Can I Stay at Home Instead of a Nursing Home?
Understanding CAP/DA, PACE, and Medicaid In-Home Care in North Carolina
The good news is, North Carolina Medicaid offers programs that can help people receive care at home—rather than entering a nursing facility. These programs include:
CAP/DA (Community Alternatives Program for Disabled Adults)
PACE (Program of All-Inclusive Care for the Elderly)
PCS (Personal Care Services)
Home Health Services
Let’s break each down—and walk through a real-life example of how these programs might help you or someone you love.
CAP/DA: Help at Home for Disabled Adults and Seniors
CAP/DA is a Medicaid waiver program for people who would qualify for nursing home care but want to stay in their home or community.
To be eligible, you must:
Be age 18 or older
Be financially eligible for Medicaid
Require a “nursing home level of care”
Need at least one home-based service, such as:
A home health aide
Medical supplies or assistive equipment
Home-delivered meals
Personal Emergency Response System (like Life Alert)
Home modifications
Respite care
CAP/DA also offers a “consumer-directed” option, allowing a participant (or their representative) to hire their own caregiver, including trusted family or friends.
Note: CAP/DA has a limited number of slots in each county. There may be a waitlist, so planning early is critical.
PACE: Day Center + Home-Based Comprehensive Care
PACE is a Medicaid/Medicare program designed for people age 55 or older who need nursing-level care, but can still live at home safely.
PACE provides:
Day health center programs (meals, activities, rehab, medical care)
Home care, transportation, and social work
Medical management and prescriptions
It’s a one-stop-shop for total elder care, coordinated by a central team. Participants typically attend a local PACE center multiple times per week.
To enroll in PACE, you must:
Be 55+
Live in a county where PACE is available
Qualify for nursing home care
Be able to live safely at home with support
Further sources can be found at: https://medicaid.ncdhhs.gov/providers/programs-and-services/long-term-care/program-all-inclusive-care-elderly-pace
PCS: Hands-On Help with Daily Tasks
Personal Care Services (PCS) are available for Medicaid recipients who need help with Activities of Daily Living (ADLs), such as:
Bathing
Dressing
Eating
Toileting
Mobility
An independent assessment determines eligibility. PCS can be used at home or in an adult care home, and doesn’t require full nursing home-level care.
Home Health Services: Short-Term or Skilled Medical Help at Home
This program covers medically necessary skilled services, such as:
Skilled nursing (e.g. wound care)
Physical, occupational, or speech therapy
Medical supplies
Home health aides
This is useful after hospitalizations or for chronic conditions and can be used in any residential setting (except a hospital or nursing facility). Importantly, the patient does not need to be homebound to qualify.
Further resources can be found at https://medicaid.ncdhhs.gov/providers/programs-and-services
Example: Meet Robert and Mae
Robert (80) has Parkinson’s and recently fell at home. His wife Mae (76) does her best to help him, but it’s getting harder.
They have limited income and assets, and Robert is eligible for Medicaid.
Here’s how they might benefit:
CAP/DA could offer in-home aides, meals, and even pay Mae to be Robert’s caregiver.
PACE is available in their area. Robert could attend the PACE center during the day for meals, therapy, and medical care—while Mae rests.
PCS would help Robert with dressing and mobility daily, even if they don’t yet qualify for full CAP/DA.
After his fall, Home Health Services could send a nurse and physical therapist to help him recover safely at home.
Medicaid Eligibility: Why You Need to Plan Ahead
These programs are incredibly valuable—but Medicaid has strict income and asset limits. The rules are different depending on whether you're single or married, and what kind of care you're applying for.
That’s why it’s important to plan well before you ever need care. There are legal strategies available to:
Protect your home
Avoid spending down everything you’ve worked for
At Willett Legal, we work with families to create long-term care and Medicaid eligibility plans—so that when the time comes, your choices are protected and your care can be delivered at home, where you want to be.
Ready to Plan Ahead?
Whether you're thinking about yourself or helping a parent, now is the time to explore your options. Contact Willett Legal to schedule a consultation and learn how we can help you prepare for the future—with peace of mind.
