Aging in Place with Dignity: Home Care for Veterans and Adults with Disabilities

Families across Wyoming face the same hard questions: How can my loved one stay safe at home as their needs increase? Is it realistic for a Veteran with complex medical issues or an adult with intellectual or developmental disabilities to “age in place” without moving to a facility? How do we balance dignity, independence, and safety in a rural state where services may be spread out?

National experts in aging, disability, and Medicaid long-term services all point to the same answer: home-based care and “aging in place” can work extremely well when it is planned carefully, funded appropriately, and grounded in person-centered support. National Institute on Aging+2National Institute on Aging+2

This flagship guide walks through what aging in place really means, who benefits most, how home-based care works behind the scenes, how funding streams such as Medicaid home and community-based services (HCBS) and Veterans benefits fit together, and the concrete steps families and guardians can take to make home a realistic, safe, and stable long-term option.

1. What “Aging in Place” Really Means

“Aging in place” is more than a slogan. The National Institute on Aging (NIA) describes it as growing older at home and in the community, with health, personal, and other support services brought into the home so that people can live as independently as possible. National Institute on Aging

At the same time, NIA explains that long-term care itself is not defined by a building but by the type and duration of help a person needs with everyday activities such as bathing, dressing, eating, and moving around, as well as more complex tasks like managing medications, finances, and transportation. National Institute on Aging

Putting those ideas together, aging in place with home-based care means:

• Remaining in a real home, not an institution

• Having the right help, at the right time, for daily activities and health needs

• Receiving ongoing support from trained caregivers, clinicians, and community resources

• Staying as independent and self-directed as possible, even when assistance is needed every day

For Veterans and adults with disabilities in Cheyenne and across Wyoming, aging in place is not about “doing everything alone.” It is about building a care system that allows them to live in a home that feels like theirs while still getting the level of support that a nursing facility or group home might otherwise provide.

2. Who Benefits Most from Home-Based Care

2.1 Veterans with complex or chronic conditions

Many Veterans live with chronic medical conditions such as heart disease, diabetes, lung disease, or traumatic brain injury. Others live with posttraumatic stress, depression, or anxiety that makes crowded institutions overwhelming and destabilizing. For these Veterans, a quiet, structured, home-like setting can be more therapeutic than a large facility, as long as they have access to:

• Reliable medication management

• Regular primary and specialty care

• Help with daily activities and transportation

• Emotional support and predictable routines

Home-based programs can be combined with Veterans Affairs (VA) services such as home-based primary care, homemaker and home health aides, and respite programs to create a complete long-term care system without a move to a nursing home.

2.2 Adults with intellectual and developmental disabilities

Adults with intellectual and developmental disabilities (I slash DD) often do best in stable, consistent environments where relationships can grow over time. Many have already experienced multiple placements, changes in staff, and disruptions in services. A home-based model, especially when connected to Medicaid HCBS waivers, can provide:

• Twenty-four-hour supervision in a small, home-like setting

• Life skills coaching in real contexts, such as cooking, shopping, or community outings

• Behavior support plans that are consistent from one day to the next

• Opportunities to integrate into the community rather than being isolated

For these individuals, aging in place is not only about getting older. It is about preserving continuity and avoiding the trauma of unnecessary moves.

2.3 Family and unpaid caregivers

Families are often the backbone of long-term care. National data show that millions of people receive help from family, friends, and neighbors with tasks like bathing, cooking, and getting to appointments. National Institute on Aging+1

Yet caregiver burnout is real. Home-based care models that bring in additional support – whether through paid caregivers in the home, structured host home arrangements, or respite services – can allow families to continue caring without collapsing under the weight of round-the-clock responsibilities.

3. How Home-Based Care Works Day to Day

Home-based long-term care can look very different from person to person, but most high-quality programs share a similar backbone.

3.1 Comprehensive assessment

The process usually begins with a detailed assessment that covers:

• Medical diagnoses, medications, and treatment plans

• Cognitive status, communication style, and behavioral needs

• Functional abilities, such as walking, transferring, and feeding

• Emotional health and trauma history

• Daily routines, preferences, and cultural or spiritual priorities

• Safety risks in the current living environment

This assessment serves as the foundation for the care plan and helps decide which services and supports are necessary.

3.2 Person-centered care planning

Once needs and strengths are understood, a person-centered plan is developed. That plan should:

• Be led as much as possible by the person receiving services, with support from those they choose

• Translate big goals such as “stay in my own home” or “be more independent” into specific actions

• Define who does what – family, paid caregivers, nurses, therapists, and community partners

• Include safeguards for health, safety, and rights

When the person is a Veteran or receives Medicaid HCBS, person-centered planning is a requirement, not just a best practice. Federal policy emphasizes that these plans must reflect the person’s own preferences and vision for a good life, and must be updated regularly as circumstances change. Medicaid+2Medicaid+2

3.3 Services that may be included

A home-based care plan often blends several types of support, such as:

• Personal care: help with bathing, grooming, dressing, toileting, and eating

• Homemaker services: meal preparation, light housekeeping, laundry, shopping

• Skilled nursing: wound care, medication setup, injections, monitoring chronic conditions

• Therapies: physical, occupational, or speech therapy delivered in the home

• Behavioral support: structured strategies and coaching to address challenging behaviors

• Respite: short-term relief for primary caregivers

• Day activities: structured community days, volunteering, or supported employment

• Transportation: assistance getting to appointments or community activities

The mix is not static. As needs change, the plan should be adjusted so that the right supports are in place without overspending or leaving gaps.

4. How Home-Based Care Is Funded

Paying for long-term care – especially at home – is often the most confusing part for families. Two funding streams are especially important: Medicaid home and community-based services and VA benefits.

4.1 Medicaid home and community-based services (HCBS)

Medicaid is the primary funder of long-term services and supports in the United States. Within Medicaid, home and community-based services (often called HCBS) allow people who qualify for an institutional level of care to receive services at home or in the community instead. KFF+1

According to a recent issue brief from KFF, about four and a half million people receive Medicaid-funded home care services each year, including older adults and people with disabilities who would otherwise require nursing facility care. The brief highlights that HCBS programs cover a range of services such as personal care, homemaker support, and case management, and that states vary significantly in who is eligible and what is covered. KFF

For families, this means:

• If the person meets medical and financial criteria, Medicaid may pay for long-term care at home instead of in a nursing facility

• Services are delivered through state-designed waiver programs and other authorities, each with specific rules

• There may be waiting lists or prioritization criteria, depending on state funding levels

In Wyoming, the Home and Community-Based Services Section of the Department of Health administers waivers that fund individualized supports at home and in the community for people with intellectual disabilities and other limitations. Wyoming Department of Health+1

4.2 Veterans benefits and programs

For eligible Veterans, VA provides a variety of home-based programs such as home-based primary care, homemaker and home health aide services, and Veteran-directed care. These programs can be combined with state and community services to create a robust package that supports aging in place. Veterans Affairs+1

Depending on circumstances, a Veteran may also receive help with:

• Medical equipment and supplies

• Transportation to VA appointments

• Caregiver training and support

• Respite care for family caregivers

Many families benefit from having both a Medicaid case manager and a VA social worker involved, especially when care is provided in a specialized home that serves multiple Veterans or people with disabilities.

4.3 Private pay and long-term care insurance

Some individuals and families pay out of pocket for part or all of their home-based long-term care, particularly when they do not qualify for Medicaid or are waiting for waiver services to become available. Long-term care insurance policies, where they exist, may reimburse for home-based services if policy criteria are met.

Private pay does not replace the need for a strong plan. It simply changes who funds the services. Even when paying privately, families should insist on the same standards of person-centered planning, documentation, safety, and oversight.

5. Is Aging in Place Realistic and Safe for Your Situation?

Aging in place is powerful, but it is not always the right choice. The National Institute on Aging discusses several factors that influence whether staying at home is realistic and safe, including how much help a person needs, the suitability of the home, the availability of family or paid help, and the person’s health and mobility. National Institute on Aging+1

Families, guardians, and professionals should look honestly at:

• Functional needs: Can the person transfer safely, manage stairs, and avoid falls with support?

• Cognitive and behavioral needs: Are there memory issues, wandering, or behaviors that could put the person or others at risk?

• Home layout: Are bathrooms and bedrooms accessible? Are there hazards such as clutter, loose rugs, or narrow hallways?

• Support network: Are there reliable caregivers, both family and paid, who can cover all needed hours?

• Rural factors: How far is the home from hospitals, clinics, and emergency services? How do winter storms or long distances affect access?

If the answer is “yes” to many of these questions, aging in place with a structured home-based program may be ideal. If the answer is “not yet,” changes to the home, additional support, or a different housing option may be needed.

6. Building a Safer Home-Based Environment in Rural Communities

Rural communities like those surrounding Cheyenne have strengths – close-knit neighborhoods, a slower pace of life – but they also pose challenges for home-based care.

6.1 Transportation and distance

Long distances to clinics, limited public transportation, and harsh winter conditions can make medical follow-up difficult. Strong home-based programs often:

• Coordinate telehealth visits when appropriate

• Plan appointments strategically to reduce unnecessary trips

• Maintain backup transportation plans for urgent situations

6.2 Emergency preparedness

Every home that serves people with complex needs should have a written emergency plan covering:

• Power outages and heating issues

• Severe storms, especially winter weather

• Medical crises that require rapid response

• Backup staffing if a primary caregiver is ill or delayed

This planning should be part of the person-centered plan and reviewed regularly with everyone involved.

6.3 Community integration

Even in rural settings, community life matters. People receiving home-based care should have opportunities to participate in:

• Local recreation, faith communities, or clubs

• Volunteer work or supported employment

• Health-promoting activities such as walking, pool therapy, or adaptive sports

Community integration is not “extra.” It is central to well-being and aligns with the intent of HCBS programs, which aim to keep people integrated in their communities rather than isolated. Medicaid+1

7. A Step-by-Step Action Plan for Families in Cheyenne and Across Wyoming

For families, the theory only matters if it translates into concrete steps. Here is a practical roadmap.

Step 1: Document needs and goals

Write down:

• Current medical conditions and medications

• Daily tasks that require help

• Behavioral or mental health concerns

• The person’s own priorities, such as staying near certain family, keeping a pet, or continuing specific community activities

This becomes your starting point for all conversations with providers and funders.

Step 2: Clarify eligibility and funding

• Talk with a Medicaid HCBS case manager about eligibility for home and community-based services and any applicable waivers

• If the person is a Veteran, contact VA social work or a local Veterans service organization to review available home-based programs and benefits

• Ask specifically how Medicaid, VA, and private resources can be combined without gaps or duplication

Step 3: Identify potential home-based providers

Look for providers who:

• Have experience with Veterans, adults with I slash DD, or both

• Can describe their approach to person-centered planning and rights

• Understand rural realities such as winter access and emergency planning

• Are willing to collaborate closely with families, guardians, and case managers

Step 4: Visit homes and ask detailed questions

When touring a potential home:

• Observe interactions between staff and current residents

• Look for cleanliness, accessibility, and a calm atmosphere

• Ask to see sample care plans, medication logs, and emergency procedures

• Clarify who is in the home at night and on weekends, and how backup coverage works

Step 5: Build a team, not just a placement

Aging in place works best when there is a team that includes:

• The person receiving services

• Family and guardians

• The home-based provider

• Medicaid and VA case managers or social workers

• Clinical providers such as primary care, mental health, and therapy services

This team should meet regularly, formally or informally, to review progress, address concerns, and update the plan.

8. Measuring Quality Over Time

Choosing a home-based option is not the end of the journey. Quality has to be monitored over time. Families and professionals can look at:

• Health outcomes: Are hospitalizations, emergency visits, and falls decreasing or at least not increasing?

• Participation: Is the person engaged in activities they enjoy, both at home and in the community?

• Stability: Are there frequent staff changes, conflicts, or unexplained disruptions?

• Documentation: Are records accurate, timely, and reflective of what is actually happening day to day?

• Satisfaction: Does the person feel heard and respected? Do family and guardians feel informed and involved?

If patterns of concern emerge, they should trigger a structured review of the person-centered plan, staffing, and environment, not just quick fixes.

9. Bringing It All Together

Aging in place with dignity is absolutely possible for many Veterans and adults with disabilities, even in rural states like Wyoming. It requires:

• Clear understanding of needs and goals

• Thoughtful use of funding streams such as Medicaid HCBS and VA programs

• Strong, person-centered planning anchored in national best practices

• A safe, well-prepared home environment

• Ongoing collaboration among families, providers, and systems

When those pieces are in place, home-based care becomes more than an alternative to facilities. It becomes the preferred, proactive strategy for long-term stability, community connection, and quality of life.

References

Kaiser Family Foundation. (2025, February 18). What is Medicaid home care (HCBS)? KFF

National Institute on Aging. (2023, October 12). Aging in place: Growing older at home.