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Denver Coordinated Workgroup

The Denver Coordinated Workgroup is made up of experts from the field of aging who are committed to creating and sharing information in order to guide people to the services they need to thrive as they grow older. The Denver Coordinated Workgroup created several resource guides to give an overview of what services are available to older adults and caregivers. 

Detailed Guide to Services

Taking care of your teeth and gums as you get older is an important part of maintaining overall health. Dental care focuses on prevention, diagnosis, and treatment of diseases of the teeth and gums. A general dentist can provide preventative care and maintenance. If more advanced care is needed, you can be referred to a specialist.

How do I get this?

Medicare – Medicare does not cover routine dental care but may cover disease-related services like those needed to treat oral cancer. You may have dental coverage through supplemental insurance or an Advantage Plan. To find out, call the customer service number on the back of your health insurance card. If you would like to purchase supplemental insurance or an Advantage Plan, call your local State Health Insurance Assistance Program (SHIP) office at 1-888-696-7213. You may only be able to purchase this type of coverage at certain times of the year.

Private Pay - Some people purchase dental insurance – contact your local State Health Insurance Assistance Program (SHIP) office at 1-888-696-7213 to ask about options.  If you have dental insurance, call your insurance company to find out what services are covered. Also, the front desk person at your dental clinic may be able to help explain your benefits. Click the link below to see a list of dentists – always check to make sure the dentist accepts your insurance.

Colorado Dental Association - Find a Dentist: www.findadentist.ada.org

Public – There are public programs that help with the cost of dental care.  You usually have to go through an application process to see if you are eligible.  

  • Medicaid / OAP - Depending on your income, you may qualify for Medicaid to pay for your dental care. The Colorado Medicaid Dental Program is run through an agency called DentaQuest. Those who receive Old Age Pension (OAP) also receive limited dental benefits through DentaQuest. If you already receive Medicaid or OAP, contact DentaQuest to learn more about your coverage: 1-855-225-1729 -- you will need to have your Medicaid ID handy. To find out if you qualify for Medicaid or OAP, you can:
    • contact your county Department of Human Services for eligibility guidelines and an application
    • visit secure.force.com/AC_Welcome to complete an application online
  • The Colorado Dental Health Care Program for Low Income Seniors provides services for older adults who do not qualify for Medicaid but who make less than 250% of the Federal Poverty Guideline. In 2017, you need to make less than $2,512/month for a 1-person household or less than $3,383/month for a 2-person household. Call 1-800-221-3943 for more information and a list of providers in your county. You can also find a list here: colorado.gov/pacific/hcpf/colorado-dental-health-care-program-low-income-seniors -- click on “Grantee Appointment Information by County page”

Veterans - You may be eligible for dental services and should contact your county Veteran Services Office (VSO) for more information: https://www.colorado.gov/pacific/vets/county-veterans-service-offices. You can also call the Colorado Division of Veterans Affairs: 303-284-6077 (Denver location) or 303-914-5832 (Lakewood location).

Community - Private and public organizations periodically assist in special circumstances. For more information, call your Area Agency on Aging / Aging & Disability Resource Center: 1-844-265-2372 (statewide).  You can also call the Colorado Gerontological Society at 1-855-293-6911 for other options.

Things to consider

If you need to have expensive dental work done, ask for an estimate for the services before they are provided to you. Once you have an estimate, you can see a different dentist to ask for a second opinion. Then you can decide which is best and most cost-effective for you.

If you plan on applying for financial assistance to help cover your dental costs, do not start your dental care until you submit an application and receive an answer as to whether or not you’re approved for assistance. Often, financial assistance will not cover care that has already been started so it is important to plan ahead. Note: if you have a dental emergency, seek care immediately.

Most people go to a dentist office for routine care. There are also mobile clinics that may offer services in your area. If you are homebound, some dental hygienists will come to your home for teeth cleanings.  

Need more assistance or want to talk with someone?

  • Aging & Disability Resources for the Denver Metro Area: 303-480-6700
  • Aging & Disability Resources for Colorado: 1-844-265-2372
  • Colorado Gerontological Society: 1-855-293-6911
  • Eldercare Locator (a national hotline for aging resources all over the US): 1-800-677-1116

 

Who provides dental care and how they are licensed:

Dentists are licensed to practice dentistry with either a DDS (Doctor of Dental Surgery) or a DMD (Doctor of Medicine in Dentistry, or Doctor of Dental Medicine). These degrees are the same – it just depends on what the university calls their program.

Dental hygienists are licensed to clean teeth and gums. They also teach you how to take care of your mouth at home. Their professional organization is the Colorado Dental Hygienists’ Association: www.codha.org.

Dentists and dental hygienists must renew their licenses every other year:

Colorado Department of Regulatory Agencies - Verify a Professional License www.colorado.gov/dora/licensing/Lookup/LicenseLookup.aspx  

Dental assistants work closely with dentists on certain dental procedures and often help with tasks before and after the dentist meets with you.

To file a complaint about a dental professional:

Colorado State Board of Dental Examiners

www.colorado.gov/pacific/dora/Dental_Board

Click on these links for more information:

Mouth Healthy (from the American Dental Association for consumers): www.mouthhealthy.org

Frequently Asked Questions – Colorado Dental Association: www.cdaonline.org/public/publiced/frequently-asked-questions

Estate planning should be completed while you are alive. Estate planning is when you prepare documents to tell others how to take care of yourself and your assets. Some documents go into effect after you die; others go into effect if you are alive and not able to communicate your wishes (i.e. if you have dementia or are in a coma). These documents can also be used if you need temporary assistance to manage your financial or medical matters, for example, having someone else pay your bills while you are in rehabilitation.  

How Do I Get This?

An estate plan is usually made with an attorney but you can also fill out many of these forms on your own -- see “Legal Assistance” resource guide for more information. An estate plan should be reviewed annually to be sure they still reflect your wishes. You can revoke or update these documents at any time before you become incapacitated.  

Estate plans may include:

  • Advance Medical Directives
  • Financial Power of Attorney
  • Wills and Trusts

The term “Advance Medical Directives” refers to the documents that allow you to plan ahead in writing to make sure your consent or refusal for medical treatment is respected in situations where you cannot communicate yourself.  

By signing an advance medical directive, you are not giving away your right to make medical decisions when you are able to communicate them. It simply makes your beliefs and wishes known in the event that you are not able to communicate for yourself.  

Advance medical directives include:  

  1. Medical Durable Power of Attorney (MDPOA) is a document where you designate who can make medical decisions for you if you become unable to do so yourself. By selecting this person and preparing this document, you make your wishes known to the medical community and your loved ones. Additionally, veterans who are registered with the VA medical center must have a separate MDPOA called a VAPOA generated by the Veterans Administration -- ask your VA healthcare provider for more information.
  2. Living Will is a document that tells healthcare providers and appointed representatives what life-sustaining treatments you do or do not want in the event that you have a terminal condition and cannot make your own decisions, or if you are in a persistent vegetative state. Your healthcare providers must follow your instructions.  
  3. CPR Directive is a form that allows you to choose if you want cardiopulmonary resuscitation (CPR) in an emergency. It tells healthcare providers not to resuscitate you if you stop breathing or your heart stops beating. A CPR Directive is signed by your healthcare provider after you’ve had a discussion about whether or not you want CPR performed.  

You may also hear about a do-not-resuscitate (DNR) order. This form is filled out for your medical chart if you are receiving care in a healthcare facility and do not want to be resuscitated if your heart or breathing stops. It is also filled out if you go on hospice services. A DNR expires when you are discharged from the facility or from hospice so if you return to the facility or start hospice services again, a new DNR order will need to be completed. Signing a CPR Directive or a DNR order does not mean you will not receive treatment for other things like infections or broken bones.

  1. The Medical Orders for Scope of Treatment (MOST) form is a bright green, two-sided document that becomes a set of medical orders when signed by your healthcare provider. Where a Living Will is a legal document, the signed MOST form is a medical order. The MOST form overrides a Living Will but the MOST form should reflect the wishes in a current Living Will.

Financial Power of Attorney is a form giving someone else the authority to manage your finances, property, and other business actions (for example, pay bills). It is called a Durable Power of Attorney if it only goes into effect when you are incapacitated. Your power of attorney must follow your preferences listed in this document and cannot override them. You can have a Limited Power of Attorney which allows someone to do specific tasks for you such as cashing checks.  

Upon death, advance directives and power of attorney forms become null and void. Wills and trusts give direction on how to manage remaining assets of the deceased person.  

Things to consider   

You are encouraged to work with an attorney to complete your advance medical directives but the forms are also available through many healthcare offices and online. Make sure you use a Colorado form since requirements vary by state. It is optional but encouraged to have them notarized. Here are two options:

Colorado Hospital Association - Advance Directives:

Colorado MOST:

  • English

    The MOST is intended to be communication tool between you and the medical community. Because English is the primary language for healthcare in Colorado, the Spanish version is not an acceptable medical order.  It can be used to help discuss options and ensure understanding but you must sign the English-language form in order for it to be official.

Quick tip: Do not keep these documents in your safe deposit box. Keep your original with other important documents that are easily accessible, tell your appointed representatives where they are located, and give copies to your healthcare providers and appointed representatives.

What happens if I don’t complete my estate planning forms?

Others will make these decisions for you and may have to pursue legal action in a case where you can’t communicate for yourself. If you do not designate a representative to act on your behalf and you become incapacitated, the courts can order someone else to manage your care or your resources:

  • Medical (or Healthcare) Proxy: In Colorado, if you do not choose someone to be your healthcare agent on your MDPOA form, healthcare providers may choose an alternate decision-maker called a “medical proxy” to make healthcare decisions for you if you can’t. Medical professionals will make an effort to contact all the people whom they believe have an interest in your care and then try to reach consensus about who will serve as the proxy decision-maker. They must make an effort to inform you of the decision. You have the right to contest a proxy chosen for you. For more information: cobar.org/For-the-Public/Advance-Medical-Directives
  • Conservatorships are when someone else manages your estate and finances. Conservatorships are appointed by a judge in the courts when they determine you are unable to make financial decisions for yourself.
  • Guardianships are court-appointments made by a judge designating someone to oversee your personal affairs including where you live or what healthcare providers you see. Guardianships are put in place when a court determines you are unable to make decisions for yourself. A representative cannot be both a guardian and a conservator.
  • Elder Probate/Mediation is a less formal and usually less expensive way than going through court to settle conflicts related to wills, trusts, conservatorships/guardianships, end-of-life decisions, family disputes, and more. Mediation is available at any time. It is helpful in maintaining relationships and when the interested parties are open to negotiation.

How do I get assistance or talk to someone?

Find an Elder Law Attorney: www.naela.org/Public/Find_a_Lawyer/Find_Lawyer.aspx

How to Choose a Lawyer: www.cobar.org/For-the-Public/How-to-Choose-and-Use-a-Lawyer

  • Colorado Legal Services: (303) 837-1313 (limited legal assistance available to people over the age of 60)
  • Disability Law Colorado: 1-800-288-1376 or visit disabilitylawco.org (limited legal assistance for people with disabilities)
  • Aging & Disability Resources for the Denver Metro Area: (303) 480-6700
  • Aging & Disability Resources for Colorado: 1-844-265-2372

Quick Tip: Many attorneys will provide a free initial consultation regarding a variety of interests and concerns. Ask about this before scheduling your first appointment.  

To file a complaint about a lawyer, call the Office of Attorney Regulation at 1-877-888-1370.

Self-Help or Low-Cost Services

See a list of low-cost legal services on the Colorado Bar Association’s website or consider attending a Senior Law Day or a Legal Clinic if you want more specific legal information: www.cobar.org/For-the-Public.

Colorado Senior Law Handbook: www.cobar.org/seniorlawhandbook

Our vision changes as we age. Some eye diseases that cause vision loss have no symptoms. That’s why it’s important to receive yearly eye exams to maintain your eye health. If more advanced care is needed, your eye doctor can refer you to a specialist.

How do I get this?

Medicare – Medicare provides limited coverage when it comes to eye care depending on your risks and medical conditions:

  • Routine Eye Exams:
    • A yearly exam for those with diabetes
    • A yearly exam for those at high risk for glaucoma (which includes having diabetes, a family history of glaucoma, if you are 50-years+ and African American, or if you are 65-years+ and Hispanic/Latino)
    • Diagnostic tests and treatments for some people who have macular degeneration
  • Eyeglasses or Contact Lenses: Medicare may cover eyeglass lenses (frames not included) or contact lenses once a year for those who have had cataract surgery.
  • Medical Procedures/Surgery: Medicare may cover surgeries that are medically-necessary including cataract surgery.  Be sure to talk to your eye doctor about what is covered before scheduling surgery.

You may have eye care coverage through supplemental insurance or an Advantage Plan – these are purchased in addition to original Medicare. To find out if you have this kind of coverage, call the customer service number on the back of your health insurance card. If you would like to purchase supplemental insurance or an Advantage Plan, call your local State Health Insurance Assistance Program (SHIP) office at 1-888-696-7213. You may only be able to purchase this at certain times of the year.

Private Pay ‐ Some people purchase private insurance. If you have vision insurance, call your insurance company to find out what services are covered. Your eye doctor’s office can also help explain your benefits. Call your local State Health Insurance Assistance Program (SHIP) office at 1-888-696-7213 to find out more about private vision insurance.

Medicaid ‐ Depending on your income, you may qualify for Medicaid to pay for limited eye care.

  • Eye exams are covered for “problem-focused” visits.
  • Glasses are covered only after eye surgery
  • Contact lenses are only covered if there’s a medical reason
  • Other vision aids are covered with prior authorization

Contact your county Department of Human Services for eligibility guidelines and a Medicaid application or visit coloradopeak.secure.force.com/AC_Welcome to complete an application online.

If you are on Medicaid, visit www.colorado.gov/hcpf/find-doctor. Use the options on the left side to select “optometrist” or “ophthalmology,” and search by your location to get a list of providers in your area.

Veterans ‐ You may be eligible for services. Contact your county Veteran Service Office (VSO) for more information: https://www.colorado.gov/pacific/vets/county-veterans-service-offices. You can also call the Colorado Division of Veterans Affairs: 303-284-6077 (Denver location) or 303-914-5832 (Lakewood location).

Community ‐ For financial assistance options, call your Area Agency on Aging / Aging & Disability Resource Center: 1-844-265-2372 (statewide) or the Colorado Gerontological Society at 1-855-293-6911. If you do not have vision insurance and are not on Medicare, Prevent Blindness has a list of low cost options: www.preventblindness.org.

If you plan on applying for community financial assistance, do not start your vision care (get an exam or order your eyeglasses) until you submit an application and receive an answer as to whether or not you’re approved for assistance. Often, financial assistance will not cover care that has already been started, so it is important to plan ahead.

A3 – Adapt, Adjust, Achieve offers personalized, respectful support for people going through vision loss. Their services may include in-home help to learn how to maintain independence, adaptive aids from talking watches to magnifying devices, support groups, and Orientation & Mobility (O&M) training to encourage successful independent living. 303-831-0117 or 888-775-2221; www.a3colorado.org

Colorado Center for the Blind offers an Independence Training Program (ITP) for people experiencing vision loss including: home management, cane travel, Braille, and computer and adaptive technology. They also offer support groups and in-home training for older adults. 303-778-1130 or 800-401-4632; www.cocenter.org  

Assistive Technology Partners provides a list of assistive technology funding resources, one-on-one assessments/consultations on how to use adaptive devices, and a device exchange program through the University of Colorado College of Engineering & Applied Science. 303-315-1280; www.assistivetechnologypartners.org

Audio Information Network of Colorado gives people with vision loss have audio access to printed materials like newspapers, magazines, grocery ads and other local publications. English and Spanish are available. 303-786-7777 or 877-443-2001; http://aincolorado.org/

Talking Book Library provides recorded, Braille, and large-print books and magazines on loan. 303-727-9277 or 800-685-2136; www.cde.state.co.us/ctbl/  

Things to Consider:

Remember that you can always ask for an estimate for any eye care before you receive services. This way, you can seek a second opinion to compare costs before making a decision.

Need more assistance or want to talk with someone?

  • Aging & Disability Resources for the Denver Metro Area: 303-480-6700
  • Aging & Disability Resources for Colorado: 1-844-265-2372
  • Colorado Gerontological Society: 1-855-293-6911
  • Eldercare Locator (a national hotline for aging resources all over the US): 1-800-677-1116

Who provides eye care and how they are licensed:

Optometrists are licensed with a doctor of optometry (OD) degree. They provide primary vision care which includes routine eye exams, vision tests, and fitting of glasses and contacts. An optometrist is not a medical doctor.

The National Board of Examiners in Optometry - Verify a Professional License: www.optometry.org/credentialing/

Ophthalmologists are medical doctors who have graduated from medical school and completed specialized training. They diagnose and treat eye diseases, perform eye surgery, and fit glasses and contacts.

American Board of Ophthalmology - Verify a Professional License: www.abop.org/verify-a-physician

Opticians are trained to design and fit glasses and contact lenses. They use prescriptions provided by ophthalmologists and optometrists. They do not perform vision tests, diagnose or treat eye diseases.

Click on this link for more information:

American Academy of Ophthalmology: www.aao.org/eye-health

Hearing loss usually happens gradually so you may not notice it at first. It is important to see your doctor regularly if you notice any changes in your hearing. Hearing tests and hearing aids are expensive and not covered by most insurance. Once you have hearing aids, consider adding them to your homeowner’s or renter’s insurance policy so that if they are lost or damaged in your home, you can get them replaced.

How do I get this?

Medicare - Medicare does not cover routine hearing tests or hearing aids. However, if your doctor or other healthcare provider orders a hearing test or balance exam because they suspect your hearing problems are related to a medical condition, then your care may be covered. These exceptions can be complicated – work with your doctor’s office to be sure you understand your coverage.

You may have hearing coverage through a supplemental insurance or an Advantage Plan – these are purchased in addition to original Medicare. Call the customer service number on the back of your health insurance card to find out if you have coverage.

To purchase supplemental insurance or an Advantage Plan, call your local State Health Insurance Assistance Program (SHIP) office at 1-888-696-7213. You may only be able to purchase this type of coverage at certain times of the year.

Medicaid ‐ Medicaid does not cover hearing care for individuals over the age of 20 unless you have a cochlear implant that you received when you were younger and now need it replaced. If you have Medicaid, visit www.colorado.gov/hcpf/find-doctor. Use the options on the left side to select “audiologist” and search by your location to get a list of providers in your area.

Veterans ‐ Call your county Veteran Service Office (VSO) for more information: https://www.colorado.gov/pacific/vets/county-veterans-service-offices or call the Colorado Division of Veteran Affairs: 303-284-6077 (Denver location) or 303-914-5832 (Lakewood location).

Community -If you plan on applying for community financial assistance, do not start your hearing care (get a hearing test or order hearing aids) until you submit an application and receive an answer as to whether you’re approved.

Colorado Gerontological Society: 1-855-293-6911; provides limited assistance for hearing tests and hearing aids; may be able to refer to other assistance

Area Agency on Aging / Aging & Disability Resource Center:1-844-265-2372 (statewide)

May be able to refer to other assistance

Marion Downs Hearing Center / Center for Hearing, Speech and Language:303-322-1871

Hearing tests, hearing aids and other hearing-related services for those with and without insurance. If you don’t have insurance, you may qualify for financial assistance. Call to see if you are eligible; will also take private pay.

Hearing Rehab Center:303-502-9720

Hearing tests and hearing aids as well as other hearing-related services for those with and without insurance; multiple locations around the Denver metro area. Payment plans available.

Things to consider:

  • Add hearing aids to your homeowner’s or renter’s insurance policy so that if they are lost or damaged in your home, you can get them replaced.
  • Ask for a quote for hearing tests or hearing aids before you receive them so you are aware of how much they will cost. You can always ask a different clinic for a second opinion and compare costs.
  • Keep hearing aids out of reach of dogs and cats – they love to chew on them!
  • If you go to the hospital, make sure to tell the nurse you have hearing aids in and be sure they record and keep them somewhere safe while you are being treated.

Need more assistance or want to talk with someone?

  • Colorado Gerontological Society: 1-855-293-6911
  • Aging & Disability Resources for the Denver Metro Area: 303-480-6700
  • Aging & Disability Resources for Colorado: 1-844-265-2372
  • Community Helpline: 2-1-1
  • Eldercare Locator (a national hotline for aging resources all over the U.S.): 1-800-677-1116

Who provides hearing care and how they are licensed:

Otorhinolaryngologists are doctors who specialize in medical problems and care of the ear, nose and throat. They are also known as ENT doctors. An ENT doctor is trained in general medicine and completes additional training to become board certified by the American Board of Otolaryngology. Some receive further credentialing to perform surgical procedures. Verify a doctor’s certification at www.aboto.org.

Audiologists are specialists trained in hearing loss, testing, and treatment options. An audiologist can fit hearing aids and make other suggestions for other devices that may help your hearing. The American Speech-Language-Hearing Association offers certification and continuing education. Find an audiologist in your area at www.asha.org/public.

Hearing Aid Specialists provide basic hearing tests, counseling, and fits and tests hearing aids. They usually work in hearing aid provider stores. The National Board for Certification in Hearing Instrument Sciences provides continuing education and certification to them. Find a hearing aid specialist in your area at www.asha.org/certification.

Click on these links for more information:

In-home care becomes necessary when circumstances such as illness, cognitive decline, frailty or injury make it difficult to remain safe and comfortable in one’s own home. There are two levels of in-home care available -- skilled or medical, and non-skilled or non-medical. You may require services from both types, or services could be provided by one or the other depending on your level of care needed.

How do I get this?

Use the list below to identify regular tasks and determine what you can do by yourself, what your family and friends are able to help with, and what is not being done. Once you have identified what you need help with, use these tasks to write a job description for what your in-home worker will be paid to do. This list is also helpful if you hire an agency which will create a care plan based on these tasks.

Tasks

  1. Bathing – standby or hands-on assistance with bathing in tub, shower, or bed.
  2. Personal (Non-Skilled/Non-Medical) Care – assistance with dressing, brushing teeth or denture care, shaving, hair care, foot care and grooming needs.
  3. Skilled (Medical) Care - care by a licensed nurse (or someone working under a licensed nurse) to manage medical needs including wound care, catheter changes and setting up medications.
  4. Medication Assist – reminding and/or assisting an individual to take medications correctly.
  5. Toileting – assistance with toileting or incontinence products.
  6. Ambulation – help walking, using a wheelchair, or other assistive device.
  7. Transfers – assistance movement from wheelchair, tub, bed, toilet, automobile, etc.
  8. Positioning – turning or changing an individual’s position to avoid discomfort or injury.
  9. Range of Motion – providing assistance in movement of legs and arms as directed by a physician or physical therapist.
  10. Eating and/or Feeding – assisting with eating.
  11. Meal Preparation – preparing nutritious meals to eat immediately or reheat later.
  12. Errands/Appointments – transporting or escorting to shopping, appointments or errands.
  13. Housekeeping – maintaining a safe, sanitary environment with a special focus on kitchen, bathroom and laundry.
  14. Supervision – providing protective supervision for individuals who are not safe if left alone because of confusion or poor judgment.

Frequently Used Terms

As you begin the search for an in-home worker, you may hear some terms which are unfamiliar to you. These terms can give you an idea of the level of care you may be looking for. Be aware that some are used by home care agencies to assign costs.

  1. Activities of Daily Living (ADLs): These are specific activities that individuals must perform with or without assistance to live independently including bathing, dressing, eating, etc.
  2. Companion – A companion provides social contact, going along on walks or errands.
  3. Homemaker - Housekeeping, grocery shopping, laundry/linen changing, and meal preparation (but no personal care).
  4. Personal Care - Dressing, bathing, hair care, ambulation, medication reminders and other non-skilled personal care needs.
  5. Personal Care Assistant (PCA) – can help with personal care needs (like bathing and management of incontinence) but cannot provide services that a licensed nurse must perform.

Paying for In-Home Care and Finding In-Home Workers

There are several methods of paying for in-home help. Try to investigate all of the options below to determine if you qualify for financial assistance. If you need assistance exploring options, contact Aging & Disability Resources at 303-480-6700 to speak with an aging specialist.

1. Hiring Through an Agency: There are many agencies offering private paid in-home services. Using an agency will save time and the interviewing process because they have a pool of vetted workers to choose from. Agencies also handle wages, taxes, timesheets, insurance coverage and management of having someone in your home. In addition to your worker, a care coordinator from the agency will have contact with you regularly to update your plan of care.

Each agency conducts their background checks differently which you’re encouraged to ask about. Services are typically structured based on the level of care you require, and you may pay more per hour. Agencies may also have requirements for a minimum number of hours. Some may offer a sliding fee scale.

2. Direct Hiring: Directly hiring a privately paid in-home worker may save you money and be more flexible in choice of schedule and worker. However, it is more work to screen, interview, file taxes, insure and hire. You may not have a backup if your worker gets sick and you are responsible for all supervision and management.

If you decide to hire privately, you must follow state and Internal Revenue Service (IRS) laws and have obligations in record-keeping for your in-home worker. Also be aware that accidents can happen to your worker while working in your home and you are liable. Contact your homeowners insurance company to learn about liability coverage. Contact the IRS and state taxing authority to understand your responsibilities for hiring a private worker.

3. Health First Colorado - Home and Community Based Services (HCBS): These are state-funded Medicaid programs offering in-home care to individuals needing personal care who meet income and resource guidelines. You must qualify financially as well as functionally based on your care needs. Apply through your county Human Services department for the financial application and through your county’s Single Entry Point for the functional assessment:

County Departments of Human Services

  • Adams (303) 287-8831
  • Arapahoe (303) 636-1130
  • Broomfield (720) 887-2200
  • Clear Creek (303) 679-2365
  • Denver (720) 944-3666
  • Douglas (303) 688-4825
  • Gilpin (303) 582-5444
  • Jefferson (303) 271-1388

Single Entry Point Offices

  • Access Long Term Support Solutions - (877) 710-9993
  • Adams, Arapahoe, Denver, Douglas
  • Adult Care Management - (303) 439-7011
  • Broomfield, Clear Creek, Gilpin
  • Jefferson County Options for Long Term Care - (303) 271-4216

4. Private Insurance: Some long-term care insurance policies provide coverage for in-home care. If you have this type of insurance, talk to your company to determine eligibility.

5. Medicare-Covered Home Health Services: Medicare provides limited, intermittent coverage for skilled/medical in-home care as prescribed by a physician to people who are homebound. It does not pay for personal care or homemaker services such as help with toileting, cooking, housekeeping, etc. Bathing help may be included while skilled care is being provided. For more information, call 1-800-MEDICARE.

Hiring an In-Home Worker

The best way to find a worker or home health agency is to get a recommendation from a family member, friend, or a trusted resource. Your place of worship or an organization you belong to may also be helpful resources.

Begin by checking on the Colorado Department of Public Health & Environment’s website to be sure the home health agency you’re considering is licensed:

www.colorado.gov/pacific/cdphe/home-care-agencies-consumer-resources

Also review the agency’s licensure record and any recorded deficiencies: click on “Inspection & Occurrence Findings”, select city or county, payment source and press “Start Search”. Click on the agency. Select “Occurrence Investigative Reports” and health surveys.

Setting up a Job Description and Contract

The purpose of a job description or contract is to clarify the duties and responsibilities of both the employer and the worker. You will want to know for yourself:

  • Hours needed
  • A brief description of duties
  • Preferences such as non-smoker or male/female
  • Hourly rate you would like to pay

Having a formalized agreement is essential if there is a dispute about salary, hours of work, tasks, etc. If you hire an in-home worker through an agency, they will create the contract. If you hire a private individual, you will need to create the contract and job description.

A contract/job description can always be revised or updated as needed. It is important to be as specific as you can in a contract to lessen the chances for confusion or disagreement. If the job involves special skills such as lifting into the bathtub or giving medications, the worker should be trained and experienced in those skills.

Arranging an Interview

When contacting possible agencies or workers, ask a few questions on the phone before setting up an interview. For example, ask about their work/business history and other experiences. Once you have decided which applicants or agency meets your qualifications, schedule the interview.

For your own safety, arrange for a friend or family member to be there for your first interview if you are hiring directly. Usually in-home agencies will send out a representative to assess your needs and create a contract before they assign a worker to you. You can ask the agency representative to be present the first time your worker comes to your home.

Have your sample contract or list of tasks ready to give to the applicant or agency representative. Write down the name, address and telephone number of the applicant or agency. Below are some suggested interview questions. Feel free to make up your own list for your particular needs.

  • For agency: What kind of insurance do you take? Medicaid? Medicare?
  • For agency: What kind of backup coverage do you have if my worker is sick or on holiday?
  • Where have you worked before? What kinds of things have you done?
  • Have you ever provided care for a person similar to what this job requires?
  • How do you feel about cooking and eating what someone else wants?
  • What is the minimum/maximum number of hours a day you can work?
  • How do you handle people who are angry or upset? How do you resolve conflict?
  • Why are you choosing to do this kind of work?
  • What makes you uncomfortable or angry?
  • What is your attitude about smoking, drinking, or using drugs?
  • Is there anything in the job description which you would not do?
  • What commitment to staying on this job are you willing to make?
  • What training/certifications do you have? (CPR, First Aid, CNA, Fundamentals of Caregiving, etc.)
  • Please give me three references: two work-related and one personal.

If the applicant is obviously unsuited, be non-committal about future contact. Remind a suitable applicant that you will need to check references before making a decision. Review the following checklist before ending the interview:

Interview Checklist

  1. Was the person on time for the interview?
  2. Was his/her appearance and grooming appropriate for the occasion?
  3. Did the applicant and I agree on the terms and conditions of the contract?
  4. Do I need to modify my contract before employing this person? How?
  5. Did I get at least three references to call to verify his/her ability to perform needed services?
  6. Did I say when I would notify the applicant of his/her acceptance or non-acceptance?
  7. Do I have the name and number of the applicant/agency?
  8. Did I feel comfortable or at ease with the person?
  9. Did I note anything that made me uncomfortable? (dress, speech, behavior, etc.)
  10. If the job involves special skills (such as lifting into the bathtub or cooking diabetic meals), will the worker require specialized training?

Checking References - never hire someone without checking references!

Before making a hiring decision, call at least three references to learn more about the applicant. Briefly describe why you are looking for a worker and ask the reference if the applicant would be a good match for your situation.

Questions to Ask References

  1. How long have you known ______________? Dates? In what relationship?
  2. Is ___________working for you now? Has ______ worked for you in the past? If no longer working for reference, ask: Why did ________ leave? Would you re-hire?
  3. What was ______’s position with you? Can you tell me more about his/her responsibilities?
  4. How did_______ get along with you and/or others?
  5. What were your impressions of _____ as a worker?
  6. Did _______ show initiative or wait to be told what to do?
  7. Did you find _______ reliable, trustworthy and honest?
  8. Was _______ punctual and dependable?
  9. What were his/her strengths and weaknesses?
  10. Were you aware of any problems with drugs or alcohol?
  11. Any other problems that could interfere with ______’s performance?

Supervising In-Home Workers

Once an applicant is offered the job and accepts, the agreement should be signed before the worker starts. Then a start date is chosen. Each party should have a copy of the signed agreement.

Here are some tips for supervising your newly-hired worker:

  1. Make a list of the steps for each task, including preferences for cleaning products and supplies to be used, the locations of these items, and reminders of parts of the task which could be overlooked, for example, "please separate the white wash" or "please sweep under the table".
  2. Avoid following the worker around the home. Instead, ask to be notified after each task is completed. Check off each step that has been finished correctly. Simply remind the worker if any step has been left out.
  3. Be sure to acknowledge any extra effort or thoughtfulness, even if what has been done does not fit exactly with your specifications. It is important to focus on the person’s good will rather than small mistakes.
  4. Correct major errors by giving information rather than criticism. Unless an error occurs repeatedly, assume the person needs more information about how something should be done.

Maintaining Open Communication with Your In-Home Worker

Open communication between you and your in-home worker can maintain a positive relationship. People appreciate being told when they are doing a good job. It is also important to tell people about factors that irritate you or unacceptable job performance. Small annoyances can often cause larger problems when not discussed.

Be sure your expectations are clear:

  • Give specific, written directions regarding duties to be performed and when breaks are appropriate.
  • Develop a checklist to be completed by yourself and the in-home worker by the end of each shift.
  • Demonstrate difficult tasks and have the worker practice for you.
  • Review privileges such as eating meals at your home and the use of your telephone.

Be fair, honest, and kind, and remember to respect your worker’s privacy.

Praise a job well done. People need to be appreciated. Describe what you like. For example:

  • "Thank you for putting non-skid strips in the bath. I feel much safer."
  • "I really appreciate the extra care you take in cleaning under the furniture (around the sink, etc.). Having a clean home feels wonderful."
  • "Thank you for making the effort to be on time."
    Get small irritations off your chest before they build up. 

     

    Ethical Considerations and Abuse PreventionCounty Adult Protective Services (APS)

    Note: APS is not an emergency service. In the event of an emergency or if you feel your life is in danger, call 911. If you are 70 years or older in the state of Colorado, the county may send a police officer to complete a welfare check.

    Become knowledgeable about common types of abuse

    Misuse of time:
  •  
    • Give criticism as soon as possible after the problem occurs.
    • Keep criticism brief and to the point.
    • Mention one incident at a time and make a suggestion for improvement.
    • Focus on the situation, issue or behavior, not the person.
    • Elder abuse is prevalent in today’s society. Unfortunately, elder abuse is all too common without proper advance planning, accountability and supervision. Abuse can take many forms from accepting gifts to theft of medical/personal items, physical abuse or emotional battering and neglect.
    • An important ethical consideration for families and older adults is how to handle gifts. An in-home worker should not accept gifts of money or anything else. It violates the professional relationship that should be established between a worker and the person receiving care. This is a difficult concept for many people to accept. The relationship between an in-home worker and care receiver is, by its nature, one that has an imbalance of power. The in-home worker is usually more able-bodied, physically and sometimes mentally. For the in-home worker to receive gifts other than wages jeopardizes the balance of power and drifts into the area of elder abuse or exploitation.
    • If you feel unsafe or uncomfortable with your in-home worker who is from an agency, contact their supervisor first. If your concerns are not being addressed or you have concerns about your own private in-home worker, contact Adult Protective Services in the county where you live.
    • Adams 303-227-2049
    • Arapahoe 303-636-1750
    • Broomfield 720-887-2271
    • Clear Creek 303-679-2365
    • Denver 720-944-2994
    • Douglas 303-663-6270
    • Gilpin 303-582-5444
    • Jefferson 303-271-4673

 

  • Using up time doing easier tasks first. On your checklist, be sure the harder or more critical tasks are listed first.
  • Taking frequent breaks, excessive use of mobile devices or watching TV.
  • TIP: Use supervisory skills and written checklist to maintain a professional relationship.
  • Taking advantage of the person:

     

    • Worker wins trust and then takes advantage of sympathy and/or friendship by sharing personal and/or financial problems, resulting in you offering “loans” or gifts to the worker.
    • Persuades you to sign for hours not worked, allowing late arrival/early leaving, bringing children/partner/friends to work.
    • Offers to be listed on or help change legal documents (for example, offers to be an agent on Power of Attorney forms or will, or a beneficiary or co-signer on bank accounts/property)

    When In-Home Help is Resisted

    Even though in-home workers may be essential, the idea is sometimes resisted. It is important to respond to this issue with understanding. Some common concerns are:

    Maintaining Sense of Independence

    Many people view accepting a stranger’s help as an insult to their independence. What they may not realize is that they may have already accepted help in the form of neighborly assistance or family visits. It is important to involve the person needing care in the entire process of hiring and supervising the in-home worker.

    Fear of Depleting Savings

    It may be helpful to compute the cost of in-home care over a year so that the exact cost can be seen relative to the benefits received. Compare this to the cost of moving into an assisted living or retirement community.

    Fear of Reduced Contact with Family Members and Friends

    Assure the person receiving care that contact with family and friends will continue. Offer frequent phone calls and set dates for social contact. By stating clearly that the intention in hiring help is to prolong the ability to provide care, family and friends can sometimes show that hiring help is the very opposite of abandonment.

    Fear of Victimization

    A new in-home worker may represent a threat. After all, this is a stranger who is gaining access to the individual’s personal items. People who have hearing, vision or mobility deficits may feel very vulnerable. Ways of dealing with this issue may include:

    • Obtain Referrals from Friends: An employee of a trusted friend can be an excellent prospect.
    • Be a Physical Presence: It is sometimes wise for a family member or friend to be present during the first few sessions. Later, this person or others can make occasional, unplanned visits. Neighbors can also be helpful with this because of their proximity to the person.
    • Carefully check references and make sure a background check is completed.

    Worry About Lack of Supervisory Skills

    Older people may need to learn how to provide clear instructions and appropriate supervision to gain confidence in their in-home worker’s abilities.

    • Create a list of tasks you need help with before any interviews take place. This list is also helpful if you hire an agency which will create a care plan based on these tasks.
    • Whether you hire your own in-home worker or go through an agency, keep this list of agreed-upon tasks handy. This makes sure tasks are clearly stated and can be verified if not performed. It also structures the relationship on a professional foundation.

    Discomfort Beginning the Process

    Start slow. It may be wise to start with a small amount of hours of in-home help and gradually increase the hours as the recipient becomes more comfortable.

    Finding good legal advice and planning ahead now may help prevent difficulties later. Remember that you are the decision-maker, and the more information you have about the law and your case, the better prepared you will be to conduct or oversee the legal work you need. As is true when purchasing any product or service, it is important to be a smart consumer. Here are questions to consider:

    Do You Need an Attorney?

    Ask yourself whether you have a situation requiring an attorney’s involvement. For example, a Living Will is available from many sources and can be prepared on your own. The preparation of a trust or a guardianship proceeding, however, would almost certainly require the assistance of an attorney.

    Consider the following:

    • Do I need someone with expertise in the area of elder law to review your situation?
    • Is the matter a complex issue or one that’s likely to go to court?
    • Is my issue due to a conflict with another individual that needs an objective third party?
    • Are there any non-attorney legal resources available to assist you?
    • Is a large amount of money, property, or time involved?

    How do I get this?

    The Colorado Bar Association can let you know if legal representation would be useful and provide a list of attorneys that fits your needs. 303-860-1115; www.cobar.org. They also give information about free and low-cost legal services including:

    Denver Bar Association Legal Clinics: Pro se (do-it-yourself) clinics offered in the community on the topics of bankruptcy, divorce, small claims, and collections. They do not give legal advice or help fill out forms; they do explain legal processes.www.denbar.org/Public/Legal-Clinics.

    Court Self-Help Centers: Staff at Court Self-Help Centers can assist with locating and filling out forms, understanding court procedures, finding applicable statutes and giving referrals to community resources. A list of Court Self-Help Centers is also available at: www.courts.state.co.us/Self_Help/center.cfm.

    Colorado Legal Services - 303-837-1321

    Colorado Legal Services is a statewide client intake system offering people with low-incomes free legal assistance with civil (non-criminal) problems. Services are available in English and Spanish. Calls are received weekdays from 8:30am-4pm. After an intake interview, staff will answer your questions, send you documents addressing your concerns and, in some cases, refer you to a legal services provider in your area.

    Aging & Disability Resources - 303-480-6700 - www.drcog.networkofcare.org

    You can also call the Aging & Disability Resources’ helpline in the Denver metro area to learn more about your options for legal representation and dispute resolution, especially if your issue may be more involved with medical or social services. They can also tell you about Senior Law Day events in your area.

    Hiring an Attorney

    1. Once you have a list of attorneys who specialize in your area of need, check with the Colorado Supreme Court - Office of Attorney Regulation Counsel to verify an attorney is licensed and in good standing in the state of Colorado.

    Attorney Search & Disciplinary History: www.coloradosupremecourt.com/Search/AttSearch.asp - use the navigation tabs at the top of the page for additional information

    1. Make exploratory phone calls to help you choose the most qualified attorney to help your situation. Don’t feel embarrassed about asking questions and selecting only the best candidate for you.

    Your preliminary questions should include:

    • How long has the attorney been in practice?
    • Will the attorney provide a free consultation on this matter? If there is a fee, how much is it?
    • How much of his/her practice is devoted to your type of legal situation?
    • Does the attorney represent any special-interest groups, such as nursing homes?
    • What type of fee arrangement does the attorney require? Are fees negotiable?
    • What type of information should you bring with you to the initial consultation?
    • How does the attorney handle client complaints?

    To File a Complaint about an Attorney

    Call the Office of Attorney Regulation at 877-888-1370 or file a complaint online: www.coloradosupremecourt.com/Complaints/File_ComplaintAgainstAtty.asp

    Other Resources

    Colorado Affordable Legal Services (303-996-0010; www.coloradoaffordablelegal.com) provides legal representation in evictions and legal clinics on issues surrounding landlord/tenant rights.

    Colorado Housing Connects (1-844-926-6632; www.coloradohousingconnects.org) offers education about landlord / tenant laws, reverse mortgages and housing options in the Denver metro area.

    Denver Metro Fair Housing Center (720-279-4291; www.dmfhc.org) provides education, advocacy and enforcement of the Fair Housing Act to prevent housing discrimination on the basis of race, color, religion, national origin, gender, familial status and disability. Colorado state law also protects against discrimination based on sexual orientation, creed, ancestry and marital status.

    Disability Law Colorado (303-722-0300; www.disabilitylawco.org) provides free legal information to people with disabilities and may be able to provide advocacy and legal representation for some cases. The State Long-term Care Ombudsman is also housed in this office and handles concerns about licensed skilled nursing facilities and assisted livings.

    Mean Street Ministries (303-232-2500; www.meanstreetministry.org/home) provides free legal consultations for people experiencing homelessness. Clinics are held the second Friday of the month at 1pm. Stop by the office at 1380 Ammons Street, Lakewood, CO 80214 before Friday; walk-ins are not guaranteed service.

    National Foundation for Credit Counseling (1-800-388-2227; www.nfcc.org) connects you to financial education and credit counseling services. Specialists assist in considering alternatives to bankruptcy, developing a manageable budget, financial education and also offer housing- counseling solutions. There is a small fee.

    The State Health Insurance Assistance Program (SHIP) answers questions about Medicare fraud and abuse. Call 1-888-696-7213.

    Alternatives to Hiring an Attorney

    Many legal problems can be resolved through alternatives before you involve the courts including arbitration, mediation, consumer protection and small claims court. These alternatives are typically fee-for-service.

    The Colorado Senior Law Handbook is an excellent resource for in-depth explanations of these options: www.cobar.org/seniorlawhandbook

    Arbitration is when you meet before a judge without a jury but in the presence of one or more arbitrators. In elder law, arbitration may be involved if required by documents found in trusts.

    Mediation is when you have a neutral person who helps you reach a settlement of your dispute outside of the court system. Mediation is voluntary and the information you share stays confidential. If mediation does not resolve your dispute and you go to court, the judge and jury will not know what is said during your mediation sessions.

    Consumer protection deals with your rights as a consumer and ranges from identity theft protection to telemarketing scams to making sure you get the services you’ve paid for. The Attorney General’s Office has a Consumer Services Resource Center that provides consumer protection guidance regarding laws on scams, fraud, credit, collection agencies, contracts, mail order purchases and automobile repair and purchase. They also investigate and prosecute these cases to protect you as the consumer. Colorado Attorney General’s Office - 720-508-6000 - www.coag.gov

    In some counties, you can call your district attorney’s office to speak with a consumer fraud specialist:

    1st Judicial District Attorney's Office - Jefferson & Gilpin Counties: 303-271-6970

    2nd Judicial District Attorney's Office - Denver County: 720-913-9179

    17th Judicial District Attorney’s Office - Adams & Broomfield Counties: 303-659-7720

    18th Judicial District Attorney’s Office - Arapahoe & Douglas Counties: 720-874-8547

    For consumer protection issues in Clear Creek County, call the Colorado Attorney General’s Office: 720-508-6000.

    Small Claims Court may be appropriate if you have a monetary claim for damages up to $7,500. These courts are more informal and involve less paperwork than regular courts. Filing costs are lower and the system is often faster than the other courts. If you file in small claims court, you should be prepared to act as your own legal advocate, -gather the needed evidence, research the law and present your story.

    Quick tip: Check with the clerk in the Small Claims Court or Court Self-Help Centers for more information on what may be necessary to file and prepare for your case. Also, ask if there is a time limit on when you must file suit.

    Food Banks: places where you can go to get fresh food and dry goods to make your own meals

    Commodities: shelf-stable food items given to you to make your own meals

    SNAP (Supplemental Nutrition Assistance Program): an assistance program for those with qualifying low incomes that gives you money on a card to purchase food items; this program is offered through your county Department of Human Services and used to be called “food stamps”

    Community Meal Sites: places you can go to sit down and have a meal; some of these are only for people 60+ and others are for anyone who is interested or in need

    Delivered Meals: frozen or hot meals delivered to your door; some of these programs are for people 60+ or people with certain medical conditions

    How do I get this?

    Food Banks, Community Meal Sites and SNAP

    Hunger Free Colorado

    855-855-4626

    Food resource helpline that can give you a list of food banks and community meal sites in your area as well as which food banks will deliver to your home. Will also help you complete an application for SNAP (AKA food stamps).

    www.hungerfreecolorado.org

    Call Monday-Friday 8am-4:30pm

    Mile High United Way

    Call 2-1-1 or text your zip code to 898-211 for food banks and other nutrition resources in your area. 211colorado.communityos.org/cms/node/142

    Call Monday-Friday 8am-5pm

    Quick Tip: In order to receive food/commodities from a food bank you will need to at least have a photo ID and proof of your address (such as a utility bill). Some places require that you bring proof of income too. Call the food bank before you arrive to see what documentation they require.

    If you do not have an ID or proof of address, you can get meals at congregate/community meal sites. Call Hunger Free Colorado or Mile High United Way 211 for locations.

    SNAP: Apply for SNAP online on Colorado PEAK: coloradopeak.secure.force.com/AC_Welcome. Colorado PEAK is also available as a smartphone app.

    Note: SNAP recipients are also eligible for the Low-Income Energy Assistance Program (LEAP) program which helps pay for heating/electric. Call Energy Outreach Colorado for more information:

    1-866-432-8435.

    Delivered Meals

    Volunteers of America Meals on Wheels

    303-294-0111

    Free hot or frozen meals delivered to older adults 60+ Monday-Friday. Serves Arapahoe, Clear Creek, Denver, Douglas, Gilpin and Jefferson counties. There may be a waitlist; donations appreciated.

    Call Monday-Friday 8am-5pm

    Senior Hub: Meals on Wheels

    303-426-4408

    Serves Adams County. Free hot or frozen meals delivered to older adults 60+ Monday-Friday. There may be a waitlist; donations appreciated. Will also deliver a restaurant meal Monday-Saturday for approx. $9 each.

    Call Monday-Friday 8am-5pm

    Project Angel Heart

    303-830-0202

    Free meals delivered to those who with a current diagnosis of a life-threatening illness (including cancer, HIV/AIDS, end-stage renal disease, congestive heart failure or multiple sclerosis) and who have documented difficulty preparing or accessing healthy meals due to illness, treatment, side effects or another disability. There may be a wait list; donations appreciated. (Requires a professional referral – Call for more details).

    Call Monday-Friday 8am-5pm, Saturday 9am-3pm

    Delivered Groceries – must be present to accept delivery; no need to tip driver

    King Soopers - 303-778-5464; homeshop.kroger.com

    Grocery delivery service for the Denver metro area. Place order online with $10.95 delivery charge or over the phone (for additional $9.95 order fee). $50 minimum purchase; call to see if they deliver in your area (generally will deliver within 20 miles of a store).

    Deliveries made during a 2-hour timeslot: 8am-10pm, 7 days a week

    Walmart - grocery.walmart.com

    Grocery delivery service for the Denver metro area. Must place order online with $7-10 delivery charge; $30 minimum purchase; will usually bring groceries inside the house. Call Monday-Friday 7am-7pm; deliveries available 7 days/week.

    Safeway - www.shop.safeway.com

    Grocery delivery service for the Denver metro area; type in your zip code online to see if they deliver to your address. Must place order online; $49 minimum purchase and approximately $9.95 delivery fee.  Delivery fee waived for orders over $150.

    Deliveries made 7 days a week, 9am-10pm

    Instacart - www.instacart.com/locations

    Instacart is a website where you can order groceries (including pet food) from participating stores in your area. Orders must be placed at least 2 hours in advance; delivery fees range from $7.99-9.99 (Fee waived for first delivery). Hours vary by store.

    Other Resources

    Denver Urban Gardens (DUG)

    303-292-9900

    www.dug.org

    Seasonal garden plots are available for rent to have a place to grow your fruits and vegetables. Cost is $10-75/plot for the season depending on location; scholarships available

    Call Monday - Friday 9am-5pm

    Denver Food Rescue

    720-675-7337

    www.denverfoodrescue.org/

    Rescues food that would otherwise go to waste and delivers it to partnering organizations for you to pick up for free.  Call or visit their website for location information.

    Call Monday - Friday 8am-5pm

    Quick Tip: Depending on where you live, private chef services may be available to you. Look online to find services in your area.

    Things to Consider

    • Churches, religious organizations, and some nonprofits have meals for their communities. They may also deliver holiday baskets of food. Call to find out more information.

    Need more assistance or want to talk with someone?

    • Aging & Disability Resources for the Denver Metro Area: 303-480-6700
    • Aging & Disability Resources for Colorado: 1-844-265-2372
    • Eldercare Locator (a national hotline for aging resources all over the US): 1-800-677-1116

    Click on these links for more information:

    • Food Bank of the Rockies: foodbankrockies.org/Senior Resource
    • Guide: seniorsresourceguide.com/directories/Denver

    Taking care of another person is strenuous and stressful, no matter how long and loving your relationship. Some people feel trapped in their own homes, unable to leave because the person they’re caring for is not safe alone or because they get anxious if he or she is away more than a few minutes. In some situations, a person’s sleep is interrupted frequently by the needs of the person who is ill. This continual tiredness adds to the stress and inability to think clearly. It may be hard not to get annoyed when well-meaning friends say "take care of yourself," but it is good advice. Who will be there to care for your loved one if you get sick? Taking a break on a regular basis may help you to keep going, as can nutritious food and adequate rest. Here are some ideas about how to find that break or "respite."

    A positive approach to respite care will be the first step to success. Many people have found that:

    1. Having a few hours to call your own is not a selfish act. It is wise and healthy to maintain other interests, relationships, and to have fun.
    2. When finding a provider, you may have to make a lot of phone calls, spend time on hold, or call back several times. Be patient and persistent. Some community organizations have staff who can help you prioritize these calls. In the Denver metro area, call Aging & Disability Resources at 303-480-6700.
    3. None of the respite options will be ideal. It may be the case that no adult day care program or hired helper will provide care to your standards. No arrangement of care-sharing will fit perfectly into your routine. Use whatever is available anyway. The more demand there is for respite care, the more options we will have.

    Resist the temptation to compare respite care options with what your loved one might have preferred earlier in life. That was then; this is now. Instead, compare today’s choices with the person’s current state.

    Make two long-range plans -- one which assumes you will stay in good health; the other in case you become incapacitated yourself.

    Become familiar with sources of information and support in the community, such as local support groups, Aging & Disability Resources 303-480-6700, rec and senior centers, Meals on Wheels or other social service agencies. Keep a notebook with as many resources as you can find and get acquainted with them even if you don’t think you’ll need them.

    Visit an adult day program -- these are day centers staffed with trained professionals who provide care and socialization to your loved one while you take a break. The National Adult Day Services Association is a resource for helping you find a center and also has a checklist of what to look for when you visit: www.nadsa.org/consumers/choosing-a-center/

    Give your family and friends information about the disease or condition of the person you’re caring for. Start by holding a meeting -- away from the individual needing care -- with all invested parties living in your area. Begin with a direct conversation about the person’s needs and your role in the care. Ask what people can contribute and draw up a plan of care. Things to consider in your plan of care may include:

    • Current and anticipated needs
    • Strengths and supports that already exist
    • Prioritize goals such as socialization, accompaniment to doctor appointments, or meal preparation and then list who will do what and starting when

    Once you have a tentative plan of care, do what you can to set everyone up for success in their tasks. Be sure to invite the people caring for the individual to spend time in his or her home prior to committing to respite care.

    Be creative. When people offer to help, think of ways they can be helpful. Freeze-ahead meals, shopping, errands, dusting and vacuuming are easy, non-threatening things you could ask for that could free up some time for yourself. Even though you will still need to arrange for care, at least you won’t be using that precious time for chores. If someone can’t participate personally, perhaps he or she can help pay for professional respite care. Learn to respond quickly to every offer of help with a positive suggestion, a time and a date. It is always harder to call someone back later to set something up.

    Your loved one may reject the alternate help at first. A positive, matter-of-fact attitude on your part will help to establish the climate that this is "okay.” Don’t give up too quickly. Make sure the helper or worker understands about the way the disease affects your loved one. Try different things, such as a few prior visits with you staying there. Help the new person to interact effectively with the person. Eventually you will all adjust. If not, don’t assume your loved one will reject everyone. Keep trying. This goes for adult day programs outside your home as well. Wait a few weeks and try again.

    Piece together a plan when there are no easy or affordable solutions. Two or three families can sometimes share one full-time worker. Or you might start an informal "co-op" such as a Tuesday/Thursday coffeeklatch of four care receivers and two rotating pairs of helpers. If there are scheduling problems with an adult day program, there may be a neighbor willing to fill in the gap time or provide transportation.

    Respite Care Options:

    Adult day programs, church and service organizations, in-home health agencies, friends and neighbors, family members, volunteers through community organizations

    Later On:

    Assisted living, skilled nursing facilities, live-in helpers

    Other Help:

    Aging & Disability Resources, grants for respite from the Colorado Respite Coalition, Meals on Wheels, chore service agencies, social workers at your doctor’s office

    Keeping you -- the person providing care -- healthy is of higher importance than "not pleasing" the person needing care or compromising your standards for short periods of time. After all, if you burn out, what will the care be like then?

    Terms to Know

    Caregiver vs. Care Partner?

    The terms we use to describe one person caring for another person matter. Often, the term “caregiver” has been used to describe someone caring for a person who has a disability or is sick. What is missing in the term “caregiver” is acknowledgement that caring for someone is usually not a one-way street. Both the person receiving care and giving care are sharing something together, whether it is stories or thoughts or personal care. By using the term “care partner,” we level the power in the relationship and acknowledge that both parties have valuable things to give. When people are “care partners,” the relationship is a two-way street of give and take, and giving care is something we all can do.

    Need more assistance or want to talk to someone?

    These organizations will share local respite options and brainstorm solutions that work for you:

    • Colorado Respite Coalition: 303-233-1666
    • Seniors’ Resource Center: 303-238-8151
    • Colorado Gerontological Society - Senior Answers: 855-293-6911
    • Aging & Disability Resources for the Denver metro area: 303-480-6700
    • Eldercare Locator (a national hotline for aging resources all over the US): 1-800-677-1116

    Special thanks to Northwest Regional Council (www.nwrcwa.org) for allowing the Denver Coordinated Workgroup to borrow content for this resource guide.

    Different transportation options are available to help you get to the things you need and enjoy, especially if you decide to stop driving. This can be a big change. Many people find they need to plan their trips differently and be creative about how to get around. No matter what you choose, make sure to let someone know where you are going and when you expect to be back.

    What are my transportation options?

    Denver Regional Mobility & Access Council (DRMAC) has a transportation helpline to answer your questions about what options are available to you: 303-243-3113. You can request their “Getting There Guide” with a list of ride options (English and Spanish).

    Public Transportation

    Taxis – Prices for rides are generally based on the length of your trip. Taxi drivers are not able to help you in and out of the car but some companies offer services to people with disabilities if you mention this when you schedule your ride.

    Uber and Lyft – Uber and Lyft are similar to taxi services but you use a smartphone to schedule and pay for rides. Drivers are screened with the company’s own federal and county background checks. Drivers use their own vehicles. www.uber.comwww.lyft.com

    RTD buses and lightrail – 303-299-6000; www.rtd-denver.com

    Costs for public transit vary depending on how far you go. Monthly passes and specialty trips to sporting events or other cities like Boulder or Glenwood Springs are available. Discounts are available to people with Medicare, adults 65+, and people with disabilities – to find out about these discounts, call 303-299-2667 or visit www.rtd-denver.com/DiscountFares.shtml. RTD also has a commuter train which runs between downtown Denver and Denver International Airport.

    RTD SeniorRide picks up groups of ten or more people from a single destination to travel to select community events for a fee. Note: Passengers of any age can use this service. Call 303-299-6503, email senior.ride@rtd‑denver.com, or visit www.rtd-denver.com/seniorRide for more information.

    Additionally, RTD SeniorShopper provides rides to go shopping for people with Medicare, adults 65+, and people with disabilities for a fee. Groups of ten or more are picked up at older adult housing complexes and community centers. SeniorShopper is only available on weekdays (holidays excluded). Use the SeniorRide contact information above for this service.

    RTD ACCESS-A-Ride is an accessible bus available to those who cannot use regular bus and lightrail routes due to having a disability. Your destination must be within ¾-mile of the regular routes. (Regular routes are referred to as “fixed routes”). ACCESS-A-Ride can provide door-to-door service – meaning they will pick you up at an outside doorway and help you to the bus – during the same hours when the fixed-route buses and lightrails are running. You’ll need a medical referral to apply. Call 303-299-2960 or visit www.rtd-denver.com/accessARide.shtml.

    Quick Tip: If you have a smartphone, you can download free apps that will let you plan and schedule rides. Call your carrier for instructions on how to download apps.

    Community Options for Older Adults 60+

    Seniors Resource Center provides free transportation services to older adults (60+) to medical and dental appointments, grocery, and personal trips. Rides must be scheduled in advance over the phone. For Adams, Arapahoe, Broomfield, Denver and Jefferson counties, call 303-235-6972. For unincorporated Jefferson County, Clear Creek and eastern Park County, call 303-679-2552. Donations are appreciated.

    Broomfield Easy Ride Senior Transportation – 303-464-5534 -- offers free transportation services to older adults to medical appointments, the Broomfield Senior Center and to the grocery store. Personal appointments and special trips are provided as able.

    Douglas County First Call – 303-660-7519 -- Douglas County residents 60+ may call for free rides to medical/dental appointments, grocery shopping trips, meal sites, adult day centers and other personal trips.

    Via offers free rides to medical appointments and meal sites for residents of rural Adams County (Brighton, Bennett, Strasburg and Watkins) on weekdays. Via also offers travel training on transportation options in the Denver metro area to older adults and people with disabilities. Call 303-447-2848 or go to www.viacolorado.org/services/.

    Volunteers of America offers free rides to residents 60+ of Clear Creek and Gilpin counties on weekdays for medical and dental appointments, grocery shopping, meal sites, and local priority trips such as to the nursing home, laundromat, cemetery and polling stations. Rides must be scheduled in advance. Clear Creek residents call 303-567-2382. Gilpin residents, call 303-582-5444.

    Medicare & Medicaid

    Medicare Part A covers 80% of the approved amount for medically necessary emergency ambulance rides. Medicare only covers rides to the closest, most appropriate medical facility. If you choose to go to a medical facility farther away, the extra cost will be passed on to you.

    When you get an ambulance for a non-emergency situation, and the ambulance company thinks that Medicare may not pay for your ambulance service, the company must give you an “Advance Beneficiary Notice of Non-Coverage” so you are aware that you may be responsible for the full cost of the ride.

    To file an appeal against Medicare for non-payment, call KEPRO at 1-844-430-9504 for assistance.

    In some cases, Medicare covers non-emergency, medically necessary ambulance rides – for example, travel to get diagnosed for a health condition when other forms of transportation aren’t appropriate for you. Call 1-800-MEDICARE or the number on the back of your health insurance card to find out more.

    Medicaid Rides to Medical Appointments -- Medicaid provides rides to medical appointments. You must be approved before using this service and schedule these rides in advance. Call: 1-855-264-6368.

    Medicaid Non-Medical Rides -- If you have Medicaid under Home & Community-Based Services (HCBS) or another waiver, you may be eligible for non-medical personal trips, for example rides to the grocery store, meal sites and adult day programs.

    You must be approved by Medicaid before using this service. Once you’re approved, schedule rides 48-hours in advance. To learn more, talk to your Medicaid case manager – these are by county. For Adams, Arapahoe, Denver and Douglas counties, call Access Long-term Support Solutions: 1-800-511-5010. For Broomfield, Clear Creek and Gilpin counties, call Adult Care Management at 303-439-7011. For Jefferson County, call Jefferson County Options for Long Term Care at 303-271-4216.

    Veterans

    Call the Colorado Division of Veterans Affairs to see if there are transportation services available for you: 303-284-6077 (Denver location) or 303-914-5832 (Lakewood location).

    Transportation safety

    Transportation companies are regulated by the State of Colorado through the Department of Regulatory Agencies (DORA) at 303-894-7855 or online at www.colorado.gov/dora.

    To file a complaint about a transportation company including concerns about safety, rates, insurance, and quality of service issues, call 1-800-456-0858 or go to www.dora.state.co.us/pls/real/CCTS_oWEB.trans_complaint_form.

    Why might the Department of Motor Vehicles (DMV) ask me to take a re-examination to keep my driver’s license?

    • When you have two accidents within three years of each other.
    • If an immediate family member or medical provider feels, for medical reasons, you may be unsafe to drive. (They must write a letter to the DMV to request re-examination).
    • When a law enforcement officer files an incident report requesting re-examination.

    For more information, call 303-205-5600 or visit www.colorado.gov/pacific/dmv/driver-services-frequently-asked-questions.

    Colorado’s Guide for Aging Drivers and their Families and AARP Driver Safety class information can be found here: http://www.drivesmartcolorado.com/programs/older-adult-driver/.

    Need more assistance or want to talk with someone about resources?

    • Denver Regional Mobility & Access Council (DRMAC) Transportation Helpline: 303-243-3113
    • Aging & Disability Resources for the Denver Metro Area: 303-480‐6700
    • Aging & Disability Resources for Colorado: 1‐844‐265‐2372
    • Community Helpline: 2‐1‐1
    • Eldercare Locator (a national hotline for aging resources all over the U.S.): 1‐800‐677‐1116

    YOUR TRANSITION FROM MEDICAID TO MEDICARE

    Do I have to take Medicare if I have Medicaid? Yes!

    If you are on Medicaid and will be transitioning to Medicare in the future, this guide can help.

    Q: WHAT IS THE DIFFERENCE BETWEEN MEDICAID AND MEDICARE?

    Medicaid:

    Provides medical coverage for people with low incomes or with disabilities. Note: In Colorado, Medicaid is called Health First Colorado: Colorado's Medicaid Program.

    Medicare:

    Provides medical coverage for people 65 and over or with qualifying disabilities.

    1. DETERMINE YOUR ELIGIBILITY FOR MEDICARE. YOU BECOME ELIGIBLE FOR MEDICARE WHEN YOU:
    • turn 65.
    • have been receiving Social Security Disability Insurance (SSDI) for two years.
    • receive a diagnosis of end stage renal disease (you are a kidney dialysis or kidney transplant patient).
    • receive a diagnosis of Lou Gehrig's disease (amyotrophic lateral sclerosis, or ALS).

    Remember, you need to enroll in Medicare through Social Security. If you're not yet eligible for Medicare, consult this guide shortly before you become eligible.

    1. SHORTLY BEFORE YOU BECOME ELIGIBLE FOR MEDICARE, MEET WITH YOUR LOCAL COUNTY HUMAN SERVICES OFFICE TO DISCUSS YOUR FUTURE MEDICAID BENEFITS.

    Your county human services office will most likely need to help you enroll in a Medicare Savings Program (MSP). Look for redetermination paperwork from Medicaid — it will arrive in the mail several months before you become eligible for Medicare.

    1. LEARN MORE ABOUT YOUR MEDICARE SAVINGS PROGRAM (MSP) OPTIONS.

    A Medicare Savings Program (MSP) is an income- and asset-based program that helps you cover costs related to Medicare.

    Medicare Savings Programs have different levels of coverage based on your income and assets:

    • Qualified Medicare Beneficiary (QMB): Pays your Medicare Part A and/or Part B premium, deductibles and coinsurance or copays.
    • Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI-1) programs pay your Part B premium but not your deductibles and coinsurance or copays.
    1. UNDERSTAND THAT KEY CHANGES MAY OCCUR WITH YOUR MEDICAID ELIGIBILITY:
    • Medicare Savings Programs have different income limits than the type of Medicaid you may have now. Your income may affect your eligibility and coverage levels.
    • Although Medicaid may not have taken into account your assets or resources in the past, the Medicare Savings Programs do have asset or resource limits.

    Note: If you are in the Working Adults with Disabilities (WAwD) Medicaid Buy-In program you may remain in the WAwD until you are 65. (If you are in WAwD, you will be responsible for your Medicaid Buy-In premium; WAwD will help pay your monthly Medicare Part B premium, deductibles and copays/coinsurance.)

    1. BEGIN THINKING ABOUT HOW YOU WANT TO RECEIVE YOUR MEDICARE.

    There are many Medicare coverage options and cost choices. Attend a Medicare 101 class, a Medicaid-to-Medicare class or speak with a State Health Insurance Assistance Program (SHIP) counselor to help you understand your options. Colorado State SHIP: 888-696-7213. Local office for Arapahoe, Douglas and Jefferson counties: 303-480-6835.

    1. ENROLL IN A MEDICARE (PART D) PRESCRIPTION DRUG COVERAGE PLAN.

    If you do not enroll into a Medicare Part D standalone drug plan or Medicare

    Advantage plan that includes Part D drug coverage, you will not be able to get your medications at the pharmacy. Once you are eligible for Medicare (Part D) Prescription Drug Coverage, Medicaid will stop paying for your prescriptions at the pharmacy.

    Remember: Medicaid always pays last. Now that you are eligible for Medicare, Health First Colorado (Colorado's Medicaid program) requires you to use Medicare.

    Note: If you qualify for Medicaid, a Medicare Savings Program (MSP) or Extra Help (Low-Income

    Subsidy for Medicare Prescription Drug Coverage) and you aren't able to pick up your prescriptions at the pharmacy, please contact SHIP for help accessing temporary Medicare drug insurance through the Limited Income Newly Eligible Transition Program (LI NET).\

    1. IF YOU HAVE SUCCESSFULLY COMPLETED STEPS 1-6 AND MET ALL QUALIFICATIONS, YOUR ASSISTANCE NOW COMES FROM THE STATE OF COLORADO (MEDICARE SAVINGS PROGRAM) AND THE SOCIAL SECURITY ADMINISTRATION (EXTRA HELP –LOW-INCOME SUBSIDY FOR MEDICARE PRESCRIPTION DRUG COVERAGE).

    UNDERSTAND YOUR COVERAGE

    Medicare divides your coverage into three parts:

    Part A: Hospital Insurance

    Medicare Part A is premium-free for those who have worked for a total of 10 years or more. Sometimes people receive this benefit based on a parent's or spouse's work history.

    If you have a Qualified Medicare Beneficiary (QMB) Medicare Savings Program you will receive assistance paying your Part A premium, copays or coinsurance. However, if you have Specified Low-Income Medicare Beneficiary (SLMB) or Qualifying Individual (QI-1) you are responsible for paying Medicare's copays and coinsurance.

    Part B: Medical Insurance

    Medicare Part B has a monthly premium. Your Part B premium will be covered at no cost to you if you qualify for a Medicare Savings Program – Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) or Qualifying Individual (QI-1). If you have Qualified Medicare Beneficiary

    (QMB) you will receive assistance paying your Part B copays or coinsurance. However, if you have Specified Low-Income Medicare Beneficiary (SLMB) or Qualifying Individual (QI-1) you will be responsible for paying Medicare's copays and coinsurance.

    Part D: Prescription Drug Coverage

    Medicare Part D is provided through a private insurance company. You will use Part D for your prescriptions at the pharmacy. If you qualify for Medicaid or a Medicare Savings Program, then you will receive Extra Help (Low-Income Subsidy for Medicare Prescription Drug Coverage). Extra Help provides financial assistance including the option of enrolling into a $0 premium, $0 deductible Part D Plan. With Extra Help, you'll pay lower copays at the pharmacy. Extra Help is provided by the Social Security Administration. You must enroll in a Medicare Part D plan to receive coverage for your prescriptions.

    Depending on where you live, Medicare Advantage (Part C) or Special Needs Plans (SNP) may be available to cover your prescriptions.

    For help comparing plan options or applying for these financial assistance programs, contact your local SHIP counselors (888-696-7213).

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