PACE or the AD Waiver? A Family Guide for Staying Home in Omaha

Two programs, one goal

Both programs serve people who meet Nebraska's Nursing Facility Level of Care but want to live at home. The AD Waiver, run by DHHS, pays for services such as personal care, chore, respite, adult day health, home-delivered meals and emergency response systems, coordinated by a services coordinator, usually from ENOA for people 65 and older. PACE, offered in the Omaha area by Immanuel Pathways from its center on Sorensen Parkway, takes over all of a participant's care, paid by Medicare and Medicaid together.

Side by side

Sources: Nebraska DHHS AD Waiver pages; Immanuel Pathways Eastern Nebraska.

When the waiver usually fits better

Families who value their parent's long-time doctors, who already have a good home care agency, or whose parent wants to move into a waiver-certified assisted living facility usually lean toward the waiver. It pays for Supported Residential Living in certified ALFs, with the resident paying room and board. It also leaves the family more choice of providers, at the cost of more coordination work.

When PACE usually fits better

Families juggling many specialists, frequent hospital visits and transportation problems often find PACE a relief: one team, one phone number, rides to the center and to appointments, and the program responsible for everything, including nursing home care if it becomes necessary. PACE is also open at 55, and to people who do not have Medicaid, though Medicare-only participants pay a premium.

What a week looks like on each

On the AD Waiver, a typical week for a parent at home might include personal care aide visits several mornings, a chore visit, home-delivered meals, an emergency response pendant, and perhaps two days at an adult day program, with the services coordinator checking in monthly and the parent's own doctors handling medical care. Family usually coordinates appointments and transportation not covered by the waiver.

In PACE, the same parent might ride the program's van to the Sorensen Parkway center two or three days a week for meals, activities, therapy and clinic visits, with home care aides on other days arranged by the PACE team, and the PACE physician and nurses managing medical care. One team calls the family when something changes.

What happens if nursing home care becomes necessary

On the AD Waiver, a move to a nursing home ends waiver services; Nebraska Medicaid then pays the nursing home for an eligible resident, who keeps a $75 monthly personal needs allowance. In PACE, the program remains responsible: if the team decides nursing home care is needed, PACE pays for it and keeps managing the participant's care. For some families that continuity is the deciding factor.

Costs families should expect on each

For a parent with both Medicare and Medicaid, PACE usually has no premium and no copays for covered services. On the AD Waiver, the parent keeps regular Medicare and Medicaid coverage, and services are paid by Medicaid, though a parent with income above the standard may owe a monthly share of cost under the Medically Needy program. In both cases, housing, food and everyday living costs stay with the family unless the parent lives in a waiver-certified assisted living facility, where room and board is the resident's charge. Ask each program to show you, in writing, what your parent would pay each month.

How to decide

Call both. ENOA's Information and Assistance line, (402) 444-6444, can explain the waiver and local services; Immanuel Pathways can confirm whether an address is in its service area and schedule an intake. Have ready a list of daily activities your parent needs help with, current doctors and medications, recent hospital stays, income and savings. A person cannot be in both programs at once, but can switch later.

Whichever program a family chooses, review it after three months. Is the help arriving as planned? Is the parent safer, less isolated, better rested? Are the caregivers holding up? Both programs can adjust: the waiver's services coordinator can change the plan, and the PACE team can add services. If neither is working, the other is still an option, as are assisted living and, when needed, nursing home care.