Arizona offers the Arizona Long Term Care System (ALTCS), a Medicaid-managed care program that provides home- and community-based services (HCBS) to elderly and physically disabled residents who require nursing facility level of care. ALTCS promotes independence by allowing participants to receive needed supports at home or in community settings rather than in institutional facilities. Services may include personal care assistance, homemaker services, home-delivered meals, adult day health care, transportation to medical appointments, home modifications, assistive devices, respite care for family caregivers, and self-directed attendant care. To qualify, applicants must be Arizona residents, meet Medicaid financial eligibility guidelines, and demonstrate a need for a nursing facility level of care as determined through a Pre-Admission Screening (PAS) that assesses ADLs and IADLs. In this article, we explain what Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs) are and how needing help with these tasks is central to qualifying for Arizona’s ALTCS program.
What Are ADLs (Activities of Daily Living)?
Activities of Daily Living (ADLs) are fundamental self-care tasks that a person must perform daily to live independently. Difficulty with ADLs is common among seniors or those with disabilities and indicates a need for supportive services. Core ADLs include:
- Mobility (Ambulating/Transferring): Safely walking, getting in and out of a chair, or transferring from a bed to a wheelchair.
- Dressing: Selecting and putting on clothing without help, including managing fasteners.
- Eating: Feeding oneself—using utensils to move food from plate to mouth and consuming it.
- Personal Hygiene: Bathing, showering, and completing grooming tasks like shaving, brushing teeth, and combing hair independently.
- Toileting (Continence): Using the toilet independently—getting there in time, transferring on/off, and cleaning oneself afterward.
When a person cannot perform several of these tasks without assistance, it signals that ongoing care or home-based supports may be needed.
What Are IADLs (Instrumental Activities of Daily Living)?
Instrumental Activities of Daily Living (IADLs) are more complex tasks necessary for living independently in a community. While not performed every day, they are critical for managing household and personal affairs. Key IADLs include:
- Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and household items.
- Meal Preparation: Planning and cooking meals—gathering ingredients and safely using kitchen appliances.
- Housekeeping: Keeping the home clean and livable—tasks like cleaning, doing laundry, and taking out the trash.
- Money Management: Managing finances, such as paying bills on time, balancing bank accounts, and budgeting.
- Transportation: Getting around or arranging rides—driving oneself or arranging transit to appointments and errands.
- Medication Management: Managing and taking medications correctly—remembering to take the right pills at the right times and refilling prescriptions.
- Communication: Using the phone or computer to communicate—looking up phone numbers, making calls, sending emails, and staying connected with others.
A decline in IADLs is often an early warning that additional support will be necessary, even if ADLs remain manageable.
Why ADLs and IADLs Matter for ALTCS Eligibility
Arizona’s ALTCS program serves individuals who require nursing facility level of care but prefer to remain in their homes or community settings. Eligibility is determined through both financial and functional assessments. The functional eligibility assessment—called the Pre-Admission Screening (PAS)—is conducted by an AHCCCS nurse or social worker and focuses heavily on the applicant’s ability to perform ADLs and IADLs. If an applicant cannot perform multiple ADLs without help (e.g., bathing, dressing, toileting, transferring) or has significant IADL deficits (e.g., meal preparation, housekeeping, medication management), they are likely to meet the nursing facility level of care requirement.
During the PAS, the assessor reviews the person’s ability to transfer safely (e.g., bed to chair), walk, feed themselves, manage hygiene, use the toilet, prepare meals, handle money, and maintain a clean living environment. Cognitive impairments—such as memory issues from dementia—are also considered, since they affect daily functioning. When someone cannot complete several ADLs independently or cannot reliably perform key IADLs, they are deemed at risk of institutionalization and thus eligible for ALTCS HCBS services.
Arizona Long Term Care System (ALTCS)
ALTCS is Arizona’s managed care program for individuals who are elderly (65+), blind, or have a physical disability and require nursing facility level of care. Unlike many states, Arizona does not impose enrollment caps on ALTCS; all who qualify receive services. To apply for ALTCS, an individual (or authorized representative) submits an application to AHCCCS, and a Pre-Admission Screening (PAS) is scheduled. Eligibility criteria include:
- Arizona residency.
- Medicaid financial eligibility (income and asset limits).
- Nursing facility level of care confirmed by PAS.
- Age 65+ or adult (18+) with a qualifying physical disability or blindness.
Once approved, ALTCS provides an array of services based on assessed needs. Examples include:
- Personal Care: Assistance with ADLs—bathing, dressing, toileting, transferring, ambulating, grooming, and feeding.
- Homemaker Services: Household tasks such as housekeeping, laundry, and light meal preparation (IADLs).
- Adult Day Health Care: Supervised day programs that provide social stimulation and skilled care.
- Home-Delivered Meals: Nutritious meals delivered to the home for those unable to prepare meals.
- Respite Care: Temporary relief for family caregivers, either in-home or at community-based settings.
- Transportation: Non-emergency medical transportation to appointments and errands.
- Home Modifications and Assistive Technology: Minor home repairs and adaptive equipment (e.g., grab bars, wheelchair ramps) to improve safety.
- Self-Directed Attendant Care (SDAC): Participants can recruit, hire, train, and supervise their own caregivers (including family members), allowing greater control over how care is delivered.
ALTCS also covers institutional care (e.g., nursing facility) if home-based services are no longer appropriate, but the emphasis is on enabling individuals to remain safely in their homes or communities.
Signs That Your Loved One May Qualify
Below are practical indicators that a person may qualify for ALTCS due to challenges with ADLs and IADLs:
- Unsafe Transferring or Ambulating: Needing assistance to move from bed to chair or relying on furniture and walls to walk indicates reduced mobility (ADL: transferring/ambulating).
- Missing Meals or Weight Loss: An inability to cook or feed oneself safely suggests IADL deficits around meal preparation or feeding (ADLs/IADLs).
- Personal Hygiene Decline: Skipping showers or appearing unkempt signals trouble bathing or grooming (ADLs).
- Medication Errors or Memory Lapses: Frequently missing doses or confusing medications shows difficulty with medication management (IADL).
- Unpaid Bills or Untidy Home: Piles of mail, late bills, or cluttered living spaces reflect challenges with money management and housekeeping (IADLs).
A pattern of needing help with multiple ADLs—such as bathing, dressing, and toileting—as well as struggles with IADLs like meal prep and medication management, strongly suggests a nursing facility level of care and supports eligibility for ALTCS. Document these challenges for the PAS to demonstrate functional need.
We’re Here to Help: Next Steps and Contact Information
Navigating ALTCS applications and assessments can be complex, but you don’t have to do it alone. At Momba Home Care, we help Arizona families understand eligibility criteria, prepare for the Pre-Admission Screening, and complete the application process. If you notice your loved one struggling with daily tasks or if a healthcare professional has recommended nursing facility care, it may be time to explore ALTCS HCBS services. Our team provides compassionate guidance every step of the way—from gathering financial documentation to coordinating in-home supports—to ensure your loved one stays safely in the community. Call us or contact us today to learn how to get started with Arizona’s ALTCS program for home and community-based care.