What is the difference between a home care agency and a case management agency?
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A case management agency assesses needs, writes the care plan, arranges the services and monitors whether they are working. A home care agency employs the aide who comes to the house and does the hands-on work. On Georgia's EDWP waiver these are two separate providers, and a family usually deals with both.
Two different jobs that both get called “home care”
When a family starts looking for help, everything gets filed under the same heading. It is not the same thing, and the difference decides who you call when something goes wrong.
A home care agency, sometimes called a provider agency, employs people. It hires, trains, schedules and supervises the aides who come to the house and do the work: bathing, dressing, meals, light housekeeping, getting someone safely from the bed to the chair. When the shift is not covered, that is the home care agency’s problem to solve.
A case management agency does not employ any of those people. It works out what a person needs, writes it into a plan of care, arranges the provider agencies who will deliver each piece of it, and then monitors whether the whole arrangement is actually holding up. When the plan is wrong, or the person’s needs have changed, or three different services are not talking to each other, that is the case management agency’s problem to solve.
Apple Community Health Services is the second kind. It is an approved EDWP case management agency. It does not send the aide.
Side by side
| Case management agency | Home care agency | |
|---|---|---|
| What it does | Assesses, plans, arranges, coordinates and monitors | Employs and sends the person who does the hands-on work |
| Who comes to the house | A case manager, on the schedule the waiver sets, to assess and review | A personal support worker or aide, on the schedule in the care plan |
| What it is responsible for | The care plan being right and the services being in place | The shift being covered and the work being done properly |
| Who pays | Medicaid pays the agency directly. No bill goes to the member or family. | Medicaid pays the provider agency for the waiver services in the plan. |
| Can the member choose it | Yes, and the member may change it | Yes, and the member may change it |
Why the waiver is built this way
The split is deliberate. The person deciding what care someone needs is not the person who gets paid for delivering the hours. Keeping the assessment separate from the delivery is a check on the system, and it is one reason the plan of care carries a physician’s or a medical director’s attestation rather than only a provider’s word.
It also means a family can be unhappy with one without losing the other. If the aide is not right, the plan and the case manager stay put while a different provider agency is arranged. If the case management is not working, that can be changed too, and the services in the plan continue while it is sorted out.
Who to call when something goes wrong
This is the practical value of knowing the difference.
The aide did not turn up, or turned up late, or is not doing the tasks in the plan. Call the home care agency first. That is a scheduling and supervision matter and they own it. Tell the case manager too if it keeps happening, because a pattern is a plan problem.
The hours in the plan are no longer enough, or the wrong services are in it. Call the case manager. Changing what is in the plan is their work, not the aide’s and not the aide’s employer’s.
Something changed – a fall, a hospital stay, a spouse who can no longer manage. Call the case manager. That is the trigger for a reassessment.
You want a different provider agency. Tell the case manager. The member has the right to choose their providers and to change them, and the case manager is obliged to tell the member what is available in their area.
If you are not on the waiver yet
If nobody has been assessed and no plan exists, this whole structure is still ahead of you. The starting point is the Area Agency on Aging, which runs the Aging and Disability Resource Connection, and which handles the intake and the level-of-care screening. What happens after that is described in the application.
Questions people ask about this
So do we need both?
On the waiver, yes. The case management agency holds the plan and coordinates it. Provider agencies deliver the individual services in it, including the personal support worker who comes to the house. They are separate contracts with the state and separate organizations.
Does the case management agency choose the home care agency for us?
The member chooses. The case manager's job is to tell the member what providers are available in their area and let them pick, not to hand them a single name.
Can one company do both?
Georgia licenses and enrolls these as separate provider types, and Apple Community Health Services is a case management agency only. It does not employ the aides who come to the house.
We already hired a private caregiver. Do we still need a case management agency?
If you are paying privately and not using the waiver, no. The case management agency exists because the waiver pays for the care, and Medicaid requires the assessment, the plan of care and the monitoring that go with it. If you want the waiver to pay, that structure comes with it.
Related questions
- The case manager's role What an EDWP case manager does month to month, and the Georgia rule that gives a member the right to choose their case management agency and to change it.
- What the waiver covers The services Georgia's EDWP waiver pays for at home, from a personal support worker to home-delivered meals, and how each one gets into a care plan.
- What Georgia Medicaid covers at home What Georgia Medicaid pays for when an older adult needs help at home: personal support, meals, adult day health, respite, nursing and more.
- Choosing your provider Georgia waiver rules give a member the right to choose their EDWP provider, oblige the case manager to tell them what is available, and forbid bundling all services with one company.