Consumer Directed Services or home health?

We run both services. People ask us all the time which one they need. The honest answer is that they fix different problems, and plenty of people need both.

The difference in one sentence

	Consumer Directed Services	Home health
What it is	Non-medical personal care	Skilled clinical care — nursing and therapy
Who chooses the person	You do — anyone but your spouse	The agency assigns licensed staff
Who employs them	You are the employer; we are the fiscal agent	The agency
Can a relative be paid	Yes	No
Physician order required	No	Yes
Who decides eligibility	Missouri DHSS, after an in-home assessment	Your physician, plus your payer
How long it lasts	Ongoing, while you remain eligible	Episodic — it ends when the skilled need resolves
Typical pattern	Regular hours, often daily	Short visits, tapering over weeks
Paid by	MO HealthNet	MO HealthNet, private insurance, private pay

You probably need home health if…

• You have a wound that needs professional care.
• You need injections, IV therapy, or catheter or ostomy care.
• You are recovering from a stroke, a fall, surgery or a hospital stay and need physical, occupational or speech therapy.
• A condition like heart failure or COPD needs clinical monitoring.
• Your physician has said you need skilled care at home.

See the home health services →

You probably need CDS if…

• What you need is help with bathing, dressing, meals, laundry and getting to appointments.
• The need is ongoing rather than tied to a particular illness.
• You want to choose who comes into your home — often a family member.
• You are a MO HealthNet participant, 18 or older, with a physical disability.
• You would rather direct your own care than have it managed for you.

Check CDS eligibility →

Why people often need both

Here is how it often goes. Someone has a stroke and spends two weeks in hospital. They come home needing physical therapy, speech therapy, and a nurse to watch their new medicines. That is home health. Over a couple of months it does its job and stops.

What does not end is that they now need help bathing and dressing every morning. No clinical benefit covers that. If they are a MO HealthNet participant, Consumer Directed Services does — and their daughter can be the paid attendant.

What we do about the handover

The gap between the two is where families get hurt. Home health ends on schedule. Only afterwards does the family find out that nothing pays for the daily help their relative still needs. That discovery usually happens during a crisis.

Because both services sit inside one organization here, that conversation can happen before discharge instead of after. Our medical social workers raise it as a matter of course, and if CDS is the right fit we can start the process while home health is still running.

Medical social work →

And if neither is right

Sometimes the answer is an agency-directed private-duty arrangement, or assisted living, or something else entirely. We will say so. Steering someone into a benefit that does not fit their situation wastes months they may not have.