Home Care for Alzheimer’s and Dementia Patients in Philadelphia

Caring for a family member with Alzheimer’s disease or another form of dementia at home is among the most demanding caregiving situations a family can face. The needs are constant, they escalate over time, and they involve a combination of personal care, safety supervision, and emotional endurance that few other conditions require. Philadelphia families managing this reality should know that Medicaid-funded home care programs are designed to support them —and that a family member can be the paid caregiver.

What Dementia Home Care Looks Like

Home care for someone with Alzheimer’s or dementia covers the same personal care services as any other home care arrangement — bathing, dressing, grooming, toileting, meal preparation, medication reminders, and mobility assistance. But dementia adds layers that make the care more complex.

Supervision is constant.  Individuals with moderate to advanced dementia may wander, leave the stove on, attempt to leave the house, or become confused about their surroundings. The caregiver provides ongoing safety supervision — which is fundamentally different from the intermittent help someone with a physical disability might need.

Communication changes.  As dementia progresses, your loved one may have difficulty expressing needs, understanding instructions, or recognizing familiar people. The caregiver must read nonverbal cues, manage frustration (both their own and the care recipient’s), and maintain patience through repeated questions and disorientation.

Behavioral challenges.  Agitation, sundowning (increased confusion and anxiety in late afternoon/evening), resistance to care (refusing to bathe, dress, or eat), and in some cases aggression are common in mid-to-late-stage dementia. Managing these behaviors requires skill, consistency, and emotional resilience.

Progressive escalation.  Unlike many other home care situations where needs remain relatively stable, dementia care needs increase over time. A care plan that was adequate six months ago maybe insufficient today. Regular reassessments are essential.

Why Family Caregivers Excel in Dementia Care

In our experience at CareChoice, family caregivers are often better suited for dementia care than agency-assigned aides — not because they have more training, but because they have more history. Your mother may not recognize a stranger who walks through the door, but she responds to your voice, your touch, the way you’ve always talked to her. That familiarity is a genuine clinical asset in dementia care: it reduces agitation, improves cooperation with personal care, and helps maintain whatever cognitive connection still exists.

This is why Participant-Directed Services is so powerful for dementia families. The person providing care isn’t a rotating cast of unfamiliar faces — it’s someone the care recipient has known their entire life.

Medicaid Coverage for Dementia Home Care

Dementia home care in Philadelphia is funded through Community HealthChoices, the same system that covers all Medicaid home care in the city. The
functional assessment evaluates both physical ADLs and cognitive function — memory, decision-making, orientation — which means the assessment captures dementia-related needs, not just physical care needs.

In our experience, individuals with moderate-to-advanced dementia typically qualify for substantial care hours because the supervision component alone is significant. But the assessment must document the cognitive and behavioral needs specifically. If the assessor only evaluates physical ADLs and doesn’t capture wandering, sundowning, resistance to care, or the need for continuous supervision, the authorization will be lower than it should be.

During the assessment, describe the behavioral challenges in detail. How often does your loved one attempt to leave the house? How frequently do they resist bathing or dressing? Do they have sundowning episodes? How often do they forget to eat or take medications? These details drive the hours.

Combining Home Care with Adult Day

For dementia families, the combination of a paid family caregiver at home and a structured adult day program during weekday hours can create a comprehensive care system. Adult day centers provide cognitive stimulation, social engagement, meals, and health monitoring in a supervised setting — all of which benefit individuals with dementia. The family caregiver handles mornings, evenings, and weekends at home, and the adult day program covers the middle of the day.

This combination also protects the caregiver from burnout— which is especially high in dementia caregiving due to the emotional intensity and the 24/7 nature of the supervision required.

When to Consider Additional Support

If your loved one’s dementia has progressed to the point where they need continuous overnight supervision, or where behavioral challenges create safety risks that a single caregiver cannot manage, it may be time to explore additional services: overnight respite, a second family caregiver sharing hours, or in some cases a discussion about facility options— not as a default, but as a thoughtful assessment of what level of care keeps your loved one safe.

CareChoice helps Philadelphia families with dementia care navigation — from the initial assessment through care plan development, PDS enrollment, and ongoing support as the condition progresses.

Contact CareChoice →Philadelphia team

Written by Shamere Dunswell, Community Relations Manager | CareChoice