet fundamental social need around areas such as transportation, food or housing.
Senior care startup DUOS also helps place expert personal assistants, called Duos, into the homes of seniors. The company works directly with consumers as well as with payer and provider organizations. Last year, the company banked $15 million in a series A round backed by Optum's venture arm.