Stage 2, Section 5: Formal Support Services

Find community services that enhance your care receiver’s quality of life and offer you relief from caregiving.

One thing to remember is that there are various funding resources for the same service. One example of a service is adult day care, which provides relief for caregivers and a safe, stimulating daytime environment for care receivers. Adult day care may be purchased privately, sometimes covered by a scholarship if the adult day care center is part of a religious-based organization, or paid for by a variety of federal and Florida state funding sources including Older Americans Act, Community Care for the Elderly, and Medicaid Waiver.

Each funding source has times when funds are available to add new clients and times when funding is limited. Waiting lists are based on the care needs of the client and are not provided on a “first come, first served” basis. Even if there is a waiting list for services, your care receiver may qualify sooner because his or her needs are greater than those of another person who applied at an earlier time.

Funding Provided through the Area Agency on Aging

Here are common types of government funding for community services with eligibility requirements and services paid for by each funding source:

  • Federal Older Americans Act (OAA) requires a person be sixty or over in order to receive services, but priority is given to low income, minority individuals living in rural areas. Some OAA-funded services may have a waiting list while others do not. There is no charge, but donations are accepted. You may call the agencies that provide these directly. These services are not case managed, and each provider has a specific priority policy developed for that service. To find out what organizations are the designated providers of OAA services, call the Helpline at 1-800-963-5337.
  • Older Americans Act Title III-C programs include congregate meals served in a group setting and home-delivered meals. OAA Title III-B services include information and referral, adult day care, chore services, homemaker, counseling, emergency alert response, legal assistance, and transportation. Even if you are on the waiting list for state-funded programs such as Community Care for the Elderly (CCE), you can call OAA providers to see if they have OAA hours of service available while you continue to wait for CCE. CCE is discussed below.
  • The National Family Caregiver Support Program, under Title III-E of the Older Americans Act, is a federal program that pays for services to relieve caregivers: screening and assessment, respite care in the home or in a facility, counseling, chore services, and medical supplies are a few of the services available through this program.
  • Caregivers eligible for this program must be adults who are providing in-home care for a person over the age of 60 who needs help with activities of daily living. As with other OAA programs, these services are not case managed, priority policies are set locally rather than at the state level, donations are accepted, and there may be a waiting list. For more information on this program see National Family Caregiver Support Program. Persons age 55 and over who serve as primary caregivers for relatives under 18 may qualify for the Kinship Care Grandparent Program.
  • Community Care for the Elderly, or CCE, is a Florida state-funded program that provides a case manager to assess the needs and determine what services should be provided. Call The Helpline at  1-800-963-5337 and request a referral to Intake. For inquiries from outside of the area call 727-217-8111.
  • The Intake process is based on a telephone screening assessment. This produces a priority score that, along with funding availability, determines whether the caller is on a wait list and how soon a case manager will complete an in-home assessment and develop a care plan, which is required for CCE services. Having a caregiver may lower a person’s priority score compared to people living in the community with no support. Persons on the waiting list are reassessed every six months, as a situation may change for the worse, making someone a higher priority. The statewide priority system in Florida was established by the Florida Department of Elder Affairs (DOEA).
  • To be eligible for CCE, a person must be sixty or over and functionally impaired, needing help with the normal demands of living. There is no income or asset requirement for CCE; however, clients are assessed a co-payment that is based on their monthly income.
  • CCE can provide a variety of services including case management, case aide, adult day care, chore, companionship, counseling, emergency alert response, emergency home repair, escort, health support, home-delivered meals, home nursing, homemaker, industrial cleaning, pest control, medical therapeutic services, medication management, nutrition counseling, and other services. The consumer has a choice of providers for these services.
  • Community Care for Disabled Adults is similar to Community Care for the Elderly but targets individuals under sixty. To be referred to the agency that provides this service, call The Helpline.
  • The Alzheimer’s Disease Initiative Program, or ADI, is another Florida state-funded program for which eligibility and priority are handled in a manner similar to CCE except that persons must be at least 18 years or older and have a diagnosis of memory or other cognitive loss and who have a live-in caregiver. Services include case management, caregiving training and support, case aide, and respite care in the home or in a facility. Call The Helpline for more information, and remember that this may be a resource for someone under sixty with Alzheimer’s or related dementia.
  • Home Care for the Elderly, or HCE, can provide a small basic subsidy (stipend) for caregivers of seniors who are eligible for nursing home care under Medicaid but who are cared for at home. Special subsidies are available for reimbursement of supplies, equipment, and services for those who qualify.
  • *Medicaid Waiver programs use federal Medicaid dollars that could have paid for nursing home care. Instead the State has a Waiver to match the federal dollars with State funding to pay for home and community based services for persons who would otherwise be in a nursing home. To be eligible for Medicaid Waiver programs, a client must meet the current income and asset requirements for Medicaid in a nursing home and must have a level of care that might require nursing home placement if home care options were not provided. This involves filing an application with the Florida Department of Children and Families and a level of care assessment by the Department of Elder Affairs CARES Unit. For more information, call The Helpline.

*Please note that the Medicaid Waiver Programs with the exception of PACE, that are listed above transitioned to the Statewide Medicaid Managed Care Long-Term Care Program on February 2014 for Pasco and Pinellas County.

  • In-home services paid for by Medicaid Waiver for eligible persons include case management, case aide, companion, attendant, chore, medical supplies, counseling, environmental accessibility adaptations (ramps, grab bars, etc.), escort, family training, health support, home-delivered meals, homemaker, nutritional risk reduction, personal care services, personal emergency response systems, pest control, risk reduction, respite care, skilled nursing, specialized medical equipment, and physical, occupational, and speech therapy. Just as in CCE or ADI, services are purchased for the client based on a care plan completed by the case manager.
  • There is also an Assisted Living  Medicaid Waiver program that pays for placement in selected assisted living facilities rather than nursing home care

At Risk Situation

If your care receiver remains on the waiting list for community services so long that you cannot continue home care without services to give you relief, he or she is at risk of placement in a facility. If you want to try to keep your care receiver at home, ask for a reassessment by an intake specialist even if it isn’t time for your care receiver’s six-month review. Because your care receiver’s situation may have worsened, he or she may now be a higher priority for government-funded services.

If you are at the point of considering placement in a nursing home, you may want to contact the local Department of Elder Affairs (DOEA) CARES Program office located in Largo, Florida. Call CARES at 727-588-6882 in Pinellas or 727-943-4958 in Pasco.

Nursing Home Diversion

The Nursing Home Diversion Program began in Pasco and Pinellas counties in October of 2003. Clients must be living in the community, must meet a nursing home level of care, and must meet the Medicaid income and asset guidelines. Clients choose a participating Managed Care Organization to provide their services. Offered services and facilities may be different for each company. These companies have contracts with the State to manage the care of program participants. These Managed Care Organizations receive a set monthly fee regardless of how many hours of service are provided and whether the service is provided in the home or facility. Accessing this program depends on the client’s priority for service and the availability of funds to add new applicants. Call 1-800-963-5337 for more information.

For the current income and asset limits for eligibility for Medicaid coverage of long-term care needs in Florida, visit www.floridamedicaid.com. This site by Medicaid attorneys is updated regularly. If you have more questions, you may want to consult an elder law attorney.

Veterans Administration

The Veterans (VA) Administration is an underused resource worth investigating on behalf of your care receiver. Some services that used to be available only to veterans with service-related injuries are now available to other eligible veterans, sometimes with coinsurance payments (co-pays) for those who do not meet low income and asset requirements. Bay Pines VA Healthcare System, where eligible veterans can receive services, is located in St. Petersburg, Florida.

One VA program that is not well known is Aide and Attendance. Another is respite care for dementia patients. For help in obtaining Veterans benefits, call the Pinellas County Department of Veterans Services (727-464-8460) or the Pasco Veteran’s Service Office (727-834-3282 or 352-521-5172). For more information, see “Veterans Benefits”, in the More Tips and Resources section of this Handbook. If you have additional questions, call the Veterans Administration’s toll-free line, 1-800-827-1000 or visit the Veterans Administration (VA) web site, www.va.gov.

Private Pay Options

Many of the same services that are available through government-funded programs are available on a private pay basis. Private pay services allow you to tailor the services to your needs and avoid the wait lists frequently found with government-funded programs. Even those receiving some government-funded services such as day care, may supplement with private pay services in order to meet their need.

  • There are many businesses in Pinellas County and Pasco County that provide in-home services such as help with house keeping and respite care. Take care of yourself and consider paying for at least four hours of relief a week.
  • Meals can be delivered to your home, ready for you to warm and eat when you are ready. Private case managers can help coordinate care. There are also physicians and other health care providers who will make home visits.
  • Licensed home care agencies can provide assistance with personal care such as bathing your care receiver. Some agencies require a four-hour minimum visit, but others will come for fewer hours at one time. Services do not have to be purchased on a daily basis and the agencies will help you design a schedule that fits your needs.
  • Adult day care is available on a private pay basis. Some assisted living facilities offer Senior Day Programs that are similar to adult day care. You can drop your care receiver off for 4 to 12 hours, and the cost depends on how much care is needed. Alzheimer’s care may be more expensive than independent care.

Helpful Resources

  • Family Caregiver Alliance Fact Sheet comparing using a home care agency with hiring someone privately is called “Hiring In-Home Help”. It can be found on the www.caregiver.org web site.