GuideHome health vs home care vs consumer-directed care in South Dakota
What each kind of program is, who employs the caregiver and when a family member can be paid.
Home health: the medical benefit
In South Dakota, skilled home health is Home Health Agency 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 South Dakota 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 South Dakota the agency route is Personal Care Agency Services. 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
South Dakota's consumer-directed option is Assistive Daily Living Services Waiver and South Dakota Family Support 360 Waiver (FS360). 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: Assistive Daily Living Services Waiver and South Dakota Family Support 360 Waiver (FS360) allow 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
South Dakota offers structured family caregiving through Structured Family Caregiving (SFC). 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 South Dakota pays for care at home
Waiver in-home services: Home and Community-Based Options and Person-Centered Excellence 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.
Which one fits
- Needs nursing, wound care, injections or therapy at home: home health (Home Health Agency Services).
- Needs daily help and wants an agency to supply and manage the aide: Personal Care Agency Services.
- Wants to choose the aide, including a relative where allowed: Assistive Daily Living Services Waiver and South Dakota Family Support 360 Waiver (FS360).
- Lives with a family member who provides care most of the day: Structured Family Caregiving (SFC).
- Meets nursing-home level of care and needs more than personal care: Home and Community-Based Options and Person-Centered Excellence Waiver.