CAP/DA or PACE? Two Ways Triad Seniors Stay Home With Medicaid Help

Two programs, one goal

For someone who needs the level of care a nursing home provides but wants to stay home, North Carolina offers two main paths. The Community Alternatives Program for Disabled Adults (CAP/DA) is NC Medicaid's home and community-based waiver. The Program of All-Inclusive Care for the Elderly (PACE) is a combined Medicare and Medicaid program built around a care team and day center.

Both require a nursing facility level of care. After that, nearly everything differs, from who your doctor is to how services are arranged.

Side by side

Sources: NC Medicaid CAP/DA program page; North Carolina PACE Association program list.

Who tends to choose CAP/DA

People with long-standing doctors they trust, families who want to direct care themselves, and adults under 55 with disabilities. CAP/DA's consumer-directed option lets a participant hire a trusted aide, sometimes a relative, with a financial management agency handling payroll.

The catch is access: CAP/DA has limited slots and often a waiting list. NC Medicaid's contact center (1-888-245-0179) can point you to the case management entity for your county.

Who tends to choose PACE

People who would welcome a day center several days a week, who have many medications and appointments to coordinate, or whose families want one team in charge. PACE of the Triad in Greensboro (336-550-4040) lists Guilford and Rockingham counties; Randolph Health StayWell Senior Care in Asheboro (336-628-4200) serves Randolph.

PACE enrollment is by ZIP code, so confirm your parent's address first. Participants with both Medicare and Medicaid usually pay no premium.

What both programs leave to the family

Neither CAP/DA nor PACE provides round-the-clock care at home. Both assume the participant can be safe between visits and day-center hours, often with family filling gaps in the evenings and overnight.

Be honest about nights. If your parent cannot be left alone overnight and no family member can stay, an adult care home or special care unit may be the safer choice, with Special Assistance for those who qualify.

Getting started this week

Call the PACE program for your county to ask whether your parent's ZIP code is covered and to schedule an eligibility visit. At the same time, ask NC Medicaid's contact center for the CAP/DA case management entity in your county and whether there is a waiting list.

If your parent is not yet on Medicaid, apply at the county department of social services; CAP/DA requires it, and PACE is far more affordable with it.

Questions to ask each program

Ask PACE how many days a week your parent would attend the day center, how transportation works from your parent's address, who the primary care provider would be, and how after-hours problems are handled. Ask what happens if your parent is hospitalized and which hospitals PACE uses.

Ask the CAP/DA case management entity how long the current wait is, how the assessment works, how many hours of aide service a typical participant receives, and whether consumer direction is available for the relative you have in mind. Write the answers down side by side; the right choice is often obvious once the details are on paper.

How to decide

Ask your parent what matters most: keeping their own doctors, or having everything handled by one team. Then call both: the PACE program for an eligibility visit, and the CAP/DA case management entity about slots and timing.

If neither fits, Medicaid personal care services, adult day care and family caregiver support through the Piedmont Triad Regional Council (336-904-0300) can help. If staying home stops being safe, an adult care home with Special Assistance is the next step.