When you apply for a home aide, you will meet with a Social Worker or caseworker who will ask you a long list of (somewhat embarrassing) questions about what kind of help you need.
What Happens During the Screening?
The screening is usually 1-2 hours and will ask details on your care needs. You do not have to leave your house for the interview. In some states it is done over the phone. In other states, they will send someone to visit you in your home.
I Cannot Answer Questions!
If you are not well enough to sit up and answer questions, a family member or caregiver can answer for you.
Some readers have also had success explaining that they are unable to sit and talk for extended times, and requesting that some of the questions be emailed to them the week before, so they can write down their answers and email them back ahead of time. This can make the in-person interview much easier and faster.
Is The Interview Hard? Is It Scary?
Many of our readers report that applying for home care is much faster and simpler than applying for disability. Many readers have found that the Social Workers who conduct these interviews are nice and supportive, and will listen to what you are saying without challenging you or judging you.
Update: Now that Medicaid is switching to managed care in most states (private insurance companies) some readers report that some of the Social Workers are less friendly. Other people continue to report that the workers were very compassionate and helpful. Either way, they will still need to work within the rules, so learning about the guidelines ahead of time will be a great help to you.
That Sounds Good! If My Social Worker is Nice Will I Get Approved?
Even if the Social Workers are really nice to you and really like you and really want to help you, they still have to follow the rules.
According to the rules, if you do not meet the criteria, you will automatically disqualified. It does not matter how sick you are or how poor you are or how bad your problems are. It does not matter if you are literally going to starve to death because you have no way to get groceries.
And it doesn’t matter how nice the caseworkers are. Even if they like you a lot and they are really nice and they really want to help you, they will still deny you. They may look really sad when they do this.
If you learn the rules and understand the process, there is a much better chance they will be able to give you the help you want and need. Then everyone will be happy.
What Are The Rules? What Do I Need to Know?
The number one most important thing you need to know is how the personal care questions work.
Before your interview, spend some time thinking about these questions. Many of us with chronic illness get so used to our own limitations that we forget or stop noticing that we need help with personal care. We may just think it’s perfectly normal to go a month without bathing or changing clothes!
You may find it helpful to spend some time thinking and reading about personal care questions, or keep a little notebook by your side for a few days and write down any time someone helps you with personal care, or any time that you skip eating, bathing, dressing, brushing your teeth, etc, because you don’t have help.
Personal Care Questions
The personal care questions are the most important questions in the interview. These questions may also be called “activities of daily living.”
Many of our readers report that they had difficulty qualifying for home care or getting approved for enough hours because they did not think through the personal care questions.
Before your assessment, it can be a big help to carefully consider each area of personal care. You may discover that you have some needs you never thought to mention! Some people find it helpful to write down notes ahead of time about each personal care area.
If speaking or thinking clearly is hard for you, you can ask to email your notes ahead of time to the person doing the assessment. Some caseworkers appreciate getting the notes in writing, because this makes their job easier.
Here’s where you can learn more about what you will be asked and what kinds of things to think about ahead of time: 21 Questions To Ask Yourself About Personal Care
Questions About Your Life
After the personal care questions, they may ask you a list of other questions. You do not have to say “yes” every time or get everything perfect, just be honest and do the best you can with it. These questions are not as important as personal care questions, but if the questions show you have a lot of problems, you may qualify for more hours or services. Sample questions:
- “How often do you talk to your family?”
- “How often do you feel sad?”
- “Do you have any food allergies?”
- “Do you do any social activities?”
- “Do you have trouble chewing?”
- “How many medications and supplements do you take?”
Choosing Agency or Self Directed Care
After the personal care and life questions, they may ask you if you want to select your own aides or get aides sent from an agency. You have three choices:
- Find, select, hire and oversee your own aides
- Ask a friend or family member to oversee your aides
- Have aides sent by an agency
Self Direction Questions
If you decide you want to oversee your own aides, they may ask you a few quick questions to make sure you will be able to do this. There are no wrong or right answers. Just use common sense. Sample questions:
- What will you do if your caregiver steals from you?
- How will you find a caregiver to hire?
- What will you do if you have a medical emergency and no one is home?
How Do I Know if I Will Be Approved?
In most states, a person will be approved for a home aide only if they need help with personal care (such as bathing, eating, or dressing). After the person is approved they may qualify to get other types of help (such as transportation, shopping, cooking, or cleaning).
Some states have programs for people who do not need personal care. California has the best program in the country for this. In other areas, it may be very limited or non-existent.
If someone has significant mental impairments or cognitive problems (for example developmental disabilities, traumatic brain injury, or dementia) the rules may be somewhat different, and they may be able to qualify, even if they need no direct personal care help.
Many states have a point system for approving people for this program. You can learn more here: How Do I Know if I Meet the Criteria for State Home Aide Programs?
Advice from the Virginia Poverty Law Center
From the guide on Long Term Care and Medicaid in Virginia.
“This is not the time to emphasize what the person can do for herself, but to recognize all the ways the person needs help.
“For example, if a person is asked whether she can feed herself, it is important to mention that she needs help cutting up meat, opening a milk carton, or pouring milk, etc.
“If the person has bladder or bowel accidents and is sometimes incontinent, this needs to be mentioned even though it may be embarrassing.
“If the person can essentially dress herself, but can’t manipulate buttons or zippers or needs help tying her shoes, these limitations should be pointed out to the screening team.
“If the screeners are not told about ways the person needs help, they may decide the person does not need long-term care services and may not approve the person for coverage. Don’t exaggerate the individual’s limitations, but don’t hide them.”
Tip: If You Live in California
If you live in California you do not need to focus on everything on this page. California has a program called IHSS that does not require personal care and is much easier to qualify for. Some other areas have programs like this as well, but they are more rare and more limited.
Tip: If You Are Too Ill to Answer Questions
If you are too sick to answer questions, someone else can do the interview for you. For example, a parent or a caregiver can answer the questions for you. Another option is to request to answer some of the questions ahead of time by email.
Tip: Request Disability Accommodations
You can contact the interviewer ahead of time to request any accommodations you need to make the interview possible, or to protect you from having symptoms. One common request is to not wear perfume or scented products. One of our readers even requested the interviewer put on a tyvek suit!
If the request is important to you, it is best to do it in writing by mail or email. Sample language: “I am writing to request a disability accommodation for my upcoming assessment. Due to my disabilities, I am unable to sit up and talk for extended periods. I am requesting to receive assessment questions by email one week before the meeting, so I may respond in writing when I am able.” If you have a doctor’s letter confirming your condition, you can enclose this with your request.
Tip: Ask for the Interviewers Email
If you have difficulty speaking on the phone, ask for an email address. You can coordinate the interview, scheduling, follow up questions by email.
Tip: Be Embarrassing
Some people run into problems because they downplay their needs when answering questions about their needs because they feel shy or embarrassed or because they haven’t stopped to think about all the kinds of small ways they need assistance throughout the day. When applying for home care, it is very important to be honest and talk about all the help you need, even if you feel shy. It’s hard to do, but just think about how happy you will be if this helps you get the care you need. After you are brave and do it the first time, it will get much easier!
Tip: Don’t Say No Unless it is NEVER
If you ever need help in any area, always mention this. If your answer is “sometimes” you can say “Yes, I need that kind of help some of the time” or “I need that when my symptoms are bad” and then briefly explain how and when. If you say no, you may get automatically get disqualified. If you explain help you sometimes need, the Social Worker will consider the situation and may still approve you.
Tip: Describe your worst day
Many of our readers report that their Social Workers and Medicaid workers recommended that they answer questions by describing what it is like for you when your symptoms are bad. If you get stuck: Try starting your sentence with the these words “When my symptoms are bad…..”
Tip: Think About Every Little Thing
If you need partial assistance in personal care, or assistance only some of the time, be sure to let them know. In some cases, you will still be able to qualify. Many people get turned down for home aide programs, or have to apply more than once because they answer the questions about personal care too quickly, or because they do not meet with their doctor first to talk about all their personal care needs. It’s very important to let them know any kind of assistance you need in each of the personal care areas (bathing, feeding, dressing, mobility, etc)
Tip: Focus on Personal Care
Do not waste time explaining all the little help you need in areas that are not personal care. This will just make the interview really long and won’t help you. Focus on personal care: bathing, feeding, dressing, mobility, and toilet. Please remember: Laundry and cooking does not count as personal care.
Tip: Your Interviewer May Not Know the System
Many states use a point system to decide who qualifies. It is possible that the person doing your assessment will not know the point system. They will ask you the questions and check boxes based on your answers.
Then the completed assessment form will be sent to someone else who will review it and make a decision. The person who interviewed you may not know why they are checking these boxes or how the decision will be made.
Tip: Never Take No For an Answer Over the Phone
If you call for an interview and they say no, don’t give up. Never ever (ever ever ever) take no for an answer over the phone. We cannot begin to tell you how many of our readers were told “no” when it was not true. Always request the decision in writing and ask how you can appeal. Make sure you only talk directly to a person who manages screenings for “medicaid waiver” or “medicaid longterm care.” Other medicaid workers may not know how this program works.
Tip: Talk to Your Doc
Here’s a cautionary tale: We heard from one reader who was on a waiting list for an entire year. When she got to the top of the list, the program sent a form to her doctor. The doctor was very busy and did not remember exactly what help this patient needed. The doctor checked some of the wrong boxes on the form, and the entire application was denied.
Tip: Give a Clear Answer
If possible, try to keep your answers brief and clear. If you give a long, confusing, rambling answer, there is a greater chance you will be misunderstood.
The person who is doing the interview is not going to write down a long story. When they ask a question, they might write one sentence, or they might write 0 sentences. They might just check a box.
They do not need or want a long story about your life. They need to know what box to check. They are busy. They need to know whether to check “yes” or “no” so they can move to the next question.
Tip: Talk about help you usually need
This program is not designed for people who need 24 hour care. If you need help sometimes, but not others, let them know. In many states the criteria is what help do you usually need. For example, if you usually need help bathing, but sometimes bathe by yourself, you may still qualify. Some states will ask number of times per week or percentage of time you need help.
Some states will have more specific criteria like: Needs help in this area at least 4 times per week.
Tip: Shopping and Cooking Doesn’t Count as Help with Eating
If they ask you about eating, it does not matter if you tell them about shopping and cooking. They need to know if you ever need help with the physical act of eating, getting food to your mouth, or assistance with sitting up, or eating safely without choking. In some cases, help opening cartons, cutting food, and lifting water bottles may also count. After you are approved, you may be able to get help with shopping and cooking, but you will not qualify based on these needs.
Tip: Laundry Doesn’t Count as Help with Dressing
If they ask you about dressing, it does not matter if you tell them you about laundry. They need to know if you ever need help with the physical act of getting clothes on your body. After you are approved, you may be able to get help with laundry, but you will not qualify based on these needs.
Tip: Bathing Can Include Grooming
When they ask about bathing, be sure to let them know if you need any grooming help as well – for example brushing your hair, shaving, clipping your nails, washing your face, brushing your teeth. If you get or need any assistance in any areas, be sure to let them know.
Tip: The Past Week
In some programs they will look at the help you needed or got in the past seven days and this is how they will decide if you qualify. It’s important to describe any help you got or need. If you got no help, or not enough help, describe any problems you had because of lack of help (for example, missing meals, not changing clothes, not bathing, bathroom accidents).
Tip: Bathroom Accidents
They may ask you if you have toilet “accidents” (Times when you did not make it to the bathroom in time). If you have had accidents: Be honest. This is HARD, but it is worth it. It is worth being embarrassed for a few minutes, if it means that you will get help you need every day! If you have not had accidents because someone is assisting you: Try answering this question by letting them know the help you are getting and estimating how often you would have accidents if you had no assistance. If you never got or needed any kind of help in this area, just be honest. It is possible you will still qualify, but it depends on your state and the rest of your care needs.
Tip: If You’ve Had Falls
If you have had any history of falls in your home, make sure to mention this when discussing bathing, dressing and bathroom care. A history of falls may mean that they will consider you need supervision in these areas.
Tip: Cognitive Problems
Some programs will take into consideration if someone has cognitive problems (such as problems with behavior and orientation) and this person needs to be supervised, monitored or reminded to do self-care tasks. For example, people with Alzheimers, Dementia, Traumatic Brain Injury or Developmental Disabilities. In some cases, people can also experience severe cognitive problems because of side effects from medications, or symptoms of mental illness, or physical illnesses.
Tips For Children
For children, they will consider what is developmentally appropriate. For example, it might be appropriate for a one year old to require a lot of help with dressing, but not for a twelve year old. Some states have specific guidelines outline exactly what is appropriate for each age group in each category. Ask for a copy.
Tips If Someone Is Helping You Now
Many readers report that their interviews went better after the Social Worker explained this key point: If someone is helping you now, make sure to let them know what help you would need if no one was there. Some people leave out their care needs because they are already getting help, and this leads to an inaccurate assessment. Make sure to let the Social Worker know any kind of help you get or need so that they can fill out the forms accurately.
The amount of hours you get will be affected by the amount of help you already get. Make sure to let the social worker know if there are any reasons why your helpers are not available to give you more unpaid help (for example: if they are also caring for others, have full time jobs, have health problems themselves, live far away, etc)
Tip: Upcoming Changes
It’s also a good idea to also let them know if the person who is helping you now is going to be able to continue at the current pace. If there have been any changes that would lead to your help decreasing, make sure to tell them. If all your care needs area already met, this may lead to less or no hours.
Here are a few examples from readers who had situations where they needed more care because their current caregiver was unable to continue giving same level of care: Change in job schedule; new child in the house; caretaker is overly-burdened and cannot continue care at current pace; caretaker develops health problems; caretaker is leaving town; caretaker is unpaid and agreed to help for a limited time; caregiver no longer willing to help; caregiver was paid and funds have run out to continue paying.
Tips from Washington Law help
“Give as much detail as you can. DSHS will assume any unpaid help you get means you need less paid help. If this is not true, explain why. Make sure the assessor includes that info in the assessment notes.
“Example: you might use all your paid care every month but still need help for times the caregiver is not there. Tell the assessor if your unpaid helper is not always able to help you or is only available to help over and above the paid care you get. Make sure the info about how much unpaid help you get is correct.”
Tip: Gathering Information
Before your interview, it may be helpful if you can have ready a list of your doctors, contact information for doctors, current medications, current diagnosis, and information on how often you take each medication. This is not required, so if you don’t have all this information together, don’t worry. It will just make things a little easier.
Tips from Daniella
“My interviewers were very heavily focused on “how often” I needed help with specific activities. It was really hard to answer that so I just said “multiple times a week” for everything.
“Also, I did find out through someone at the long term care office that they consider showering at least once every 7 days to be sufficient (i.e if you can shower at least once a week without help, you don’t need help bathing).
“That seems crazy to me, but there are times that I haven’t been able to shower for more than seven days so I did qualify for help with bathing.”
Daniella’s story: How I Got Denied (and then approved!) For Medicaid Home Aides
Take a look here to learn a whole lot more about how these programs work: How to Apply for a State Home Aide
Success stories. Stories from people in waiver programs, how they applied and how they got approved: How I Got Approved for a Home Aide
Connect with others in waiver programs. At the bottom of this page, you can find Facebook groups for people to use Medicaid home care The Self-Advocate’s Guide to Disability Home Aides
Learn more about how others applied and what services they are getting now: How Did You Get Home Care? (Survey Results)
Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working.