1. Executive Office of Elder Affairs
Home Care Program
Executive Office of Elder Affairs
May 2014

2. ELD Home Care Program Team
Mary DeRoo – Director of Home and Community Programs
Susan Tompkins-Hunt – Asst. Director Home and Community Programs
Brenda Correia – Coordinator of Elder Community and Support Programs
Sandy Brown – Clinical Assessment & Eligibility RN
CAE & Home Care RN Manager
Devon Garon– Waiver Program Manager
Shannon Philbrick –Home Care Program Coordinator
Quality Manager

3. Brief history 27 Home Care Corporations (HCCs) established 1973-1975
Each with a unique geographic service area
Community based non-profits
51% of board members must be aged 60+
ASAP law passed in 1997 – c.19a§4b
Request for Responses (RFR) issued 2010; designation of 27 Aging Services Access Points (ASAPs)
Statutory responsibilities of ASAPs:
Information & Referral
Clinical eligibility for Medicaid-funded institutional and community based care
Care management and service coordination
Authorization and purchase of services
Protective Services

4. ASAPs perform many functions
Information and Referral
Nursing facility pre-admission screening
Functional eligibility determinations
Financial eligibility (Home Care Program)
Needs assessment
Care plan development
Authorization of services
Monitoring of service delivery
Reassessment
Protective Services

5. Home Care Programs
Provide interdisciplinary care management and in-home support services to elders in Massachusetts.
Eligibility is based on age, residence, income, and ability to carry out daily tasks such as bathing, dressing and meal preparation (functional impairment level).

6. Eligibility for Home Care
Age and residence:
60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder)
Resident of Massachusetts and not living in an institutional setting or Assisted Living Residence.
Income:
Based on a sliding scale, monthly co-payments of $9 - $140 are required for individuals/couples with income above the Federal Poverty Level. Respite/Over-Income eligible, monthly cost sharing of 50% - 100% of the service plan cost is required.
Functional Impairment Level (FIL):
Require assistance with at least 2 Activities of Daily Living (ADLs) or 6-10 ADL/IADLs (Instrumental Activities of Daily Living) and have a critical unmet need (any ADL, meal preparation, food shopping, home health services, Respite, transportation for medical treatments).
Exceptions to the Uniform Intake Policy:
At Risk. Elders who are at risk due to a variety of factors, including, but not limited to substance abuse, mental health problems or cultural and linguistic barriers.
Protective Services. Elders who are receiving or are eligible to receive Protective Services…
Congregate Housing. Clients residing in a Congregate Housing Facility.
Waiver Clients. Clients who are eligible for the Home and Community based Waiver Program.

7. State Home Care Programs
Home Care Basic - a program for elders who:
meet the Home Care enrollment eligibility
require assistance with I/ADLs.
have an Average service cost per consumer is no more than $266/month. (Not a per person limit.)

8. State Home Care Program
Respite Over-Income – a program that supports caregivers in meeting the needs of elders who:
Meet the Home Care Program eligibility criteria of
60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder)
Residents of Massachusetts
Functional Impairment Level (FIL)
have an annual income over $26,562 (single) or $37,584 (couple) and are willing to pay an income-based percentage of the cost of services (50% to 100%)
Are not MassHealth eligible
Are not eligible for other programs

9. State Home Care Programs
Enhanced Community Options Program (ECOP) – a subset of Home Care Basic consumers who are:
60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder)
State Home Care Program eligible
Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )
Not MassHealth Standard eligible
Service plan cost of two times the level of services provided through Home Care Basic Non-Waiver.

10. Home Care Non-Waiver Services
Personal Care
Home Health Aide
Supportive Home Care Aide
Respite
Companion
Skilled Nursing
Adult Day Health
Behavioral Health
Chore
Environmental Accessibility Adaptations
Grocery Shopping/Delivery Services
Alzheimer’s/Dementia Coaching
Home Delivered Meals
Homemaker
Laundry Services
Medication Dispensing System
Home Delivery of Pre-packaged Medication
Nutrition Assessment/Counseling
Personal Care
PERS/Enhanced PERS
Supportive Day Care Programs
Transitional Assistance
Transportation
Vision Rehabilitation
Home Based Wandering Response Systems

11. Home & Community Based Services Waiver Programs
Home Care Basic Waiver – a subset of Home Care Basic consumers who are:
60 years of age or over
State Home Care Program eligible
Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )
MassHealth Standard eligible
In need of and/or receiving a Waiver Service

12. Home and Community Based Services Waiver Programs
CHOICES - a subset of waiver consumers who are:
60 years of age or over
State Home Care Program eligible
Meet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )
MassHealth Standard eligible
In need of and receiving a Waiver Program Service
Service plan cost of two times the level of services provided through Home Care Basic Waiver.

13. Frail Elder Waiver (FEW) Expanded Income Eligibility
Frail Elder Waiver (FEW) Expanded Income Eligibility for MassHealth Standard:
-Elders who meet all Waiver program eligibility criteria except for MassHealth Standard eligibility:
With income at or below 300% SSI FBR
($2,163/month in 2014)
Have countable assets below $2,000
-Can apply for MassHealth Standard using the FEW expanded income eligibility rule

14. Home Care Waiver Services
Personal Care
Home Health Aide
Supportive Home Care Aide
Homemaker
Respite
Companion
Skilled Nursing
Chore
Environmental Accessibility Adaptations
Grocery Shopping/Delivery Services
Home Delivered Meals
Laundry Services
Supportive Day Program
Transitional Assistance
Non- Medical Transportation
Home Based Wandering Response Systems
Alzheimer’s/Dementia Coaching
Home Delivery of Pre-packaged Medication
Medication Dispensing System
Occupational Therapy
Services not available through the waiver program, available through the MassHealth State Plan:
PERS
Transportation for medical
ADH

15. Care Planning/Care Management
Care Manager completes an initial on-site assessment (OSA) to determine consumer eligibility
Initial Service Plan is created with consumer to address identified unmet needs.
visit schedule of an OSA at least every six months dependent upon program enrollment and need
Annual re-determination of home care program eligibility
review of care plan/service plan at least annually
Annual re-determination of personal care needs, as well as clinical eligibility for waiver and ECOP by ASAP RN

16. Service delivery options
Traditional service providers
ASAP contracted service providers
Consumer Directed Care – a service delivery option for non-waiver enrolled consumers in accordance with EOEA PI-09-08
Consumer can choose to recruit, train and hire their own worker for personal assistance services
ASAP authorizes an average number of hours per week and is responsible for the overall management of program service costs within the limits for HCB-NW and ECOP program
Services Offered
Homemaking
Personal Care
Home Health Aide
Transportation
Chore
Companion
Other assistance with I/ADLs
Services provided must meet needs identified in the assessment process or otherwise identified as necessary for the health, welfare and community independence of the consumer.

17. Wait Lists Currently, there are no wait lists for: Home Care Programs
ECOP (Enhanced Community Options Program)
No Expectation for a wait list through Fiscal Year 2014

18. Wait Lists and Exceptions
Effective September 8, 2009, ASAPs were required to establish a Home Care Program waiting list. Applicants are screened at intake to determine whether the applicant meets one of the following exceptions:
Eligible for Enhanced Community Options Program (ECOP) or Medical Frail Elder Home and Community Based Services Waiver;
Active or triaged Protective Services consumers in need of Home Care Program Services
Elders being discharged from nursing facilities and hospitals, including chronic and rehabilitation hospitals who need Home Care Program Services in order to return to the community;
Elders enrolled in hospice care who require Home Care Program Services.
All eligible applicants who meet one of the exception criteria described above shall be enrolled in the Home Care Program. All other applicants must be placed on the Home Care Program waiting list.
Referral sources must be informed at the time of referral that the applicant may be enrolled in a program or placed on the waiting list, as appropriate.
ASAPs should offer information regarding other community sources of assistance that may be available to the applicant.

19. Wait List Priority Levels
Criteria for the assignment of priority levels. Priority levels are based on the need for services.
Priority Level 1: The applicant has no informal support or other formal support and has at least one of the following Critical Unmet Needs:
Personal Care
Home health services
Transportation to medical treatments
Grocery shopping
Priority Level 2: The applicant has limited formal and/or informal supports (inadequate to meet demonstrated need) or the caregiver requires respite to continue involvement and the applicant has at least one of the following Critical Unmet Needs:
Priority Level 3: The applicant has limited formal/informal supports and a Critical Unmet Need of grocery shopping.
Priority Level 4: The applicant has a Critical Unmet Need of meal preparation.

20. Family Caregiver Support Program
National Program implemented by Elder Affairs through ASAPs
Funded primarily with Federal Title III-E funds; with limited state and local agency funds
Program with a multi-faceted approach that supports the Caregiver.

21. Caregiver Specialist
Caregiver Specialist focuses on supporting the Caregiver
Conducts caregiver assessments
Develops a caregiver action plan
Provides personal assistance in connecting caregivers with resources and services which may include
Respite care options
Supplemental Services
One-on-one counseling & coaching
Identified training in group settings or for individuals
Facilitates family meetings

22. Who is eligible to be a Caregiver
A family or informal caregiver who is
caring for an elder 60 or older, or someone with Alzheimer’s
a grandparent aged 55 or older caring for a child age 18 or younger
over the age of 55 caring for a disabled individual between the ages of 18-59; cannot be the parent
Contact the Massachusetts Family Caregiver Support Program: Local ASAP AGE-INFO or

23. Other Community Options
Veteran’s Independence Plus (VIP)
Certified Home Health Agency
Optional for consumers with Medicare A coverage, as well as other insurers
Private Pay Home Care
Optional for all consumers

24. Veteran’s Independence Plus Program (VIP)
VIP Program serves
veterans of any age
at risk of nursing home admission
Supports family Caregivers
VIP Program qualifications
receive primary care at Bedford or Boston VAMC (Veteran’s Administration Medical Center)
have a VA primary care team
meet the eligibility criteria for home and community based services as determined by VA
Receive a referral to VIP Program from the VA Medical Center
ASAP Case Manage (Care Advisor) VIP enrollees

25. Certified Home Health Agency
CHHA’s are home care providers certified by Federal Medicare Program
Provide and bill for services
Meet requirements for patient care and management
CHHA’s provide:
In-home assessment
Developed plan of care
Skilled care health services for 60 day increments

26. Qualifying for Certified Home Health Care (CHHA)
To qualify for Medicare home health coverage, a person must:
Need skilled care (SN, OT, PT)
Have a physician’s order for care and have seen by the physician ordering care either within 90 days before care or 30 days after starting care
Be homebound, i.e. unable to seek medical attention without “severe taxing effort”
Discharge from an acute or rehabilitation/hospital is not necessary
Family members or others can refer to CHHA
Physician’s order for care is required (see above)

27. Private Home Care For more information contact local ASAP or ILC
Private pay home care services can be purchased in hourly blocks of time or as overnight or live in services
Private pay home care companies provide a broad range of services
Private pay home care services are not subject to eligibility rules and restrictions, or ASAP/EOEA monitoring requirements
Private pay home care companies can be a company within a Certified Home Health Agency, but not always
For more information contact local ASAP or ILC

28. Information and Referral
Contact the local ASAP or ILC AGE-INFO