The OPTIONS program: in-home help for Pennsylvania seniors 60 and older

What is the OPTIONS program?

OPTIONS is a Pennsylvania Department of Aging program that helps older adults get support in their own homes. It is run locally by the Area Agency on Aging in each county.

It was designed for people 60 and older who need some help to stay at home but do not qualify for Medicaid's long-term care. That describes many of the families who call us: a parent who is not wealthy, is not on Medicaid, and has started needing help with bathing, meals or getting around.

One thing to know up front: OPTIONS is not an automatic benefit for everyone who qualifies. Services depend on available funding, and the Area Agency on Aging first looks at what other help your parent already has. That is why it is worth calling early. The first call starts the assessment, and if there is a waiting list, it gets your parent on it.

Who can get help through OPTIONS?

According to the Department of Aging, your parent must:

• Be 60 or older.
• Live in Pennsylvania.
• Be a U.S. citizen or lawful permanent resident.
• Have needs, found through an assessment, that make daily life harder because of physical or mental frailty.

There is no income limit to participate. A few situations do rule OPTIONS out. Your parent cannot use it while enrolled in Medicaid long-term care (a nursing home, the LIFE program, or home care through Community HealthChoices) or in the Act 150 program. OPTIONS also does not serve people living in personal care homes, assisted living or nursing homes.

What can OPTIONS pay for?

Every Area Agency on Aging offers these main services through OPTIONS:

• A care manager who assesses needs, writes a care plan with your family, arranges services and checks in regularly.
• Personal care: help with bathing, dressing, grooming, using the toilet, eating, moving from bed to chair, and medication reminders, usually from a home care agency.
• Home-delivered meals for someone who cannot shop or cook.
• Adult day programs at a licensed adult day center.

Depending on the county and its funds, an Area Agency on Aging may also offer short-term help in a crisis, help with household tasks, home changes such as grab bars or a ramp, medical equipment, an emergency call button, pest control, and rides to medical appointments. Ask your county what it offers right now.

How many hours of help will your parent get?

It depends on the assessment, local funding and a monthly limit the state sets on most OPTIONS services. People with the greatest needs can sometimes receive more.

In real life, OPTIONS personal care often means a few hours a week rather than daily shifts. Many families use those hours for the most important tasks, like a morning shower and getting dressed, and cover other hours privately or with family help.

Will your parent have to pay anything?

Possibly a share. There is no income test to qualify, but your parent will be asked about income, and many people are asked to contribute toward services on a sliding scale. The care manager works out the share during the assessment and reviews it each year or when income changes. Short-term crisis help is not part of that share. Ask the care manager to explain how it applies to your parent before services start.

How do you apply for OPTIONS?

It starts with one phone call. Here is what usually happens next.

1. Call the Area Agency on Aging for the county where your parent lives. Our guide to Area Agencies on Aging lists the name and number for each of our 16 counties. You can also call the Department of Aging at 717-783-1550 to be connected.
2. A short phone screening. Someone asks about your parent's situation, who helps now, and what is not getting done.
3. A home visit. A care manager comes to the house and asks about daily activities, memory, health, home safety and the help family already gives. They also gather income information for the sliding scale.
4. A care plan. If your parent qualifies and OPTIONS can help, the care manager writes a plan listing services and hours.
5. Choosing how care is provided. For personal care, the county may arrange a home care agency it works with. Some counties also let your parent hire a worker directly.
6. Services start, or a waiting list. If funding is available, help begins. If not, your parent goes on the county's waiting list, which is ordered by need and date.
7. Regular check-ins. The care manager stays in touch, reassesses at least once a year or when needs change, and adjusts the plan.

How can you prepare for the home visit?

Write down what really happens on an ordinary day and on a bad one. The care manager will ask about bathing, dressing, eating, the toilet, getting around, medications, cooking, housework, shopping and getting to appointments, as well as memory, mood and the help family already gives.

• List your parent's medications, doctors and recent hospital or emergency room visits.
• Note any falls or near-falls, missed meals, missed medications, and nights your parent was confused or up wandering.
• Write down who helps now and when: which family member comes on which days, and what they do.
• Gather income information, such as Social Security and pension amounts.
• Be there if you can, or join by phone.

Many older adults downplay their needs to a stranger. It is perfectly fine to add, kindly, "Mom, tell her about Tuesday."

What if you disagree with the decision?

Ask for the decision in writing, along with an explanation of your right to appeal. Before appealing, call the care manager. The assessment reflects one moment in time, and sometimes a new assessment after a hospital stay, a fall or a change in the family's availability is all that is needed. If your parent's needs have grown, ask for a reassessment rather than waiting for the yearly one.

Is there a waiting list for OPTIONS?

Sometimes. When funding is limited, an Area Agency on Aging may keep a waiting list and serve people in order of need and date as money becomes available. Waiting lists differ by county and change from year to year.

Ask directly: "Is there an OPTIONS waiting list for personal care right now, and about how long is it?" If there is a wait, ask to be assessed anyway so your parent's place is set, and ask the care manager what else might help in the meantime.

What if your parent needs more help than OPTIONS can give?

If the assessment finds that your parent needs nursing-home-level help, the Area Agency on Aging will ask them to apply for Medicaid long-term care. If your parent qualifies financially, home care would then come through Community HealthChoices, which can usually approve more hours than OPTIONS. If your parent applies and does not qualify financially, OPTIONS can continue. The care manager will guide you through it.

How does OPTIONS compare with other Pennsylvania programs?

Three programs are easy to mix up. This side-by-side may help you see which one fits.

Our page on the Pennsylvania Caregiver Support Program explains that program in more detail.

Can you combine OPTIONS with private care?

Yes, and many families do. A common pattern is OPTIONS covering a few hours of personal care a week, with the family paying privately for extra hours, evenings or a weekend shift.

It's Your Home Care accepts OPTIONS referrals through the county Area Agency on Aging. When a family adds private hours, we keep the schedules and billing separate, so you can see which hours the county covers and which your family covers. Our guide to paying for home care in Pennsylvania shows how OPTIONS fits with long-term care insurance and VA benefits.

What is a good first step?

Call your parent's county Area Agency on Aging this week, even if you are not sure OPTIONS is the answer. In Dauphin County, that is the Dauphin County Area Agency on Aging at (717) 780-6130. In Lancaster County, the Lancaster County Office of Aging at (717) 299-7979. In York County, the York County Area Agency on Aging at (717) 771-9610. The full list for all 16 counties we serve is in our guide.

If help is needed before the county can start services, or you would like to add private hours, call us at (717) 695-2704 or request a consultation. We are happy to talk through your options, with no obligation.