Can my mother stay at home instead of going to a nursing home?

The short answer

Often, yes. Georgia has a Medicaid program built for precisely this: the Elderly and Disabled Waiver Program. If your mother needs the level of care a nursing home provides, the waiver can pay for services in her own home instead.

That sounds backwards until you see the logic. Ordinarily Medicaid will pay for a nursing home but not for help in someone’s house. A waiver sets that rule aside, so the funding can follow the person home. The same test that would qualify her for a facility is the test that qualifies her for home services.

There are real conditions attached, and there are situations where home is not the right answer. Both are below.

What does ‘nursing-home level of care’ mean?

It is a formal standard, not a doctor’s opinion in the moment. Georgia assesses it with a standardized tool called the DON-R, which scores how much help a person needs with everyday activities – bathing, dressing, moving around, eating, using the bathroom, managing medications – and how much supervision she needs because of memory, judgement or behavior. A medical form called the DMA-6 carries the clinical picture alongside it.

Two things surprise families. The first is that it is about function, not diagnosis: a specific condition does not qualify or disqualify anyone by itself. The second is that people are often closer to meeting it than they expect, because they are quietly compensating for their mother by doing three hours a day of things nobody has written down.

Under Georgia’s General Services manual §602.11, the plan of care and the attestation of level-of-care need can be signed either by her own physician or by the case management agency’s medical director. That matters practically: an agency with a medical director does not have to wait on a busy physician’s office to move a case forward.

The level of care page goes through the assessment in more detail.

What does it actually look like at home?

Not a hospital in the living room. In practice, a week under the waiver usually looks like this.

A personal support helper comes on set days for a set number of hours. She helps your mother shower, get dressed, move safely between rooms, get a meal together, do laundry, keep the kitchen and bathroom in order. If your mother needs help getting up in the morning, that visit is scheduled in the morning.

Around that, other pieces get added as they are needed:

• Home-delivered meals on days there is no helper
• Adult day health two or three days a week, which gives her somewhere to go and gives whoever cares for her a workable day
• Skilled nursing visits for anything clinical
• An emergency response button for falls
• Respite, so the main caregiver can go away for a weekend
• Home modifications such as grab bars or a ramp, within program limits
• Structured Family Caregiving, if a relative lives with her – see the Structured Family Caregiving page

A case manager builds that plan with her, arranges the providers, and revisits it when things change. Medicaid pays the case management agency directly, and no bill for case management ever goes to your mother or to you.

The hours are set from the assessment, not from a menu. Nobody can tell you a number before the assessment happens.

Where home genuinely does not work

This is the part that gets left out of most articles, so here it is plainly.

The waiver does not provide 24-hour care. It funds scheduled visits. If your mother cannot be left alone at 3am, the waiver hours do not solve that on their own – somebody has to be there, and that somebody is family, a live-in arrangement, privately paid help, or a facility.

Home is also the harder option when:

• Her medical needs are genuinely complex and continuous, rather than intermittent
• She wanders, or her judgement at night puts her at risk in a house nobody can lock down
• The house itself cannot be made safe – stairs that cannot be avoided, no accessible bathroom
• Transfers have become a two-person job and there is only one person
• The family caregiver is exhausted to the point where they are becoming unwell themselves

None of those are failures. A facility is a legitimate choice, and for some people it is the safer and kinder one. The point of the waiver is that it is a choice rather than a default – the default used to be that the money only existed in one place.

What has to be true for this to happen

Three things, in order:

1. She meets nursing-home level of care. Assessed as above.
2. She meets Medicaid’s financial rules. Income and asset limits apply, and they differ between the two versions of the waiver. See income and assets.
3. A slot is available. The waiver has a limited number of funded slots and there is often a waiting list. See the waiting list page.

Time from first call to services starting is realistically two to six months. If a decision has to be made this month, read hospital discharge options as well, which covers what can bridge the gap.

How to find out

The Area Agency on Aging is the state’s front door – in metro Atlanta that is the Atlanta Regional Commission, through its Empowerline service. You can also talk directly to a case management agency about whether the program looks like a fit and what the assessment involves.

You have the right to choose which providers you work with, and to change them later; see choosing your provider.

Nothing here is a determination of eligibility. Only the assessment and Medicaid’s own review can decide whether your mother qualifies.