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There are currently only 19 states that require licenses for hands-on care provided by Private Duty (PD) companies, and Lawrence Meigs, CEO of Visiting Angels, believes licenses will be required in all 50 states in the coming years. "Legislation for licensing of Private Duty companies is pending in a number of additional states right now, but several things need to happen in order for this to become commonplace nationwide."


Meigs hopes the National Private Duty Association will begin to lobby for good state license laws, and encourage its members, some of whom operate without licenses, to obtain these approvals at the state level. Visiting Angels agencies are licensed in all the states that require licensing; however, in states such as New York, where the licensing process can take a year or longer to complete, many PD agencies operate unlicensed. Meigs says that many people who approach Visiting Angels about New York franchises withdraw from the process or buy a franchise from an unlicensed agency when they learn how long it takes to obtain licensing in the state, even though Visiting Angels offers consultation and assistance with fees.


New York's penalties for unlicensed agencies are unforgiving. If New York state examiners see that a state license applicant has previously serviced clients in PD, the applicant may be investigated as a possible "scofflaw." If the state finds that the agency has performed personal care or other prohibited activities, the license application is suspended indefinitely and sanctions can be assessed.


In general, the need for state licensing seems to revolve around the issue of personal care (bathing, dressing, and ambulation assistance) for care recipients. Some states, like Florida, require higher level licenses, such as the "Nurses Registry License," if an agency is to provide hands-on care. According to Meigs, many agencies claim that their home care assistants never touch clients, although virtually all clients need some degree of personal care that involves touching, even if it is help getting out of a chair.


In Florida, Visiting Angels calls for all franchisees to apply for one of the higher level licenses that permit hands-on care within months after they sign a franchising agreement, rather than the "Homemaker Companion Certification," which does not permit hands-on or personal care.


Meigs believes that as momentum toward licensing continues to grow, most PD agencies will realize that "licensing actually provides tons of opportunities for PD agencies, particularly much greater potential to gain referrals from states and counties, and to have provider agreements with Long-Term Care Insurance Companies."


Said Meigs, "It is time for the PD industry to come out of the closet on this issue, get licensed and go forward."


For more information about Visiting Angels, a franchisor of at-home assisted living services for seniors, please visit