Community-based Care

Older adults with disabilities can live at home with the help of their family and some special programs. These programs provide health care and help older adults with some daily activities.

While these programs exist across the country, not every local area has one.

You can find out more about these and other programs for older adults by calling your local Area Agency on Aging at 1-800-677-1116 or visiting

Area Agencies on Aging 

Area Agencies on Aging (AAA) are local agencies that are available throughout the country. They receive government funding to offer information and connect people with local services. The AAAs also:

  • Advocate for the needs of older adults.
  • Assess their needs.
  • Coordinate individual plans and services to meet these needs.
  • Manage local, state, national, and private funding to offer home care, home modifications for safety, meal delivery, transportation, respite care (short breaks for caregivers); caregiver support, and counseling about choices related to health insurance and legal services.

Home Health Care

Medicare pays for some types of home health care. Many people pay for their home care themselves.

Medicare pays for home health care when a person:

  • Has to remain in their own homes due to a medical problem, except for quick non-medical outings.
  • Needs skilled medical home care from a nurse, therapist, or other medical professional.
  • To support skilled care during transition of care for older adult with complex health issues.

Medicare home health care isn’t offered 24 hours a day, seven days a week. So, people who need around-the-clock support often get help from family members, friends, or privately hired professionals. (See also the chapter on Home Care.)

Adult Day Services

Adult day service centers offer several social and support services to groups of older adults in the community. These centers may also offer health care. For example, a nurse may take a person’s blood pressure or help them take their medications.

Often the people who go these centers need help with daily activities when family caregivers are working or need a short break. Some adult day centers also have programs for older adults with dementia.

Medicare doesn’t generally pay for adult day services. However, Medicare Advantage plans, Medicaid or other insurers may cover some services.

Program of All-inclusive Care for the Elderly

The Program of All-inclusive Care for the Elderly (PACE) provides adult day services for frail older adults age 55 or older. PACE serves people who would be in a nursing home if they didn’t have help from PACE. The goal is to keep these adults in the community as long as is practical.

Generally, older adults in PACE spend most days at an adult day services center. They also get medical care there. A team of health and other types of service providers know the older adults well and also can care for them at home.

Services can include:

  • Respite care (a short break for caregivers)
  • Transportation
  • Medications
  • Rehabilitation (including maintenance physical and occupational therapy)
  • Hearing aids, eyeglasses, and other benefits

PACE combines money from Medicare and Medicaid to provide services. To find a program near you, visit the National PACE Association website.

Managed Long-term Care Programs

States run these programs that help people with chronic health problems or disabilities receive the services and supports they need.  States mix Medicaid funds with other sources to offer these services.

States contract with managed long-term care plans to offer a wide range of health and support services. People who get these services must be eligible for Medicare and Medicaid. States give the contracts to:

  • Home care agencies
  • Nursing homes
  • Hospitals
  • Care systems that integrate health and long-term services and supports

These programs receive a fixed payment for each person that participates in their program. They use the flexibility of this type of payment to provide services that people need.


Last Updated June 2023

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