Home Care Licensure Will Protect Seniors

Eileen DohertyDenver, CO — Most older adults prefer to live in their own home for as long as possible. In 2011, 8.6 million Americans used home care according to the Joint Commission. The general consensus is that individuals have better health outcomes if they live in their own home.

However, two of the most frequent reasons that older individuals who use home care are re-admitted to the hospital is due to medication errors and falls. These incidents often occur because hospitals discharge patients with shorter hospital stays. Most patients are sicker when they are released, thus making the need for highly skilled home care even more important. Medicare pays for many of these home care stays.

Many individuals also need personal care with such things as cleaning, bathing, laundry and grocery shopping. This care is often provided by home care agencies which specialize in serving those who pay privately or who have Medicaid as a payer source.

In Colorado agencies who provide skilled services are licensed by the Colorado Department of Public Health and Environment (CDPHE) with a Class A licenses. Agencies which provide more custodial assistance or non-medical services have a Class B license. These agencies hire their staff, provide training, conduct background checks, secure appropriate liability insurance, and monitor the care that is provided to the older adult.

Colorado also has several other models that are used to provide more patient directed care. These are home care placement agencies, consumer directed attendant support services (CDASS), and in-home support services (IHSS). These agencies provide similar administrative services, but are more focused on patient centered care. The agencies are responsible for background checks, helping to monitor the care and ensure that services are provided to meet the needs of the patient. Patients are more involved in the directing the care.

One model, home care placement agency, is registered with the CDPHE. The placement agency is responsible for working with the patient and finding an individual who works as an independent contractor under the supervision of the older adults. The older adult is responsible for hiring and paying the care giver, as well as providing training, supervision, and oversight.

Another model is the Consumer Directed Attendant Support Services model in which the client hires their own staff (possibly even family members), is responsible for training, supervision, and paying the client (through a third party vendor).

The last model that is used in Colorado is In Home Support Services (IHSS) is available to Medicaid clients. The Medicaid approved home health agency agrees to hire the attendant that is identified by the client. The agency also is responsible for providing training and paying the caregiver, as well as providing 24-hour back-up in case the care giver needs additional support.

Per Colorado law, the continuation of licensure of home care agencies was reviewed in the summer of 2013. The major recommendations of the Home Care Sunset Review include: a) continuation of licensure; b) improvement of background checks to prevent abuse, neglect and exploitation, and c) increased oversight of home care placement agencies. The Colorado legislature will be asked to continue this licensure in the 2014 session.

The benefits of licensure of Class A and Class B agencies are improved standards of care. Agencies are required to provide minimum training for administrators and staff, supervision of care that meets minimum industry standards, background checks of all staff, and care plans that meet the needs of the patient.

With licensure, consumer protection is enhanced because complaints about care can be investigated. Occurrences such as thefts, financial exploitation, medication errors and other abuses can be reported and CDPHE investigates the situation to determine if anyone is at fault and to provide assistance to the victim.

With the support of the Colorado legislature, patient protections in home care are ensured with licensure and oversight. For more information about home care call 303-333-3482.


Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society since 1982. She has almost 40 years of experience in education and training, advocacy, clinical practice, and research in the field of gerontology. She is an adjunct instructor at Fort Hays State University teaching non-profit management. She can be reached at 303-333-3482 or at doherty001@att.net.


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