Person- and family-centered service plans

The Centers for Medicare & Medicaid Services should require a needs assessment of all family caregivers who assist Medicaid HCBS program participants. 

Publicly funded HCBS programs and hospital discharge planners as well as Medicare Chronic-Care Coordination and Care Transition programs should assess family caregivers' needs, develop person- and family-centered service plans, and offer evidence-based caregiver support services. These services can include education and skills training, counseling, and support groups. 

The federal government should expand the requirement to assess the needs of family caregivers under the 1915(i) HCBS state plan option to all assessment tools for Medicaid HCBS authorities. Such assessments will identify family caregivers at risk for burnout before they are unable to provide care or compromise their own physical and mental health and support them in their caregiving roles. 

Federal and state policymakers should: 

• expand support for family caregiver services such as education and training, counseling, legal consultations, and respite care, which can delay or decrease the likelihood of needing to enter a nursing facility; 
• preserve and expand funding for respite care services in a range of settings, such as personal care services in the home or adult day services, to ensure that more family caregivers can have a break from their caregiving duties; 
• preserve and expand funding for respite care services regardless of whether the consumer is eligible for Medicaid or a publicly funded program, or is a private-pay individual; 
• allow family caregivers who are assisting individuals with moderate incomes, and who would not otherwise qualify for publicly funded respite services, to buy into or otherwise access these services; 
• establish policies to pay relatives and friends who care for people with LTSS needs as part of a service plan; and 
• design programs and policies to protect consumers and avoid the erosion of family-care networks. Programs and policies should protect consumers, guard against fraud and abuse, and avoid disincentives for unpaid caregiving.