Ann and Bill are happily retired, empty nesters. Their kids are grown with kids of their own. Each of their adult children is very busy with careers and their own kids. Ann and Bill are both very much into traveling, volunteering, spending time with their grandkids, and socializing with the many friends they’ve made over the years. They also want to stay healthy and active. And yet, Bill has been noticing some health issues of late.

Bill, ever the realist, reminds Ann that they need to think about their health as they get older and what it will mean for themselves and their children. They both plan to be around for a long, long time! Ann and Bill want to stay at home as long as possible. They plan to do that by finding help when they need it – which for Bill, may be very soon.  Bill has been doing some research on in-home health agencies and is confused. There are so many options in both services and payer sources. He’s not sure what is what. Let’s help him clarify it here in this blog. 

Two Types of Home Health Agencies

In general, agencies providing service to seniors at home are either personal care agencies or home health care agencies. The state of Colorado defines a personal care agency (or Class B agency) as:

“Assistance with activities of daily living, including but not limited to bathing, dressing, eating, transferring, walking or mobility, toileting, and continence care. It also includes housekeeping, personal laundry, medication reminders, and companionship services furnished to a home care consumer in the home care consumer’s temporary or permanent home or place of residence, and those normal daily routines that the home care consumer could perform for himself or herself where he or she physically capable, which are intended to enable that individual to remain safely and comfortably in the home care consumer’s temporary or permanent home or place of residence.”

Personal care agencies are not licensed to provide medical care. The care they provide is defined as Activities of Daily Living (ADL). These activities are done daily and are necessary for independent living. They are listed in the definition above. Other home care services could be grocery shopping and other errands, cooking meals, cleaning, laundry, and other small home-based tasks. Personal home care employees do not need to be licensed health care professionals, however, it is a good practice for these agencies to employ Certified Nursing Assistants (CNA). Colorado requires CNAs and home health aides to have 75 total hours of training that includes at least 16 hours of clinical work. Most personal care agencies will pay for this training to hire and retain staff. 

The other type of home care agency is a skilled home health agency (or Class A agency). Colorado defines this type of agency as: 

“Health and medical services furnished to a home care consumer in the home care consumer’s temporary or permanent home or place of residence that include wound care services; use of medical supplies including drugs and biologicals prescribed by a physician; in-home infusion services; nursing services; home health aide or certified nurse aide services that require the supervision of a licensed or certified healthcare professional acting within the scope of his or her license or certificate; occupational therapy; physical therapy; respiratory care services; dietetics and nutrition counseling services; medication administration; medical social services; and speech-language pathology services. “Skilled home health services” does not include the delivery of either durable medical equipment or medical supplies.”

As you can see from the definition, staff in a skilled home health agency could include many separate specialists including physical therapists, social workers, nutritionists, Registered nurses, and speech therapists. In other words, you will have a whole team of people working with you and your family to keep you well at home. 

How do I know which agency I need?

Your doctor will help you and your family make this important decision, but the state of Colorado offers these guidelines.

When is skilled care required?

  1. General Symptoms/Conditions
    1. Broken skin or inactive skin problems, wound care
    2. Use of prescription ointments, stockings, and exercise
    3. Cannot independently eat, chew, swallow, or is at risk of choking and aspiration
    4. Taking medications or suppositories
    5. Using catheters or enemas
    6. Respiratory care
    7. When the client’s condition requires a nurse
    8. Involves circulatory problems, loss of sensation

When is personal care appropriate?

  1. General Symptoms/Conditions
    1. When medical condition improves and less assistance is needed for functional mobility.
    2. When the client only needs companionship
    3. When the client is fully trained with adaptive equipment
    4. When the client only needs assistance to stand
    5. When the client does not require skilled transfer or ambulation
    6. Medication reminding is not needed

The experts say that the time to move a patient from personal to skilled care is when the patient requires assistance with their mobility and needs help to transfer or ambulate. 

Home Health Licensing

Colorado requires all home health agencies to be licensed by the Health Facilities and Emergency Medical Services Division (Division) in the Colorado Department of Public Health and Environment (CDPHE). This regulation was put in place to address the concern regarding improper patient care and criminal activity by some agencies. It’s worth noting that not every state requires the licensing of home health care agencies. Although not required, some skilled home health agencies also seek accreditation from the Accreditation Commission for Health Care which partners with the Centers for Medicare & Medicaid Services (CMS) to grant national accreditation to agencies that consistently exceed expectations. 

How Much is Home Health Care?

The cost of home health care varies widely across the state and agencies. Experts estimate the average hourly rate for Denver is $30, Fort Collins is $28, and Pueblo is $23. Most agencies require a minimum number of four hours per day. A team of 3 giving round-the-clock care could be somewhere in the realm of $700 per day. 

How Do I Pay for Home Health Care?

Aside from paying out of pocket, there are some governmental sources of payment available for both personal care and skilled care at home. Let’s take a look at Medicaid first. 

Medicaid

In general, Medicaid pays for the long-term and acute care needed by people with limited financial resources. For example, Medicaid will pay for in-home care if it can be provided cheaper than the same care in a nursing home. These costs are paid through Medicaid waivers. Medicaid waivers are for people with disabilities and chronic health conditions. The waivers allow healthcare professionals to provide care in a person’s home or community instead of a long-term care facility.

In Colorado, this program is called the Elderly, Blind, and Disabled Waiver. Seniors have the option to choose their personal care services via the Consumer-Directed Attendant Support Services (CDASS) program. This means they can hire and manage some of their care providers, including relatives.

Under the CDASS program, personal care /attendant care services, including assistance with any of the ADLs are covered. Assistance with other activities involving an applicant’s health, such as managing medications and providing wound care, as well as homemaker services, such as housekeeping, grocery shopping, and meal preparation are also covered.

Under the same waiver, residents can take advantage of the In-Home Support Services Program (IHSS). It is very similar to the CDASS program. Covered services include homemaking services such as meal preparation, laundry, taking out the garbage, and cleaning. They also include ADL services and non-medical care. Some skilled care is included to assist with health-related activities normally performed by a nurse. With IHSS, family members can perform some nursing tasks with agency oversight. 

The differences between these two Colorado Medicaid programs can be subtle. This link is helpful in sorting them out. 

The Home Care Allowance (HCA) is a financial assistance program for elderly, low-income, and/or disabled Colorado residents. It is intended to help participants avoid going to a nursing home by paying for personal care services at home. Program participants use an allowance to pay for assistance with ADLs. Chore services that help maintain the safety and upkeep of the client’s home are also paid for with this program, as are respite care and other forms of caregiver support for unpaid caregivers.

It’s important to note that seniors cannot concurrently receive assistance from the Home Care Allowance program and the Elderly and Disabled Medicaid Waiver or the Adult Foster Care program. Make sure to review the eligibility requirements and payment methods before moving forward. For more information about any state Medicaid program, visit the Colorado Department of Health Care Policy & Financing website. 

What About Medicare? 

Medicare can also help pay for home health care, mainly skilled home care. Medicare doesn’t cover 24-hour-a-day care at home, meals, personal care services, or home services like shopping and cleaning. To qualify for Medicare, you must be homebound. Homebound is defined as needing assistance to leave home. You must also be under a doctor’s care who has ordered skilled services. 

Medicare Part A provides short-term home care after a hospital stay. You may have had surgery or a prolonged illness that makes it necessary to have help at home as you recover. Part A covers your first 100 days of home health care. If you need additional days, you will need to shift to Part B coverage. Regardless of whether your care is covered by Part A or Part B, Medicare pays the full amount of skilled services. 

Recently,  Medicare Advantage (MA) plans have offered supplemental health care benefits. There is some confusion about what defines “supplemental health care benefits.” Some in-home personal and non-skilled services, such as home health aides, may be available. Also, adult daycare, non-medical and medical transportation, and home modifications to aid aging at home could be covered. Coverage will differ depending on the plan you purchase, so be sure to do some research before you make any decisions. For more information about Medicare programs, visit the Medicare website. 

One More Payment Option

Colorado’s Old Age Pension (OAP) program provides financial assistance to older, low-income Colorado residents who are not eligible for Medicaid. The program offers help to attain a minimum monthly income. The amount of income is determined by the difference between the participant’s current income and the minimum acceptable level of income for a particular year. 

In addition to financial assistance, the OAP program provides some health care benefits. This part of the program is called the OAP Health and Medical Care Program. When you enroll in this program, you may receive a grant to pay for some home health services.

Ann and Bill have big plans for their retirement, but moving out of their home is not one of them. With some research and planning, they can find ways to bring help into their home affordably when they need it.