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 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 more quickly. Most patients are sicker when they are released, thus
making the need for skilled home care more important.
Many individuals also need personal care with such things as cleaning, bathing, laundry and grocery shopping. This care is often provided by agencies which specialize in serving those who pay privately or who have Medicaid.
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. The 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 focused on patient centered care. The agencies are responsible for background checks, helping monitor care and ensure that services meet the needs of the patient. Patients are involved in the directing 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 adult. The older adult is responsible for hiring and paying the caregiver, providing training, supervision, and oversight.
Another model is the Consumer Directed Attendant Support Services model in which the client hires their own staff, is responsible for training, supervision, and paying the client.
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, and providing 24-hour back-up in case the caregiver 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 the icensure
in the 2014 session.
The benefits of licensure of Class A and 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. 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 can
be reached at Email Eileen.