GuideHome health vs home care vs consumer-directed care in Arkansas
What each kind of program is, who employs the caregiver and when a family member can be paid.
Home health: the medical benefit
In Arkansas, skilled home health is Home health services (Arkansas Medicaid) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.
Only a licensed home health agency enrolled with Arkansas Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.
Home care: non-medical personal care through an agency
Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Arkansas the agency route is Personal Care (State Plan) (PCA). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.
The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.
Consumer-directed care: the person hires their own aide
Arkansas's consumer-directed option is IndependentChoices. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.
This is the route most families use to be paid: IndependentChoices allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.
Structured family caregiving: a paid live-in family caregiver
Arkansas has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (IndependentChoices), by the hour, as the participant's chosen aide.
Other ways Arkansas pays for care at home
Waiver in-home services: ARChoices in Homecare and Community and Employment Supports Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.
PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.
Which one fits
- Needs nursing, wound care, injections or therapy at home: home health (Home health services (Arkansas Medicaid) (HHA)).
- Needs daily help and wants an agency to supply and manage the aide: Personal Care (State Plan) (PCA).
- Wants to choose the aide, including a relative where allowed: IndependentChoices.
- Meets nursing-home level of care and needs more than personal care: ARChoices in Homecare and Community and Employment Supports Waiver.