Delaware home care programs

Home health: the medical benefit

In Delaware, skilled home health is Home Health Services. 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 Delaware Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating and household tasks is "home care" or personal care. In Delaware it is paid through the programs below rather than a separate agency personal care benefit.

Consumer-directed care: the person hires their own aide

Delaware's consumer-directed option is DSHP Plus Participant Direction (consumer-directed attendant care) and Self-Directed Personal Care/Attendant Care for Children (SDAC). 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: Self-Directed Personal Care/Attendant Care for Children (SDAC) 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

Delaware has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Self-Directed Personal Care/Attendant Care for Children (SDAC)), by the hour, as the participant's chosen aide.

Other ways Delaware pays for care at home

Waiver in-home services: DDDS Lifespan Waiver and Diamond State Health Plan Plus (DSHP Plus) Long-Term Services and Supports. 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.

State-funded: Attendant Services Program and Personal Care Services (DSAAPD). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
• Wants to choose the aide, including a relative where allowed: DSHP Plus Participant Direction (consumer-directed attendant care) and Self-Directed Personal Care/Attendant Care for Children (SDAC).
• Meets nursing-home level of care and needs more than personal care: DDDS Lifespan Waiver and Diamond State Health Plan Plus (DSHP Plus) Long-Term Services and Supports.