Deciding Between Home Health Care or a Nursing Home

Providing care for a loved one is a profound commitment, and in Pennsylvania, various programs exist to support family caregivers in this vital role. While Personal Care Assistance (PCA) broadly refers to services that help individuals with daily living activities, its important to understand that paid family caregiving in Pennsylvania primarily operates through specific Medicaid waivers. These initiatives aim to support the invaluable work of caregivers while allowing loved ones to remain in the comfort and familiarity of their own homes or the homes of family members.Understanding Personal Care Assistance (PCA) in PennsylvaniaIn Pennsylvania, Personal Care Assistance (PCA) refers to the services that help individuals with daily living activities and household tasks, enabling them to live independently. Its crucial to differentiate this from Personal Care Homes (PCH), which are residential facilities that provide housing, meals, supervision, and assistance, but typically do not offer third-party reimbursement for family caregivers providing care within them.Instead, paid family caregiving for PCA services in Pennsylvania primarily operates through various Medicaid waivers, also known as Home and Community-Based Services (HCBS) waivers. These waivers are designed to provide direct assistance with Activities of Daily Living (ADLs) and household services for older adults or individuals with disabilities who live in their own homes or the homes of loved ones. The services provided under these waivers are what constitute Personal Care Assistance in the context of paid family caregiving.Key Pennsylvania Medicaid Waivers for PCAPennsylvania offers several Medicaid waivers that facilitate paid family caregiving for Personal Care Assistance, each with specific eligibility criteria and rules regarding family members.1. Community HealthChoices (CHC) Waiver: Getting Paid to Care for Loved OnesThe Community HealthChoices (CHC) waiver is Pennsylvanias most common Medicaid managed care program that facilitates paid family caregiving for PCA. It is designed for individuals aged 21 or older who are eligible for both Medicaid and Medicare and require a nursing facility level of care. This program consolidates several former waivers into a single, comprehensive system and is administered by private healthcare insurance companies contracted by the state.Recipient Eligibility for CHC: To qualify for the CHC program, the individual needing care must meet several criteria: Age: The recipient must be 21 years of age or older. Dual Eligibility: They must be eligible for both Medicaid and Medicare. Functional Eligibility: A physician must certify that the individual has a condition requiring long-term services and supports, specifically an inability to perform essential Activities of Daily Living (ADLs) such as bathing, toileting, or transferring. A trained assessor will also conduct a functional eligibility determination to confirm the level of care needed. Financial Eligibility: The individual must meet specific income and/or asset requirements, determined by the local County Assistance Office (CAO). For example, in 2023, the income limit to qualify for the Pennsylvania Medicaid waiver program under CHC was $2,742 per month. Caregiver Eligibility (Who Can Be Paid, Spousal/Guardian Restrictions): Pennsylvanias Medicaid waivers generally permit family members, such as adult children, siblings, and even friends, to be compensated for providing care. However, under the CHC waiver, spouses (husband or wife) are typically not eligible to be paid caregivers. Similarly, individuals holding Power of Attorney (POA) for the care recipient or legally responsible guardians (such as parents caring for children under 18) are also generally excluded from paid caregiver roles under this program.Application Process: The process involves contacting the Pennsylvania Independent Enrollment Broker (IEB) at 1-877-550-4227, applying on the COMPASS website, and submitting necessary documentation, including physician certification and financial information. Once approved, the care recipient can select a state-licensed home care agency that employs family members, such as Avondale Care Group.Services Covered & How Agencies Facilitate Payments: The CHC waiver covers a range of personal care and home care services. This includes direct assistance with Activities of Daily Living (ADLs) like bathing, dressing, meal preparation, and medication management, as well as various household services. Family caregivers are hired as regular employees of the licensed home care agency, which handles all administrative tasks, including payroll and compliance.Payment Rates & Benefits for Family Caregivers: The compensation for family caregivers through Medicaid waiver programs in Pennsylvania typically ranges between $10 and $15 per hour. The number of hours approved depends on the care recipients health and needs, with a maximum of 35 hours of care per week often allowed. The maximum weekly pay rate for Pennsylvania is up to $700 per week, which aligns with or exceeds these hourly rates, potentially including overtime or other factors. Many agencies also offer additional benefits that significantly enhance the overall compensation package for family caregivers. These can include overtime pay, weekly pay, free Certified Nurse Aide (CNA) training for eligible caregivers, holiday pay (often 1.5 times the regular rate for specified holidays), 401k plans with company matching, company-sponsored healthcare insurance (with substantial premium coverage), flexible schedules, and paid time off.2. OBRA WaiverThe OBRA Waiver is designed to support individuals aged 18-59 who have a severe developmental physical disability and require an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care. This program helps these individuals live as independently as possible within their communities by providing assistance with activities of daily living (PCA services).Family Member/Spouse Eligibility: Similar to the CHC waiver, the OBRA waiver excludes spouses or legal guardians from being paid caregivers.Payment Rates: Compensation for caregivers under the OBRA waiver varies by geographic area, typically ranging from $13 to $15 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.Application: The application process also begins by contacting the Independent Enrollment Broker (IEB) at 1-877-550-4227. 3. Consolidated WaiverThe Consolidated Waiver provides support and services to a broader population, including individuals of all ages with an intellectual disability (ID) or autism, as well as children under 22 with a developmental disability due to a medically complex condition. Recipients must be recommended for an intermediate care facility (ICF) level of care based on a medical evaluation.Family Member/Spouse Eligibility: A significant difference with the Consolidated Waiver is that it explicitly allows a friend or family member, including a spouse or legal guardian, to receive payment for care provided.Payment Rates: The average pay for Pennsylvania caregivers under the Consolidated Waiver typically falls between $11 and $14.50 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.Application: To apply for the Consolidated Waiver, individuals should contact the Office of Developmental Programs (ODP) customer line at 1-888-565-9435. Important Considerations: Medicaid Estate Recovery Program (MERP)While Pennsylvanias Medicaid programs offer crucial financial relief for family caregivers, it is essential for families to understand the long-term financial implications. The Medicaid Estate Recovery Program (MERP) is a federal requirement for all state Medicaid programs to seek repayment for long-term care costs after a recipient passes away. This recovery typically applies to individuals aged 55 and older who received Medicaid long-term care services, including those provided through Home and Community-Based Services (HCBS) waivers. Assets subject to recovery can include the deceased recipients primary home, even if it was exempt during their lifetime while receiving benefits. The states claim is generally delayed if there is a surviving spouse, a child under 21, or a child of any age who is blind or permanently disabled. Families may also be able to apply for undue hardship waivers in certain circumstances. Given these potential impacts on family inheritance and assets, it is highly advisable for families to consult with an elder law attorney or financial advisor for personalized guidance on MERP and comprehensive estate planning.  

Move to a Continuing Care Retirement Community (CCRC) and prearranging your future for security and peace of mind, is a wise investment. But for many, the prospect of selling their homeand determining whether the housing market is favorablecan feel like a daunting hurdle.Holding off might seem like the safest choice, but waiting could present unexpected challenges. In reality, knowing when to move to a senior living community could make all the difference.So why is 2025 the time to make the move? Keep reading to learn more.National Housing Market in 2025As of January 2025, the U.S. housing market presents the following trends:Home Prices: Zillow forecasts a 2.6% increase in home values for 2025, indicating a relatively modest appreciation similar to the previous year's growth.Mortgage Rates: Mortgage rates have surpassed 7% for the first time since mid-2024, with the average rate on a 30-year fixed mortgage rising to 7.04%, according to Freddie Mac.Housing Starts: In December, U.S. single-family homebuilding reached a 10-month high, rising to 3.3%, according to the Commerce Department.If you're like many of our residents and have owned your home for several years, selling in 2025 could be a highly profitable move. With home values expected to rise by 2.6%, you can look forward to growing your home equity, resulting in a strong return on your investment. This makes 2025 an excellent time to cash inyouve earned it!Mortgage rates are another key factor that makes selling now a wise choice. While mortgage rates are expected to ease in 2025, improving affordability for buyers, this will also likely lead to increased demand. As a result, home prices are expected to remain high and could even rise further.Another encouraging sign for sellers is the limited housing inventory. A recent Zillow analysis revealed that the U.S. is short by 4.5 million homes to meet demand. When supply can't keep up with demand, its the perfect time to enter the market. Leaving behind the hassles of homeownership, you can enjoy a more relaxed, resort-like lifestyle thats better suited for your retirement!No more worries about finances.Unlike being at the mercy of the unpredictable housing market and the financial challenges of maintaining your own home, moving to a continuing care retirement community gives you control over your future at fixed, predictable prices. With a range of convenient amenities designed to make life easier and more enjoyable, you can rest assured knowing your well-being is supported by a reliable, long-term health plan.All Acts Retirement-Life continuing care retirement communities offer Acts Life Care, a contract that secures your future health care needs and protects your savingsno matter the economic or global uncertainties. This contract guarantees access to care options like assisted living, skilled nursing, rehabilitation, and more, should you ever need them.Acts Life Care isnt just about planning for the unknownits about offering peace of mind. Imagine knowing that your future health care costs are already covered and that your monthly fee remains stable. This solution shields you from the fluctuations of the stock market and the rising costs of health care.Staying Active and Engaged in a Vibrant CommunityAs we age, maintaining an active and healthy lifestyle is important, and there's no better way to do that than by having a plethora of activities available at your fingertips to engage your body, mind, and spirit. Many of us find that isolation increases as we get older, which can lead to depression and other health concerns. Moving to a senior living community means staying social and fostering meaningful companionship.Residents also have easy access to a wellness suite with a full-time Nurse Practitioner who is available to address common health concerns and provide regular check-ups, helping you stay ahead of your health needs.Check out the amazing health benefits of a social lifestyle in retirement.Peace of Mind with Acts RetirementWe've highlighted that every Acts community is a continuing care retirement community (CCRC), but what does that truly mean? Simply put, a CCRC allows you to move in as a healthy and independent adult, choosing from apartment homes, villas, or cottages, depending on your preference. You make a one-time entrance fee payment that secures the benefits of Acts Life Care, along with a predictable monthly fee that covers essential services like maintenance, utilities, chef-prepared meals, and a range of other amenities.Should your care needs evolve, the Acts Life Care contract ensures your monthly fee wont change because of it. Your fee stays consistent regardless of the level of care you need.The Acts Life Care contract isnt just a benefitits a promise that gives you peace of mind. Knowing that your future health care needs are already paid for, at todays prices, allows you to rest easy and focus on enjoying life without worrying about unexpected costs.No such thing as a "free" home! Learn about the hidden costs of home ownership.As we age, managing the day-to-day upkeep of our homes can become a real burdenone that may be too much to handle. In an Acts continuing care retirement community, you can say goodbye to the stress of home maintenance: no more costly repairs, lawn care, snow removal, hurricane preparations, or fixing broken appliances.Security with Acts RetirementWhen it comes to senior living, the options can be overwhelming. So, why choose continuing care retirement living with Acts Retirement-Life Communities? One word: Security.With over 50 years of leadership in the senior living industry, Acts is one of the most trusted and experienced organizations in the field. As a not-for-profit entity, our focus is on improving the lives of our residents, not generating profits for shareholders. Additionally, our Acts Life Care plan ensures that residents savings are protected for life. All these factors, along with the other benefits well highlight below, contribute to Acts maintaining a 98% satisfaction rating among current residents.Acts communities also benefit from the strength of its network. With 28 continuing care retirement campuses in nine states, Acts provides a range of options for residents to experience our unparalleled lifestyle. Our on-site healthcare centers consistently rank among the nations top facilities according to state and federal agencies.When it comes to retirement living, Acts Retirement offers unmatched strength, security, and peace of mind.

By John NicoletteWhether its deciding what we want for breakfast in the morning or when our next trip to visit family is going to be, life is filled with decisions, and each one makes some kind of impact on our lives big or small. When it comes to aging, we all have a choice to make how do we want to live out retirement? Perhaps you think youd best thrive in an independent living community, where you can make friends with like-minded individuals and indulge in high-quality dining and a robust calendar of engaging activities. Or, like most retirees, you may prefer to enjoy your retirement in the home you worked so hard to achieve. AARPs 2024 Home and Community Preferences survey discovered that seven in 10 adults aged 50+ want to stay in their own homes and live independently for as long as they can. Only 6% would prefer to move in with a family member or friend. Since most older adults want to independently age in place, what steps can they take to make possible?This doesnt have to be a journey you embark on alone the right resources, like an age-in-place program, can provide a plan that you have control over. Age-in-place programs ensure that while you live the life youve worked so hard for, your current needs and future health care needs, as well as financial assets, are covered through a comprehensive, membership-based program. An age-in-place program, which is also known as continuing care without walls, allows you to live in your home, while also providing the comfort and security of a life plan community it's the best of both worlds.Similar to a life plan community, healthy, independent retirees can join with a one-time membership fee and an associated monthly service fee that will ensure future care in their home. With membership, you receive a life-long guarantee of personal care coordination and care for if or when you require it. Age-in-place programs bring security to your doorstep by making sure that your home is safe for you to continue to live in as you age. For example, Senior Choice at Home, the only age-in-place program based here in Southwest Florida, provides its members with a home inspection upon joining the program. That inspection addresses current and potential safety concerns, like tripping hazards, uneven staircases and inadequate hallway lighting.Personal care coordinators included in the programs membership also learn members medical history, medications and preferred physicians so that in an event that a member cannot advocate for themselves, their coordinator will. They also arrange for services if needed in the future, including homemaker services, home health aides, live-in companions and a transition into assisted living if that is preferred or needed.Just as you would any other major life decision, its imperative that you dedicate time to proactively plan for your aging in place journey it is a financial commitment and requires proper planning to ensure your assets are in order prior to selecting a program that works best for you. Enrolling in an age-in-place program comes with a set cost. It means you won't have to worry about rising long-term costs or what insurance will cover. Youll know exactly what you will pay for a lifetime of long-term care right from the start.In the era of an influx of Baby Boomer retirees, thousands of older adults will soon have a decision to make will you age in place, or take the leap into a senior living community? Whatever your decision may be, there are resources to guide you through the journey. Aging in place with the security of a membership-based program presents numerous benefits, but at their core, they guarantee retirees exactly what they need in this new chapter advocacy, financial and emotional security, and freedom.About the author John Nicolette is the director of Senior Choice at Home, an age-in-place program serving older adults in Collier, Lee and Charlotte counties. Senior Choice at Home is regulated by the state of Florida as a premier life plan community without walls. To learn more, visit SeniorChoiceatHome.com or call 239-788-0694.