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Pennsylvania offers Medicaid waiver programs under the Community HealthChoices (CHC) umbrella and the Pennsylvania Department of Aging (PDA) Waiver (often referred to as the PA Council on Aging Waiver). These programs help older adults and individuals with physical disabilities remain in their homes or community settings instead of entering nursing facilities. CHC and the PDA Waiver provide long-term services and supports (LTSS) based on assessed functional needs, emphasizing assistance with ADLs and IADLs. Covered services may include personal care assistance, adult day services, home-delivered meals, transportation, home modifications, assistive technology, and respite care for family caregivers. In addition, Pennsylvanias CHC Waiver offers Participant-Directed Services that allow participants to hire and manage their own caregivers, including family members. To qualify, applicants must be Medicaid-eligible, at least 60 years old (for PDA Waiver) or 21+ (for CHC), and require a nursing facility level of care as determined through a standardized functional assessment of ADLs/IADLs. In this article, we explain what Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are and how needing help with these tasks is central to qualifying for Pennsylvanias Medicaid waivers like CHC and the PDA Waiver.What Are ADLs (Activities of Daily Living)?Activities of Daily Living (ADLs) are fundamental self-care tasks that a person must perform daily to maintain independence. Difficulty with ADLs often signals a need for supportive services. Core ADLs include: Mobility (Ambulating/Transferring): Safely walking, getting up from a chair, or transferring from a bed to a wheelchair. Dressing: Selecting and putting on appropriate clothing (including handling fasteners) without assistance. Eating: Feeding oneselfusing utensils to get food from a plate to the mouth and consuming it. Personal Hygiene: Bathing or showering and performing grooming activities like shaving, brushing teeth, and combing hair on ones own. Toileting (Continence): Independently using the toiletgetting to the toilet, transferring on and off, and cleaning oneself afterward. When someone can no longer perform several ADLs without help, it indicates that ongoing care or support is likely needed.What Are IADLs (Instrumental Activities of Daily Living)?Instrumental Activities of Daily Living (IADLs) are more complex tasks that allow a person to live independently in the community. While not necessarily performed daily, they are essential for managing ones household and life. Key IADLs include: Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities. Meal Preparation: Planning and cooking mealsgathering ingredients and safely using kitchen appliances. Housekeeping: Keeping the home clean and livable tasks like cleaning, laundry, and taking out the trash. Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting. Transportation: Getting around or arranging transportationdriving oneself or using public transit or rides to run errands and attend appointments. Medication Management: Managing and taking medications properly remembering to take the correct medicines at scheduled times and refilling prescriptions. Communication: Using the phone or computer to communicatelooking up phone numbers, making calls, sending emails, and staying in touch with others. Trouble with IADLs is often one of the first signs that someone needs more support, even if basic ADLs are unaffected.Why ADLs and IADLs Matter for Medicaid Waiver EligibilityIn Pennsylvania, needing help with ADLs and IADLs is a central eligibility criterion for the CHC and PDA Waiver programs. These waivers serve individuals who would otherwise qualify for nursing facility care but prefer to remain in their own homes or community settings. Eligibility is determined through both financial and functional assessments. The functional assessment evaluates whether an individual requires hands-on assistance with ADLs and/or significant help with IADLs, thereby meeting a nursing facility level of care. Pennsylvania uses standardized toolsoften the Pennsylvania LongTerm Care Assessment System (PaLTAS) or the Minimum Data SetHome Care (MDSHC)to score independence in ADLs and IADLs.During the functional evaluation, an assessor reviews abilities such as transferring from bed to chair, walking safely, eating, toileting, meal preparation, housekeeping, medication management, and managing money. Cognitive issuessuch as memory problems due to dementiaare also considered since they impact daily functioning. If an individual cannot perform multiple ADLs without assistance or has significant deficits in IADLs, they are likely to meet the level-of-care requirement and become eligible for waiver services.Community HealthChoices (CHC) WaiverCommunity HealthChoices (CHC) is Pennsylvanias comprehensive HCBS waiver program for individuals aged 21 and older who require a nursing facility level of care. Administered by the Office of Long-Term Living (OLTL), CHC is a managed care program that combines physical health, long-term services and supports, and pharmacy benefits under a single plan (with behavioral health carved out). To qualify for CHC: Be age 21 or older. Meet Medicaid financial eligibility guidelines. Require a nursing facility level of care (confirmed through functional assessment). Live in a setting that meets HCBS requirements (e.g., home, apartment, assisted living). Be a Pennsylvania resident. Once enrolled, participants receive a comprehensive package of services tailored to their needs. Covered services may include personal assistance, home-delivered meals, adult day services, behavioral support, professional nursing, home modifications, assistive technology, transportation, and respite care. CHC also offers Participant-Directed Services, allowing participants to recruit, hire, train, and supervise their own caregiversoften family membersto assist with ADLs (bathing, dressing, toileting) and IADLs (meal preparation, medication reminders).PDA Waiver (Council on Aging Waiver)The Pennsylvania Department of Aging (PDA) Waiver, also called the Council on Aging Waiver, serves seniors aged 60 and over who require nursing facility level of care but choose to remain at home or in other community-based settings like domiciliary care homes. To qualify: Be age 60 or older. Meet Medicaid financial eligibility requirements. Be assessed as requiring nursing facility level of care (through the functional assessment). Live in a qualifying community setting. Covered services under the PDA Waiver may include personal care assistance, home-delivered meals, homemaker services, personal emergency response systems, respite care, adult day services, minor home modifications, and transportation. Like CHC, the PDA Waiver emphasizes managing ADL and IADL needs to keep participants safely in their homes.Participant-Directed ServicesBoth CHC and the PDA Waiver offer Participant-Directed Services, which empower participants to choose and manage their own caregivers, including family members, friends, or neighbors. Under this model, participants develop a service plan with guidance from a care coordinator, set schedules, and handle payroll tasks. This flexibility helps ensure that personal care and IADL support align with participants preferences and routines.Signs That Your Loved One May QualifyBelow are practical indicators that someone may be eligible for Pennsylvanias CHC or PDA Waiver due to difficulty with ADLs and IADLs: Trouble with Personal Care: Skipping showers, unkempt hair, or wearing dirty clothes may indicate difficulties with bathing and dressing (ADLs). Malnutrition or Weight Loss: An empty fridge or significant weight loss suggests issues with meal prep or feeding oneself (ADLs/IADLs). Mobility Decline and Falls: Struggling to walk without assistance, needing help to stand, or experiencing frequent falls signals reduced mobility (ADL: transferring/ambulating). Medication Errors and Memory Problems: Missing doses, mixing up pills, or forgetting appointments point to challenges with medication management and scheduling (IADLs). Household Neglect: Piles of mail, unpaid bills, or a cluttered home reflect trouble with housekeeping and money management (IADLs). A combination of needing help with several ADLslike bathing and toiletingand difficulties with IADLssuch as meal prep and housekeepingstrongly indicates a nursing facility level of care. Document these challenges for the functional assessment to demonstrate eligibility.Were Here to Help: Next Steps and Contact InformationNavigating Pennsylvanias Medicaid waiver programs can be complex, but you dont have to go it alone. At Passion to Care, we specialize in guiding Pennsylvania families through the CHC and PDA Waiver application processesfrom the initial functional assessment of ADLs and IADLs to completing paperwork and coordinating services once approved. If you notice your loved one struggling with daily tasks or if a professional has recommended nursing facility care, it may be time to explore CHC or the PDA Waiver. Our compassionate, family-first team ensures your loved ones needs are met with dignity and respect. Call us or contact us today to learn how to get started with Pennsylvanias Medicaid waivers for home and community-based services.

Top Questions to Ask Your Healthcare Provider: A Guide for SeniorsAs we get older, our health needs change. Regular checkups and open conversations with your healthcare provider become even more important. But lets be honestmost doctor visits feel rushed or even overwhelming. You have so much you want to discuss with your doctor, only to leave the office and suddenly realize you forgot to ask all the questions you had intended to.Thats why you have to be prepared. Asking the right questions can help you better understand your health, avoid confusion, and feel more in control of your care. If youre a senioror caring for onehere are the top 5 questions you should ask your healthcare provider. Print them out, jot them down, or keep them in your phone. These questions can help make the most of every visit.1. What screenings or tests do I need at my age?This is one of the most important questions to discuss with your doctor. Prevention is key to better health. Health screenings give you the opportunity to catch potential health issues early before they become serious. Thats especially important as we get older, since the risk of certain conditions (like heart disease, diabetes, cancer, and osteoporosis) increases with age. Some screenings are age-based, while others depend on your personal and family history.  Common screenings for older adults may include: Blood pressure and cholesterol checks Bone density scan Mammogram or prostate exam Colon cancer screening Vision and hearing tests Diabetes screenings  Ask your provider: Am I due for any screenings? How often should I get these done? Do I need any lab work or imaging?   2. Are all my medications still necessary?Its common for many seniors to take multiple medications to manage different health conditions. But over time, your health needs can change, and so can your bodys response to certain drugs. Thats why its important to regularly review your medications with your doctor. Some prescriptions may no longer be needed, while others might interact with new medications or cause unwanted side effects. Asking about your current medications helps ensure youre only taking whats truly helpfuland nothing more.Always bring a list of everything you are taking, including over-the-counter drugs as well as vitamins and herbal supplements.Ask your provider: Do I still need these medications?Are there any side effects I should watch for?Can any of these medications intereact with each other - or with over-the-counter vitamins or supplements I take? 3. What vaccines do I need to stay protected?Many people tend to think vaccines are just for children. But that certainly is not the case. As we age, our immune systems become weaker, making us more vulnerable to certain infections. Certain illnesses, like the flu, pneumonia, shingles, and COVID-19, can be more serious in seniors. Thats where vaccines come into play. Staying up to date on recommended vaccines can help prevent complications and keep you out of the hospital.  Recommended vaccines for seniors often include: Flu shot (every year) Shingles vaccine (usually two doses after age 50) Pneumonia vaccine COVID-19 vaccines and boosters Tdap booster (for tetanus, diphtheria, and whooping cough)  Ask your provider: Am I up to date on my vaccines? Do I need the shingles or pneumonia shot? What about the flu or COVID vaccines?  4. How is my memory and mental health?Its normal to forget where you put your keys now and then, but memory loss that affects daily life shouldnt be ignored. The same goes for feeling down, anxious, or lonely. Your mental health is just as important as your physical health, and it deserves attention too.Memory issues and mental health concerns often go unspoken. The earlier you talk about it, the more options there are to support your wellbeing and independence. It can help to talk openly with your provider about how you're feeling emotionallyespecially after big life changes like retirement, loss, or illness. If needed, your provider may suggest counseling, support groups, or safe treatments. Ask your provider:Is my memory okay for my age?Should I be concerned about confusion or forgetfulness?How do I know if I'm just feeling low or if I'm dealing with depression or anxiety?5. What can I do at home to stay healthy and prevent illness?Staying healthy isnt just about doctor visitsits about the choices you make every day at home. From the foods you eat to how active you are, small lifestyle habits can have a big impact on your overall well-being. Your provider can guide you on safe, practical ways to support your health right from the comfort of your home.Ask your provider:What kind of exercise is safe for me?Should I be eating differently at my age?How can I improve my sleep or energy? Speak Up and Be a Partner in Your Healthcare JourneyYour doctor is your partner in healthbut youre the expert on how you feel. Dont be afraid to ask questions, bring notes, or speak up if something doesnt make sense or feel right. There are no wrong questions when it comes to your health. At VIPcare, we specialize in senior-focused primary care. Our providers take time to listen, answer your questions, and tailor care to your specific needs. From preventive screenings to chronic condition management, were here to support your health and your goals. Call (251) 257-2886 today to schedule an appointment or learn more at www.getvipcare.com.