Archive for January, 2011

New for 2011: Licensing of Colorado Home Care Agencies

January 24, 2011

 As of January 1, 2011, all Colorado home care agencies must be licensed.  This is a good thing for consumers.  Licensing of agency staff and caregivers means background checks, qualification standards, insurance and bonding, training, supervision, patient record keeping…all the things you would want for your loved ones.  There are two levels of  home care agency licensing:

Class A license. This allows a home care agency to provide both skilled and non-skilled care.  Examples of skilled care include therapeutic treatments (physical, speech, and occupational therapy), wound care, actual medication administration, and home infusion services.

Class B license. Home care agencies with a Class B license may only provide non-skilled care (sometimes called non-medical, personal care, or custodial care services).  Non-skilled care primarily consists of  assistance with the Activities of Daily Living (bathing, dressing, eating, toileting, incontinence and transferring).  Homemaker services, such as housecleaning, meal preparation and laundry are a sub-category of non-skilled care.  The Class B license also permits the caregiver to remind people to take, but not actually administer, medications.

It is important to confirm that a home care agency has obtained the proper licensing before beginning caregiving service. 

Note: Colorado home care placement agencies are not required to be licensed.  A home care placement agency merely provides caregiver referrals to consumers seeking home care services.  Caregivers obtained through a home care placement agency are employees of the person paying for their services.  This means the consumer is responsible for payroll taxes and workers compensation insurance, supervision and any other employment (hiring and termination) issues.  When my mother required 24/7 home care, I engaged a home care agency, not a home care placement agency.  There was enough going on at that time.  I did not need the additional burden of becoming the caregiver’s employer.  My recommendation is that you do the same.





Disclaimer: Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice.  Consult your tax advisor or attorney for these matters.


© Raymond Smith, The Long Term Care Specialist, 2011


Hands-on Caregiver or Care Advocate?

January 24, 2011

When a parent needs ongoing help getting through the day, the family often decides to provide needed home care themselves.  More accurately, an adult daughter or daughter-in-law usually becomes the hands-on caregiver.  This occurs in families of modest means as well as those with significant wealth.

Let’s explore what it means to be a hands-on caregiver:

1. Initially, the caregiver feels good about her decision.  It is the right thing to do.  Other siblings also feel good about the decision.  They are off the hook.

2. The caregiver’s everyday life is constrained.  Employment opportunities, existing or potential, become limited.  It is difficult or impossible to accept increased job responsibilities.  Less and less time is available for friends.  The caregiver finds it hard to find the time to take care of her own chores.  She becomes overloaded and isolated.

3. Personal relationships are stressed.  The caregiver is away more often and for longer periods of time.

4. Both the caregiver and the parent needing care suffer a loss of dignity as the parent/child relationship is reversed.  Now the child bathes the parent and perhaps helps with toileting.

5. Caregiving is hard, physical work that never seems to end.  Watching a loved one deteriorate, both physically and mentally, takes a huge emotional toll.  As shown by several studies*, caregivers burn out quickly and their own health suffers.

6. Sooner or later, the caregiver becomes resentful about her disproportionate burden.  The relationships between family members become strained and are sometimes broken.

Now let’s look at the the care advocate:

1. The care advocate manages the needed caregiving rather than providing the care herself.

2. Instead of bathing Dad, she makes sure the professional caregiver does so safely and while respecting his dignity.

3. The care advocate drops in at various times and tells Dad she loves him.  The care advocate evaluates the quality of care being provided.  She spends quality time with Dad without having to do the emotionally draining caregiving work.  The care advocate evaluates the quality of caregiving and if necessary, replaces the professional caregiver with one who treats Dad with the skill and compassion that he deserves.

4. The care advocate still has a life while ensuring that Dad is well-cared for.  She can continue her career if desired, continue with her education, maintain her spouse or significant other relationship, and keep friendships.  Family relationships do not become strained and her health is not threatened.

How does an adult child become a parent’s care advocate instead of a hands-on caregiver?  The answer is money and a willingness to spend it on professional caregiving.  Long Term Care insurance provides cash that can only be used for  professional caregiving services…so it gets used for its intended purpose…transforming a hands-on caregiver into a care advocate.  My experience has been that within families who can afford (without the benefit of insurance) to pay for professional caregiving, an adult child is frequently encouraged to be the caregiver.  I do not understand the psychology of this tendency, only that it exists.

Concluding comments:  I said that an adult daughter or daughter-in-law usually becomes the parents’ hands-on caregiver.  While this is true, it is not always the case.  Men also become caregivers, although not as frequently.  Contrary to what my readers may think, a Long Term Care crisis more often pulls families apart rather than bringing them together.  The root cause of this family tension, once you get below the surface, is usually money…if dollars are spent on care, they will not be available for the heirs.  This can become amplified with blended families (“Why should my Mom spend our money on his care?”).  Again, families sometimes become closer, but this is not the norm.

*Footnote:  Schultz, R Beach SR. Caregiving As a Risk Factor for Mortality: The Caregiver Health Effects Study. JAMA 1999.   The MetLife Study of Working Caregivers and Employer Health Care Costs.  MetLife Mature Market Institute. February 2010.

Disclaimer: Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice.  Consult your tax advisor or attorney for these matters.

 © Raymond Smith, The Long Term Care Specialist, 2011