GuideHome health vs home care vs consumer-directed care in Rhode Island
What each kind of program is, who employs the caregiver and when a family member can be paid.
Home health: the medical benefit
In Rhode Island, skilled home health is Home Health Services (RI Medicaid). 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 Rhode Island 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 Rhode Island the agency route is Home and Community-Based Personal Care and Homemaker Services (agency). 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
Rhode Island's consumer-directed option is Personal Choice Program (Self-Directed Care). 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: Personal Choice Program (Self-Directed Care) 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
Rhode Island offers structured family caregiving through RIte @ Home — A Choice for Care at Home. 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 Rhode Island pays for care at home
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.
State-funded: At HOME Cost Share Program. 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 (RI Medicaid)).
- Needs daily help and wants an agency to supply and manage the aide: Home and Community-Based Personal Care and Homemaker Services (agency).
- Wants to choose the aide, including a relative where allowed: Personal Choice Program (Self-Directed Care).
- Lives with a family member who provides care most of the day: RIte @ Home — A Choice for Care at Home.