CDS compared with agency-directed home care

These get confused constantly, and they are genuinely different products. The difference is not quality — it is control, and the type of care involved.

	Consumer Directed Services	Agency-directed home care	Home health (skilled)
Who picks the caregiver	You do	The agency assigns one	The agency assigns licensed staff
Who employs them	You are the employer; the vendor is the fiscal agent	The agency	The agency
Can a relative be paid	Yes — anyone but your spouse	Generally no	No
Who sets the schedule	You do	The agency, within its staffing	Clinical need and physician orders
Type of care	Non-medical personal care	Non-medical personal care	Skilled nursing and therapy
Requires a physician order	No	No	Yes
Who pays	MO HealthNet	Medicaid, private pay or insurance	Medicare, Medicaid or insurance
Your admin burden	Real — you supervise and sign timesheets	Minimal	Minimal

CDS suits you if…

• You already have someone you trust who could do the work.
• You want a say in who enters your home and when.
• You want a family member’s caregiving to be paid work rather than unpaid strain.
• You are comfortable acting as an employer — instructing, scheduling, verifying.
• Consistency matters to you and rotating aides would not work.

An agency may suit you better if…

• You do not want employer responsibilities at all.
• You have nobody in mind and prefer the agency to solve staffing.
• You need coverage guaranteed when your usual person is sick.
• You are unable to supervise and do not have someone who can help you do so.

You may need skilled home health if…

• You need wound care, injections, IV therapy or tube feeding management.
• You need physical, occupational or speech therapy at home.
• A physician has ordered clinical services after a hospital stay.

The trade-off, stated plainly

CDS gives you control and gives your chosen person an income. In exchange it asks you to do real work: recruiting, supervising, verifying hours, and handling it when your attendant is sick or quits. Agencies take that burden and, with it, the choice. Neither is better in the abstract — they are better for different people.