Flexible care at home: A Self-Directed Alternative for Seniors


Like many Minnesotans, Mark was facing a problem. His aging mother was at the point where she needed assistance to take care of herself. She was struggling, even with the help that he could provide when he wasn’t at work. He started asking himself the question that he had been avoiding; should she be in a nursing home? She wanted to stay in her home, but she needed help.

Mark’s situation is not unique. According to projections from Minnesota State Demographic Center, Minnesota’s oldest residents—those aged 85 and above—are expected to more than double in the next 35 years—from the current 120,000 to over 270,000. In total, Minnesotans of retirement age and above numbered 889,511 in 2018—an increase of 136,492 since 2013. This number is expected to roll over 1.26 million in the next 20 years. His mother’s wishes combined with decreasing availability of rooms in nursing homes in his area had him looking for other options, but what were they?


A Self-Directed Alternative


Self-Direction provides an alternative for those who need a nursing home level of care. Minnesota’s Home and Community Based Services (HCBS) pave the way for people aged 65 and older to remain in their homes and communities while still receiving care. Seniors that choose to self-direct can access services that provide options for direct care staff and allow them more control over their staffing including hiring, managing, training, and scheduling around their individual needs. These services allow seniors to hire family and friends to provide care including their own adult-children. Some of these services allow for the purchase of goods and home modifications to help seniors increase and/or maintain their independence while remaining in their own homes and communities longer. “For a lot of people, looking for a nursing home is just what you do. They don’t know there are alternatives to nursing home care that allow people to remain in their homes and communities.” Samantha Frederick, Director of CDS at MRCI. After hearing about the availability of these services, Mark was interested, but didn’t know where to start.


How do you sign up?


The process starts with contacting your County, Tribe, or Managed Care Organization (MCO). From there, the person requiring services will be assessed to determine their care needs. An application and determination of the person’s eligibility for Medical Assistance (MA) will also be part of this process unless completed previously. Depending on the results of the assessment and MA application, there are two programs through which a person can receive funding for services and/or goods Elderly Waiver (EW) and Alternative Care (AC).

AC and EW have their own separate eligibility requirements and covered services. Both the EW and AC programs allow for services offered through MRCI Client Directed Services including Consumer Directed Community Supports (CDCS), PCA Choice, Homemaker, Respite, as well as many other covered services. To learn more about the full eligibility requirements, covered services, and which program is appropriate for your loved one, contact your county, tribal nation, or managed care organization.


Mark and his mother were able to work with his county, and through the Elder Waiver (EW) she was able to enroll in the Consumer Directed Community Supports (CDCS) Program. CDCS has allowed Mark, as his mother’s representative, to hire his niece, Hannah, to help with his mother’s care. It’s also allowed for modifications of his mother’s home including handrails in hallways, and an accessible bathtub. Mark knows that his mother may still need the level of care provided in a nursing home eventually, but he is happy knowing that his mother is safe and independent in her own home.

“My mother had a stroke a long time ago and is doing better now. With the help of MRCI and the State we were able to get her a couple caregivers and aphasia therapy; it’s just been wonderful,” says Tasha Hanel, daughter of a CDCS participant. “she’s been able to get help in her home; she’s just not capable with as much as she was.” Tasha’s mother was able to hire Tasha’s father and aunt as her care staff.

Are you struggling with how to get the best care for your loved one? Do you have questions about your options, or the process? Please reach out to us. Have your own self-direction story to tell? We’d love to hear it!


For more information on care options for seniors, and the self-directed alternative to Nursing homes, please visit the following resources.