JoyceOC Posted February 2016
For people in NYS, here is a program to help pay for in-home care.
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Of course, they will need to qualify, but this allows your loved one to remain in their home with all the care they need.
health.ny.gov/facilities/long_term_care/waiver/
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Waivers are for a specific period of time and a more narrow set of services. Like Medicaid paying for AL is a Medicaid waiver, & this is why many states medicaid do not ever pay for AL, as those states do not even try to do a waiver program for AL, they spend their discretionary Medicaid $$ in other programs.
In home health services is another waiver program. Some states -like CA with its IHHS program done by counties - have a very organized system in place to qualify, train, pay & monitor in home care paid by medicaid.
The current trend for waiver funding is PACE or other PaCE like community center daily on site program. In many ways it makes better sense financially to fund a program where many use the services & health care professionals in a central site than doing 1-on-1 care at home or an individual AL waiver. PACE usually has a nonprofit partner that does staffing, compliance, etc so the state in theory does not have to have state employees getting paid to do those functions. The staff at a PACE are usually an employee of or contracted to the nonprofit and not an employee of the state. There is a PACE by us - the Benson Center that has as its non profit partner Catholic Charities, it is going so well that another center is being built out at another old Catholic convent site. If there is a PACE in your area, you may find that the elder will have to first be evaluated for and enroll in PACE before they can try to get on a different medicaid waiver.
Waivers tend to do 3, 5 & 8 year planning & funding cycles. Medicaid is a huge huge budget busting cost for states now as they are required to pay their share to get the federal portion, so pressure is on state budgets to defund any waivers that are 1-on-1 as they are just not cost efficient as compared to a wider community based program like PACE. All of the programs that have federal funding are required to show a cost benefit analysis (CBA) in order for funding or an action to be done. PaCE looks better for CBA than individual care. I know this is long, but I think its really really important whenever possible to share an understanding of just how the planning is often done.
Also it says "Waiver services are provided based on the participant's unique strengths, needs, choices and goals. The individual is the primary decision-maker and works in cooperation with providers to develop a Service Plan"..... therefore, I wonder how that works when the individual had dementia and cannot be the decision-maker?