Senior Citizens Handbook - Community Care Program

Senior Citizens Handbook - Community Care Program

Last updated: September 2012

(Chapter 4 Section 1 of Senior Citizens Handbook)

What It Is: A government-funded program which provides help to seniors with their daily activities to prevent them from having to go into a nursing home.

Where To Apply: For information and referral to the appropriate local agency, call the toll-free Illinois Department on Aging's Senior HelpLine at 1-800-252-8966; 1-888-206-1327 (TTY).

Who May Be Eligible: You may be eligible if you are age 60 or older, have assets valued below a certain amount, and you need the services to prevent you from having to go into a nursing home.

What is the Community Care Program?

The Community Care Program (CCP) is a government funded program which offers services to people age 60 or older who need help with their daily activities to avoid nursing home placement. CCP services include the following:

Homemaker Services

A homemaker comes to your home to help you with a wide variety of daily living tasks according to a plan which you and your case manager help to develop. These services can include:

  • Meal planning and cooking, including special diets
  • Routine housekeeping and cleaning
  • Shopping and errands
  • Personal care such as bathing, shaving and dressing
  • Laundry
  • Reminding you and helping you to take medications and
  • Going with you to the doctor or store

Adult Day Service

Adult Day Service is designed for older persons who want to remain in the community but who cannot be home alone during the day due to a physical, social, or mental impairment. It provides respite for family caregivers. It also provides socialization for isolated seniors.

Adult Day Service is provided at a specific place in or near your community, staffed by professionally trained workers. The adult day service provider will arrange for transportation for you to its facility and back to your home. A wide variety of services are provided at an adult day service site, after an assessment of your strengths and needs, and according to a plan which you and your case manager help to develop.

Required services include:
 

  • Activities designed to help you maintain your best overall level of functioning, including outings
  • Time for rest and relaxation
  • Assistance with walking, eating, going to the toilet and personal care
  • Helping you with your medications and other health-related services appropriate to your needs
  • Preparing a daily meal and
  • Emergency care

Although not required to do so, the adult day service provider may provide the following optional services:

  • Physical, occupational, speech or art therapy
  • Services provided by a licensed nurse such as skilled nursing care, catheter care, dressings, enemas, oxygen therapy and ostomy care
  • Shopping assistance
  • Going with you to doctor and other appointments

To locate an Adult Day service in your area, see Illinois Department of Aging's Website.

Information and Referral 

These services include providing information and assisting you with applications for government benefits such as Food Stamps and Medicaid. It also includes making referrals to other community service agencies such as mental health, counseling or legal services.

Senior Companion Program

The Senior Companion Program provides an array of supportive companionship services to frail seniors by using volunteers, also age 60 or older, who have limited income. These services are available to CCP clients who need companionship in conjunction with current homemaker or adult day service. You pay no portion of the cost. Services may include, but are not limited to the following:
 

  • Providing companionship in social interactions
  • Peer counseling
  • Fostering client contact with family and friends
  • Helping you to apply for public services
  • Addressing your unmet needs

For more information or to locate a Senior Companion Program near you, contact the Senior Corps Website. You may also contact your local Area Agency on Aging; or the Illinois Department on Aging Senior HelpLine.

Case Management Services

“Case managers” help older adults and caregivers determine what their specific needs are and what services are available to meet those needs. The case manager can discuss community-based services that are funded by the state and federal government and those that you can buy with your own resources. Case managers are based in local agencies which are often referred to as “Case Coordination Units.”

If you are considering long term care, you can meet with a case manager to discuss what kinds of daily activities you can do on your own, as well as those that require help. The case manager can then identify services that could help you to continue living in your own home or community.

Example: If you are recovering from a stroke, you may need home delivered meals or transportation service, or a homemaker to help with medications, preparing meals and household chores.

To locate Case Management Services (Case Coordination Units) in your community, contact your local Area Agency on Aging or Senior Helpline, or see the list online the Illinois Department of Aging's Website.

Demonstration/Research Projects 

If your local agency or the Illinois Department on Aging is administering special projects designed to improve the CCP, you may be eligible to participate in these projects.

Who is eligible?

The Determination of Need

The CCP is available only to people over sixty years of age who are citizens, lawful permanent residents or who are otherwise permanently residing in the United States under color of law.

Example:
Persons permanently residing in the U.S. under "color of law" includes refugees or persons seeking political asylum.

In order to be eligible, you must need at least some of the services described earlier to prevent you from having to go into a nursing home. Every agency determining whether you need CCP services must follow the same procedure to make this determination.

As part of this procedure, the agencies use a form called the Determination of Need, (DON). The DON has two parts. The first is a test to measure if you are having symptoms which affect your mental functioning, such as memory loss. The second part is divided into Part A and Part B. Part A rates your need for assistance in the performance of activities of daily living such as cooking, cleaning, bathing, dressing, and managing money. You receive scores for each activity. The higher your score, the more difficulty you have performing the task by yourself. Part B rates the extent to which your need is unmet from sources other than the CCP. The higher your score, the greater the unmet need. At the end of the evaluation, your scores are added up. You must have a minimum score of 37 in order to qualify for the CCP. Above the minimum score, the higher your score, the more services you are eligible to receive.

Financial Eligibility

Your financial eligibility for the CCP is based on your level of income and the property and assets you own. Depending on the level of your income or assets, CCP services may be free or you may have to contribute to the cost. Also, if your income or assets exceed a certain level, you will not be eligible at all.

Income

In general, if your monthly income (and that of your spouse, if your spouse lives with you) is below the amount set by the federal government as the poverty level, you will not be required to contribute any of your income toward the cost of CCP services. If your income is above the poverty level, your contribution is determined by the level of services you receive, their cost and CCP fee schedules.

Certain income is considered exempt and is not counted in determining your required contribution to the cost of services. There are too many exceptions to list here. However, married couples who live together should be aware that the CCP rules allow the spouse receiving CCP services to transfer income up to a certain level to the other spouse to prevent spousal impoverishment, just as if the spouse receiving CCP services were residing in a nursing home. For more information on the rules about spousal impoverishment, see the section in Chapter 2 of this Handbook titled Medicaid.

Assets

If the value of your non-exempt property and assets exceeds $17,500, you will not be eligible for the CCP. Not all of your assets are counted toward this limit. Most importantly, your home and its furnishings, your clothing and personal effects, your cars (not including recreational vehicles) and a prepaid burial plan along with burial plots and markers are not counted toward the asset limit. The CCP rules allow the spouse receiving CCP services to transfer assets up to a certain level to the other spouse to prevent spousal impoverishment, just as if the spouse receiving CCP services were residing in a nursing home. For more information on the rules about spousal impoverishment, see the section in Chapter 2 of this Handbook titled Medicaid.

How To Apply

The Local Agency Which Receives Department on Aging Funds

You have the legal right to make an application for CCP services and to have a family member, friend, or other person represent you in the application process. The Illinois Department on Aging funds local agencies to help you apply for the program. To find out which agency in your local community administers the CCP, call the Department on Aging’s Senior HelpLine at 800-252-8966 (toll free).

What the Local Agency Will Do When You Apply

This agency will determine your financial eligibility, perform the DON, and develop an individual service plan for you in consultation with you and other people you want to participate, such as your family. You must be willing to cooperate in the DON and to provide the agency with documentation of your income and assets. The agency must visit you in your home to perform the DON.

The agency must give you a decision on your application within 30 days of the date the local agency received it. Once your application has been approved, you are responsible for reporting to the local agency any change in your personal situation, including your income and assets. 

How To Appeal Denials, Terminations, Or Other Aspects Of Services

The Right to Appeal

You have the right to appeal if: 

  • Your application for CCP services is denied; or
  • You disagree with a decision to reduce, terminate or in any way change the CCP services or the manner in which those services are provided (excluding suspension).

The local agency must give you a pamphlet explaining appeal procedures during your initial home visit. You must appeal within 60 days of the action or inaction with which you disagree. You should appeal directly to the Illinois Department on Aging in Springfield by contacting the Senior HelpLine, filling out a form they will provide at your request and mailing to the following address:

Illinois Department on Aging
Division of Home & Community Services
Office of Community Care Services
Client Appeals Section
421 East Capitol Ave., #100
Springfield, IL 62701-1789

ADVOCACY TIP
If the intent to appeal by or on behalf of a client is filed within ten (10) calender days from the date of the notice of adverse action, and is followed by a written appeal as requested by the Department, CCP Services should be continued at the level in effect prior to the notice of adverse action unless the Department on Aging determines there is a threat to the health, safety or welfare of a homemaker or other service provider. Consult an attorney if there is a problem getting continued benefits while your appeal is pending.

The Appeal Procedure

Once your appeal is received, the Department on Aging will review the issues informally and notify you of its findings. If it makes no changes to the local agency's decision, you will be given a hearing before an impartial hearing officer selected by the Department. At the hearing, you have the right to be represented by a lawyer or other person and to present evidence in support of your appeal.

After the hearing is over, the hearing officer will make recommendations to the Director of the Department on Aging on how to decide the issues in the appeal. Within 90 days after the hearing, the Department on Aging will send you its final decision.

If you disagree with the Department on Aging’s final decision, you may file a lawsuit in the Illinois Circuit Court asking the court for judicial review of the agency’s final decision. Be sure to consult an attorney right away after receiving the agency’s decision, because there is a strict 35 day time limit after the date of the decision to file such lawsuit. There are other strict requirements about who must be included as a defendant.

Where to Go For More Information

Statutes and Regulations

  • The CCP is part of the Illinois Act on Aging, found at 20 ILCS 105/4.02.
  • The regulations implementing the Community Care Program are found at Title 89 Ill.Admin.Code 240.

 

Senior HelpLine and Website

The Senior HelpLine
1-800-252-8966 (Voice) 1-888-206-1327 (TTY)
This hotline provides information on programs and services for seniors. It links persons 60 years of age and older and their care-givers to local services. Professional staff briefly assess needs and send literature and written referrals for a range of services such as case management, the Long Term Care Ombudsman Program, legal services, transportation, employment, and nutrition services. Senior HelpLine staff also provide elder abuse intake and accept appeals and service inquiries from the Community Care Program clients.

The Illinois Department on Aging's website

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