Agency-directed care

In this model, an agency like Millennium employs the caregiver, handles scheduling, and supervises the care. A registered nurse reviews the plan of care. If a caregiver does not work out, the agency provides a replacement.

Consumer-directed care

In this model, the person receiving care, or a family member acting on their behalf, selects, hires and directs their own attendant. In many cases that attendant can be an adult child, another relative or a friend, and the attendant is paid for the approved hours. A services facilitator sets up the plan and a fiscal agent handles payroll.

How the two compare

• Who provides the care. Agency-directed uses an agency caregiver. Consumer-directed lets the family choose someone they already trust, often a relative.
• Who manages the schedule. The agency manages scheduling in agency-directed care. The family manages it in consumer-directed care.
• Backup coverage. An agency can usually provide a replacement caregiver if someone is sick. Consumer-directed families need their own backup plan.
• Paperwork. Consumer-directed care involves setting up a fiscal agent for payroll. Agency-directed care does not.

Many families use both

Some families combine the two: a relative provides consumer-directed care on weekdays, and an agency caregiver covers weekends or times the family member cannot be there. Both models draw from the same approved hours under the CCC Plus Waiver.