Models of Care

Models of Care

HCBS may be delivered through a medical or a personal model. The majority of funded services are provided under the medical model, in which health care workers provide services under the supervision of physicians and nurses.

Another option that is growing in popularity is the personal model, also known as consumer-directed personal assistance services. Under this model, seniors receive services in their homes from personal assistants who are not supervised by medical professionals. Typically, the senior (or a family member, friend, or representative) advertises for assistants, interviews them, and develops the job description and terms of the position. The senior receiving the service is considered a self-directed consumer and not a patient. They hire, train, supervise, and fire their personal assistants. In the personal model, seniors are in control of their care.

Unhappily, this model is readily available only to those seniors who can pay for services out of their own pockets and to some Medicaid recipients who live in states that permit payment for care under this model. However, an increasing number of states are moving their services in this direction, and many analysts consider it the wave of the future.

Another way of describing HCBS is by comparing the professionally managed services model and the cash model. In the professionally managed model someone other than the senior makes the decisions about care and services. In the cash model the senior makes the decides how to spend money for care, including purchasing services from vendors, hiring a friend to help with activities of daily living, purchasing assistive technology, or modifying the home to make it more accessible. Some states have or are developing cash programs under the federal Cash and Counseling Demonstration and Evaluation project, which is part of the White House New Freedom Initiative.

The information above is reprinted from Working with Seniors: Health, Financial and Social Issues with permission from Society of Certified Senior Advisors® . Copyright © 2009. All rights reserved. www.csa.us