Tennessee home care programs

Home health: the medical benefit

In Tennessee, skilled home health is Home health services (TennCare) (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 Tennessee 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 Tennessee it is paid through the programs below rather than a separate agency personal care benefit.

Consumer-directed care: the person hires their own aide

Tennessee's consumer-directed option is Consumer Direction (CDTN). 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: Consumer Direction (CDTN) 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

Tennessee has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer Direction (CDTN)), by the hour, as the participant's chosen aide.

Other ways Tennessee pays for care at home

Waiver in-home services: CHOICES in Long-Term Services and Supports, Department of Disability and Aging 1915(c) waivers, and Employment and Community First CHOICES. 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.

State-funded: OPTIONS for Community Living. Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Also: Family Caregiver Stipend (FCS).

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home health services (TennCare) (HHA)).
• Wants to choose the aide, including a relative where allowed: Consumer Direction (CDTN).
• Meets nursing-home level of care and needs more than personal care: CHOICES in Long-Term Services and Supports, Department of Disability and Aging 1915(c) waivers, and Employment and Community First CHOICES.