Home Care Programs

Initial Requirements To Be Eligible For Home Care

AGE: 60 OR OVER

An exception to the age requirement is made for persons under 60 with a confirmed diagnosis of Alzheimer’s Disease, or a related disorder, in need of respite services and who meet the Functional Impairment Level eligibility and determination of need eligibility criteria.

MA RESIDENT

Elder must reside in Massachusetts and can not  live in :

  • A rest home
  • Nursing facility
  • Convalescent home
  • Hospital
  • Assisted living residence
  • other licensed facility

DETERMINING YOUR LEVEL OF FUNCTIONAL IMPAIRMENT

The degree of functional impairment determined by an inability to complete ADLs and IADLs. The number of tasks an individual is unable to perform defines each FIL.

A minimum of 6 Activities of Daily Living (ADL) and/or Instrumental Activities of Daily Living (IADL) impairments

Plus 1 unmet Critical Need

 FIL  Impairments
1 4-7 ADL impairments   
2 2-3 ADL impairments
3 6-10 ADL/IADL impairments

ACTIVITIES OF DAILY LIVING (ADLS)

How many of the follow activities are you unable to perform without assistance?

  • Bathing
  • Dressing/Undressing
  • Eating
  • Transferring in and out of bed or chair
  • Mobility inside the home
  • Toileting
  • Managing incontinence

INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLs)

How many of the follow activities are you unable to perform without assistance?

  • Meal preparation (*Critical)
  • Food shopping(*Critical)
  • Housework/cleaning
  • Laundry
  • Taking medication
  • Getting around outside
  • Money management
  • Using transportation
  • Using the telephone
  • Transportation to dialysis, chemotherapy, or radiation (*Critical)
  • Respite Care(*Critical)

Program Types:
(Age 60+)

State Home Care Program

  • Program to meet needs of clients age 60 or older (such as home delivered meals, home making or personal emergency response systems)
  • Respite services
  • Waivers provide additional opportunities such
    as higher income limits to access MassHealth services and special programs

Enhanced Community Options (ECOP)

  • ECOP is available to clients 60 years of age or older requiring a more substantial care plan than the regular home care program normally would allow
  • Non-MassHealth
  • Clients otherwise clinically eligible for services in a skilled nursing facility
  • Allows complex clients to remain safely at home

Choices Program

  • Funded by MassHealth
  • For elders age 60 and over requiring a more substantial care plan than the regular Home Care Basic Waiver program would allow. 
  • Complex medical and psychiatric needs
  • This program allows a multitude of services to be brought into the home so that nursing home placement can be avoided

Specialty Programs:
(Require Masshealth and/or Medicare, Medicaide)

Group Adult Foster Care: (Age 22+)

  • Eligibility Adults age 22 or older, on MassHealth, requiring daily personal care and monthly RN or CM visits to remain safely in their homes
  • Must reside in a managed building with 24 hour access
  • Other services include Adult Day Health, home delivered meals, grocery shopping, laundry, and personal emergency response system
  • Willingness to receive PCHM a minimum of 5-7 days per week

Senior Care Options (SCO - Age 65+)

  • 5 SCO programs: Commonwealth Care Alliance, Fallon, Senior Whole Health, Tufts Health Plan and United Health Care
  • We provide Geriatric Social Support Coordinators, (GSSC’s) for SCO consumers
  • Consumers can be dually eligible for Medicaid (MassHealth) & Medicare
  • Age 65 and older
  • Our GSSC’s coordinate services with consumer’s PCP and clinical care team
  • Access to all services provided by CBES
  • Basic Medicare and MassHealth covered services

One Care: (Age 21 - 64)

  • 2 One Care programs: Commonwealth Care Alliance, Network Health in Suffolk County started October 2013
  • CBES provides Long Term Service Coordinators, (LTS’s) for One Care consumers
  • Consumers must be eligible for both Medicaid (MassHealth) & Medicare
  • Offers a broad range of medical and behavioral health services, long-term services and supports, and community-based services under one insurance plan.
  • Community based services include: care transitions assistance, community health workers, day services, home care services, medication management, home modifications, peer support, respite care, and transportation.
  • Primary care provider and care team work together to develop and individualized care plan.

Have Questions About Your Care Eligibility?