Family caregivers and their loved ones often need more autonomy and involvement with care. What options are available? Agency with Choice is a program that helps adults with intellectual and developmental disabilities (IDD) get the support they need. It puts the person in charge of their care so they can choose and train their support staff, helping them be more independent and involved in their community.
What is an agency with choice?
An agency with choice is a model of home care services that allows individuals with disabilities and/or their representatives to select their support service professionals, meaning that individuals can choose who works for them, when, where, and how, and have more control and flexibility over their services. An agency with choice also provides administrative and financial support to individuals and/or their representatives and training and development opportunities to workers. An agency with choice is offered by various agencies and organizations that act as the Employer of Record for the workers, while the individuals and/or their representatives act as the Managing Employers. An agency with choice is funded by different sources, such as the Office of Developmental Programs, the Department of Developmental Services, Medicaid waivers, or private pay.
Some examples of the agencies and organizations that use the agency with choice model are:
- The Department of Developmental Services in Massachusetts offers Agency with Choice as an option for individuals and families who want to design and direct their services in partnership with a qualified provider agency.
- The Office of Developmental Programs in Pennsylvania provides Agency with Choice as a self-direction model for individuals enrolled in ODP's waivers or base-funded services, who can act as managing employers and direct the provision of waiver services by support service professionals.
- The Department of Human Services (DHS) in Minnesota administers Agency with Choice as a financial management service option for individuals who receive home and community-based services, can share employer responsibilities with a provider agency, and have more control over their workers.
Features of Agency with Choice
Agency with Choice (AWC) is a model of home care services that allows individuals with disabilities and/or their representatives to select their support service professionals1. AWC enables individuals to exercise more choice and control over their services in their homes and other community settings. AWC also allows individuals to manage some or all aspects of their services, such as recruiting, hiring, training, scheduling, and supervising their workers. AWC is offered by various agencies and organizations that act as the Employer of Record for the workers, while the individuals and/or their representatives act as the Managing Employers. AWC is funded by different sources, such as the Office of Developmental Programs, the Department of Developmental Services, Medicaid waivers, or private pay.
Benefits of Agency with Choice
AWC has many benefits for individuals with disabilities and/or their representatives, as well as for their workers. Some of the benefits are:
- Promotes self-determination and empowerment for individuals with disabilities, as they can decide who works for them, when, where, and how.
- Enhances the quality of life and satisfaction of individuals with disabilities, as they can receive personalized and flexible services that meet their needs and preferences.
- Increases the stability and continuity of services for individuals with disabilities, as they can retain their workers longer and reduce turnover.
- Improves the relationship and communication between individuals with disabilities and their workers, as they can develop mutual trust and respect.
- Provides administrative support and guidance for individuals with disabilities and/or their representatives, who can rely on the agencies and organizations to handle payroll, taxes, insurance, and other employment issues.
- Offers training and development opportunities for workers, as they can learn new skills and improve their performance.
- Ensures fair compensation and benefits for workers, as they can receive competitive wages and access to health insurance, retirement plans, paid time off, and other incentives.
Limitations of Agency with Choice
AWC also has some limitations that need to be considered by individuals with disabilities and/or their representatives, as well as by their workers. Some of the limitations are:
- Requires more responsibility and involvement from individuals with disabilities and/or their representatives, who must manage some or all of their services.
- May pose challenges and risks for individuals with disabilities and/or their representatives, such as finding qualified workers, dealing with conflicts or complaints, ensuring safety and quality standards, or facing liability issues.
- May not be available or accessible for all individuals with disabilities, depending on their eligibility criteria, funding sources, geographic location, or service needs.
- May not be suitable or attractive for all workers, depending on their qualifications, availability, preferences, or expectations.
What services are offered through an agency with Choice?
The AWC program helps people stay independent while getting the support they need. Studies show that people who use AWC services go to the hospital less often, have better health, and are happier with their care.
AWC offers various services, like help at home or in the community, respite care, and support for social activities and work. Everyone's needs are different, so AWC customizes services to fit each person's needs and preferences.
The services offered to adults through agency with choice programs vary depending on the specific program and agency. These programs provide many services and support to help adults live independently and make choices about their care.
Here are some standard services that are offered:
- In-Home Care: Many agencies with choice programs offer in-home care services, including assistance with activities of daily living (ADLs) like bathing, dressing, and meal preparation.
- Home Health Care: Some programs provide skilled nursing and therapy services in the home for those with medical needs.
- Care Coordination: Case managers or care coordinators may help older adults access and coordinate various services, ensuring they receive the appropriate level of care.
- Transportation: Programs may offer transportation services to help older adults get to medical appointments, grocery stores, and other essential destinations.
- Meal Services: Some programs provide meal delivery services or access to congregate meal sites where care recipients can have nutritious meals.
- Respite Care: Respite care services can offer temporary relief for family caregivers by providing short-term assistance and support for care recipients.
- Personal Emergency Response Systems (PERS): PERS devices can be provided to care recipients to summon help in an emergency.
- Home Modifications: Funding or assistance with home modifications may be available to make the home more accessible and safe for care recipients.
- Adult Day Services: These programs offer a safe and engaging environment for care recipients during the day, providing socialization and activities.
- Counseling and Support Groups: Some agencies offer counseling services and support groups to address older adults and their family's emotional and psychological needs.
- Caregiver Support: Services and resources may be available to support family caregivers, including training, counseling, and respite care.
- Financial Assistance: Some programs may provide financial assistance or subsidies to help cover the costs of in-home care or other services.
- Legal and Advocacy Services: Assistance with legal matters and advocacy to protect rights and interests.
- Health and Wellness Programs: Programs may include health promotion activities, exercise classes, and educational workshops to help care recipients maintain their health.
- Long-Term Care Planning: Guidance and information about long-term care options, including assisted living and nursing home care, may be provided.
The availability of certain services and who can use them might be different depending on where you live. Suppose you're an older adult or have a family member who is. In that case, it's a good idea to contact your local agency with choice programs or Area Agency on Aging to find out what services are available in your area and if you can use them.
How does an agency with Choice impact family caregivers?
An agency with choice can impact family caregivers, depending on their role and relationship with individuals with disabilities. Some of the possible effects are:
- If a family caregiver is hired as a worker by an individual with disabilities and/or their representative, they can receive payment and benefits for providing care, which can improve their financial situation and recognition.
- Suppose a family caregiver is not hired as a worker but represents the individual with disabilities. In that case, they can have more involvement and control over the services, enhancing their advocacy and satisfaction.
- If a family caregiver is neither hired as a worker nor acts as a representative, they can still benefit from the agency with choice model, as they can have more respite and support from the workers hired by the individual with disabilities and/or their representative.
However, an agency with choice can also pose some challenges and burdens for family caregivers, such as:
- If a family caregiver is hired as a worker, they may face some role confusion and conflict between being a family member and an employee, which can affect their emotional well-being and relationship quality.
- If a family caregiver is not hired as a worker but acts as a representative, they may have to deal with administrative and managerial tasks, such as hiring, training, supervising, and firing workers, which can increase their stress and responsibility.
- Suppose a family caregiver is neither hired as a worker nor acts as a representative. In that case, they may feel excluded or marginalized from the decision-making process and the service delivery, which can reduce their trust and communication.
How to access AWC services
To access this model of care, one must be eligible for funding through the Department of Developmental Services (DDS) or other similar agencies in their state. The steps to apply for agencies with choice may vary depending on the state and the provider agency, but generally they include:
- Contacting the local DDS office or the provider agency to express interest in agencies with choice and learn more about the eligibility criteria and the available services.
- Attending a training session or orientation to understand the roles and responsibilities of being a managing employer and a co-employer with the provider agency.
- Developing an individualized budget and service plan that outlines the goals, needs, preferences, and outcomes of the individual and their family.
- Recruiting, hiring, training, and supervising the support workers who will provide direct services to the individual and their family.
- Working in partnership with the provider agency, who will handle the administrative tasks such as payroll, taxes, insurance, and compliance.
The agency with choice model is available in several states, including:
- Massachusetts
- Oregon
- Pennsylvania
- New Jersey
- Maryland
- New York
Each state may have different eligibility criteria, service options, and provider agencies for the agency with choice model. You can contact your local developmental disabilities office or the provider agency of your choice to learn more about this model of care in your state.
If you care for a family member with a developmental disability, look into an agency with choice. Their unique approach allows your loved one to have more control over their care and be more involved in their community. They can make more choices about the care they receive, which can help them be more independent and help lessen the load of caregiving.
