Home and Community Based Services for Alzheimer's

Aging in place, at home, is a common goal. People with Alzheimer's and their loved ones are no different. As the person with Alzheimer's declines, it becomes harder for them to care for themselves and their space. Home- and community-based services (HCBS) can help a person stay in their home longer.

HCBS programs allow people eligible for both Medicare and Medicaid to receive services in their homes. Medicare only provides home healthcare services. Home healthcare is for a specific medical illness.^1-4

In addition, Medicare will only cover home healthcare for people who are homebound or have skilled care needs. "Skilled care" is the term for tasks performed by a health professional. People with Alzheimer's may need more care than Medicare's home healthcare will cover.^1-4

Medicaid HCBS waiver

All states have a Medicaid HCBS waiver program. This program expands what Medicare offers. The Medicaid HCBS waiver covers more services than Medicare home health care. Specific services and levels of coverage can vary by state. Services include:^1,2,5-7

• Home modifications
• Help with chores like house cleaning
• Personal care
• Grocery shopping and meal prep
• Respite care
• Adult day center
• Therapy services
• Skilled nursing care

There are limits on how many people per state can receive waiver benefits. To qualify for Medicaid benefits, you must:^1,4,5

1. Meet your state's requirements
2. Have income and assets below a certain monetary level
3. You may also need to join a waiting list.

Long-term care

The nature of Alzheimer's means the person who has it often requires long-term care. Such care frequently falls on family members. HCBS can take some responsibility off the shoulders of the family. These services allow those with Alzheimer's to remain at home safely.⁴

Nursing homes, memory care units, and assisted living are expensive — many people with Alzheimer's need to stay home as long as possible to conserve resources. HCBS helps meet daily needs at home.⁴

Instrumental activities of daily living

Instrumental activities of daily living (IADLs) are higher-level tasks that you do to care for yourself. Problems doing these activities may be the first evidence of decline you notice in your loved one. Examples of IADLs are:^8,9

• Cleaning and housekeeping
• Paying bills
• Preparing meals
• Shopping
• Transportation
• Using communication devices (phone, computer)
• Managing medicines (keeping track of when to take them, refill them, etc.)

HCBS can assist with some of these functions as they become needed. Companion or homemaker services can meet many of these needs.²

Activities of daily living

Activities of daily living (ADLs) are more basic functioning abilities. IADL activities usually decline before ADLs. ADL decline is when your loved one struggles to do the following tasks by themselves:^8-10

• Move
• Feed themselves
• Get dressed
• Bathe or shower
• Use the bathroom (get on and off the toilet, clean themselves)
• Recognize the urge to void their bladder or bowels (incontinence)

As Alzheimer's progresses, a loved one will likely struggle more with dressing and feeding themselves. Bathing and using the toilet independently can become difficult. At this point, they may require someone trained in personal care or skilled care.^2,10

How to access services

Figuring out how to access home and community based services can feel overwhelming. The first place to start is with the County Assistance Office. They can help you sort through financial requirements and forms to determine eligibility. Other resources to consult include:²

1. Your doctor
2. Your local chapter of the Alzheimer's Association
3. Online community resource finder
4. Medicaid and Medicare's online tools
5. Eldercare locator