Home & Community Services & Supports
Regulated by the New York State Department of Health (DOH), home care consists of nursing, therapy or personal care services provided in an individual’s home. Different categories of home care include licensed home care services agencies (LHCSAs), certified home health agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs). The most common services provided are help with activities of daily living (such as laundry, shopping, housekeeping, personal hygiene and meal preparation), skilled nursing services, and physical, occupational and speech therapy. Home care helps individuals who have long term needs related to a chronic illness or disability, or short term nursing or therapy needs after a hospitalization. Home care is often an important part of assisted living services, and is provided in senior housing as well as individual homes. The service is also discussed in those sections of this guide.
LTHHCPs provide home care and other supportive services to help people who would otherwise qualify for nursing home care to remain in their homes. The Nursing Home Transition and Diversion (NHTD) waiver or the Traumatic Brain Injury (TBI) waiver also provide services to help people who have high level needs to remain in the community, however the programs deliver these services in different ways.
Adult Day Services
In New York State, adult day services come in two forms – a medical model called “adult day health care” (ADHC) and a social model called “social adult day care” (SADC). Adult day services programs offer a safe, secure, stimulating environment for people whose family circumstances allow them to remain in their homes in the evenings (and possibly on weekends), but who need some sort of supervision during the daytime. Adult day services are very appropriate for a person whose needs are ordinarily met by their own family members or friends, especially when those people may work outside the home during the day but are generally at home in the evenings and on weekends.
Social Adult Day Care is oriented toward the social aspects of life and may include games, memory orientation exercises, music, dancing and reading in a safe and supervised environment. These programs also provide a meal, some help with daily living activities (such as mobility and grooming), and offer supervised field trips and special events. These programs may be located in the community, or in adult care facilities (see the section above on “Assisted Living and Adult Care Facilities”). SADC programs are overseen by the New York State Office for the Aging (SOFA). Funding sources include contracts with managed long term care plans, some grant funding from the local offices for the aging and private pay.
Adult Day Health Care has a strong medical component. These programs are staffed by a number of professionals including a registered nurse able to conduct assessments, manage medications and perform medical tasks. These programs must be sponsored by a nursing home or a hospital, and provide social activities in addition to medical services. They are required to provide physical, occupational and speech therapy to people who need these services. In addition, they provide a full range of personal care services (from some help to total assistance with mobility, eating, dressing, bathing, grooming and toileting), social services, case management and at least one meal per visit. ADHC programs must provide or arrange transportation to and from the program. These programs are regulated by the New York State Department of Health. Funding sources include fee-for-service Medicaid, contracts with the Veterans Administration, Medicaid managed care plans as well as private pay.
A hospice is an agency licensed by the New York State Department of Health to provide medical, spiritual and emotional care to individuals with life-limiting illnesses with a prognosis of six months or less to live if the disease process proceeds on its expected course. Many hospices have added “palliative care” to extend services to more people who could benefit from receiving health care treatment to prevent or reduce pain and suffering earlier in their illness or disease process. Hospice care can be given in the home, a special hospice facility, hospital or a nursing home. Hospice also provides supportive services to the individual’s family.
Respite service provides infrequent and temporary overnight care for ill or disabled older adults for a few days or weeks. It gives caregivers (family members or friends) a short break from the stresses or responsibilities of providing constant care, enabling the caregiver to maintain a normal routine. Respite care is normally offered for three consecutive hours or longer in a day, and up to six weeks in any calendar year. Respite can be delivered in a variety of settings, including assisted living facilities, nursing homes, and a home in the community. Respite care is offered under the LTHHCP, NHTD waiver and TBI waiver programs (see the “Home Care” section above). Respite services are generally in short supply and should be reserved as early as possible. Generally speaking, respite services are overseen by DOH.
Home-delivered meals, often called “meals-on-wheels,” are provided to older adults who are unable to prepare their own well-balanced meals either on a temporary or long term basis. Often these individuals are recovering from a recent illness, surgery or other condition, which impairs their independence, creating a situation in which they become nutritionally at-risk at a time when proper nutrition is especially important. In New York State, Area Agencies on Aging provide home-delivered meals with funding from federal and state governments, local funds and participant contributions. Individual participants may use Food Stamps, cash or checks as their contribution. Home-delivered meals are also a covered service under the LTHHCP and the NHTD waiver program (see the “Home Care” section above).
Senior centers offer a broad spectrum of services and activities such as social and education services, health, nutrition, and a community resource for information and recreational activities. These centers are offered by various community groups, churches and local governments. Some senior centers are regulated by the New York State Office for the Aging and Office of Children and Family Services. These centers must provide information and referral to other needed services, group activities, counseling and outreach. Participants must be at least 60 years of age and be income-qualified.
Payment for Home and Community Based Services
The cost of in-home and community-based services varies depending on the type of program and amount of services needed. Medicare, Medicaid, long term care insurance and private insurance are payment sources for some home and community-based services. Medicare tends to cover these services on a short-term basis following a hospital stay, whereas Medicaid may cover services over a longer period of time. Insurance policies have specific criteria for what services are covered, for how long, and under what circumstances. Check with your insurer for more information.
Most of the other services above are available to people out of their own funds. Some localities have special programs for individuals with low incomes. Some services, such as home-delivered meals or respite, may be covered by Medicaid as a part of a package of comprehensive services provided through the LTHHCP or the NHTD waiver program. Local programs and agencies may provide additional supportive services and help with cost. For further information, check with your local social services department or office for the aging.
In addition, in areas of the State where mandatory enrollment in managed long term care has taken effect, the Medicaid recipient may be required to enroll in managed care once they reach the threshold of receiving certain community based long term care services for more than 120 days. The managed long term care plan then becomes the primary provider of the individual’s services, often coordinating with other providers to supply care and services.
When deciding on in-home and community-based services, consider asking the following questions:
• What are the credentials of staff providing the services? Sometimes people hire people informally to help take care of some of their daily needs. Bear in mind that hiring through a licensed or certified agency provides some consumer protections such as training, criminal history record checks and insurance.
• Is the community service provider accredited by a national organization or formally connected to an existing health care provider such as a nursing home, hospital or retirement community?
• What sort of back up or additional support can family members or friends provide or arrange to make sure the person can remain in the community safely?
• What specific services are provided and at what cost? What services are covered by insurance, and for how long? Are there more appropriate and less costly alternatives available?
• What happens when services are discontinued? Does the provider help the individual to access other services if warranted?