Nevada home care programs

Home health: the medical benefit

In Nevada, skilled home health is Home Health Agency services (Nevada 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 Nevada 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, toileting and household tasks is "home care" or personal care. In Nevada the agency route is Personal Care Services (State Plan) — agency model (PCS). 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. Personal Care Services (State Plan) — agency model (PCS) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Nevada's consumer-directed option is Self-Directed PCS (ISO model). 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 PCS (ISO model) 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

Nevada offers structured family caregiving through Home and Community-Based Services Waiver for Structured Family Caregiving (SFCG). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways Nevada pays for care at home

Waiver in-home services: Home and Community-Based Waiver for the Frail Elderly (HCBW-FE) and Waiver for Persons with Physical Disabilities. 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: Community Options Program for the Elderly (COPE). 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 Agency services (Nevada Medicaid) (HHA)).
• Needs daily help and wants an agency to supply and manage the aide: Personal Care Services (State Plan) — agency model (PCS).
• Wants to choose the aide, including a relative where allowed: Self-Directed PCS (ISO model).
• Lives with a family member who provides care most of the day: Home and Community-Based Services Waiver for Structured Family Caregiving (SFCG).
• Meets nursing-home level of care and needs more than personal care: Home and Community-Based Waiver for the Frail Elderly (HCBW-FE) and Waiver for Persons with Physical Disabilities.