Self-Directed Home Care in PA: Taking Control of Your Care Plan

If your loved one is currently in a nursing home and your family has been wondering whether they could come home, the answer in many cases is yes. Pennsylvania’s Medicaid system includes specific pathways to support the transition from facility-based care to home and community-based care — and the state actually has a financial incentive to help make that move happen.

Nursing home care is significantly more expensive than home care. Pennsylvania, like most states, has been working for years to shift the balance toward home and community-based services. Programs exist specifically to help people leave nursing facilities and return home safely with appropriate supports.

The Right to Choose Home

First, a fundamental point: under federal Medicaid law (specifically the Olmstead decision), individuals have the right to receive services in the most integrated setting appropriate to their needs. If your loved one can safely live at home with adequate supports, they cannot be required to stay in a nursing facility just because that’s where they happen to be.

This doesn’t mean the transition is automatic or simple. It requires planning, assessment, and the right supports in place. But the legal right to choose home-based care is real, and it’s a powerful starting point for families who want to bring their loved one home.

How the Transition Works

Step 1: Express the desire to transition. Tell the nursing home’s social worker or discharge planner that your family wants to explore bringing your loved one home. They are required to help you explore this option. You can also contact the MCO (if your loved one is enrolled in Community HealthChoices) or the Office of Long-Term Living directly.

Step 2: Assessment for home care services. The MCO will conduct an assessment to determine what supports your loved one would need at home. This covers personal care, homemaker services, medical equipment, home modifications (grab bars, ramps, widened doorways), and other accommodations.

Step 3: Develop a home care plan. Based on the assessment, a service plan is created that outlines every service your loved one will receive at home. This is the moment to request Participant-Directed Services — allowing a family member to be hired as the paid caregiver through the Agency with Choice model.

Step 4: Prepare the home. Depending on your loved one’s needs, the home may need modifications before the transition. CHC covers certain home modifications as part of the care plan. Medical equipment (hospital bed, wheelchair, personal emergency response system) can also be arranged through the MCO.

Step 5: Transition. Once the care plan is in place, supports are arranged, and the home is ready, your loved one moves home. The service coordinator monitors the transition closely in the first weeks to ensure everything is working and to adjust the care plan as needed.

Nursing Home Transition Programs

Pennsylvania has specific Nursing Home Transition (NHT) services designed to support individuals moving from facilities to community settings. These can include one-time transition expenses (security deposits, utility hookups, essential furnishings), transition coordination services, and enhanced care management during the initial months at home.

These services are funded through Medicaid and administered through the MCOs. Not every family knows about them — and nursing homes don’t always proactively inform residents about their options for transitioning out.

When a Family Caregiver Makes the Transition Possible

Many families explore bringing a loved one home from a nursing facility but feel they can’t manage it financially. If they’re already working, how can they provide 30 or 40 hours of care per week?

This is exactly where paid family caregiving changes the equation. Through Participant-Directed Services, a family member can become the primary caregiver and receive compensation for those hours. The income from caregiving may offset the wages the family member would otherwise need to earn elsewhere — making the transition financially viable when it otherwise wouldn’t be.

The combination of home care services, home modifications, personal care from a paid family caregiver, and respite care creates a support structure that can rival or exceed what a nursing home provides — with the added benefit of being home, surrounded by family, eating familiar food, and living according to your own routines.

What to Watch For

The transition from a nursing home to home care is a significant change, and it’s important to be realistic about what’s involved. Make sure the care plan includes enough hours to cover your loved one’s actual needs — don’t accept an inadequate authorization just to speed up the transition. Ensure any home modifications are completed before the move, not after. Build respite care into the plan from day one so the primary caregiver has built-in breaks. Have a plan for medical emergencies, including a personal emergency response system. And keep the lines of communication with the service coordinator open, especially in the first 30 days.

If at any point the home situation isn’t working, the option to return to facility care remains available. The transition isn’t irreversible — but most families who make the move successfully don’t look back.

Need help exploring the transition? → Contact CareChoice

Related: Get Paid to Care for Family in PA → | How CareChoice Helps → | Respite Care in PA →