How to Prepare for the ARChoices Assessment to Get Enough Home Care Hours in Arkansas

If your parent is applying for home-based care through Arkansas's ARChoices in Homecare waiver, the single most consequential moment in the process is the Arkansas Independent Assessment (ARIA). This is a clinical evaluation of your parent's physical and cognitive limitations. The assessment findings help determine whether your parent qualifies for the waiver and how many care hours they receive each week. Families who document their parent's limitations accurately before this assessment get adequate care. Families who don't — because they understate needs, present the parent on a good day, or simply aren't prepared — get denied or underfunded, and the appeal process to fix an inaccurate assessment is slower and harder than getting it right the first time.

What the ARIA Assessment Actually Measures

The assessment evaluates functional limitations and cognitive needs against the nursing-facility-level-of-care standard. For ARChoices, the relevant criteria include extensive assistance with transferring/locomotion, eating, or toileting; cognitive impairment requiring substantial, continuous supervision because of serious safety hazards; or a condition requiring daily clinical monitoring. The findings are used to determine the services and hours authorized.

Functional abilities to describe:

• Bathing — can they get in/out of the tub or shower, wash themselves, manage water temperature?
• Dressing — can they select clothes, put them on, manage buttons/zippers/shoes?
• Toileting — can they get to the bathroom, manage clothing, clean themselves, handle incontinence products?
• Transferring — can they get in/out of bed, move from wheelchair to chair, stand from sitting?
• Eating — can they feed themselves, cut food, manage utensils, swallow safely?
• Mobility — can they move around the home, navigate stairs, use a walker or wheelchair?

IADLs evaluated:

• Medication management — can they remember doses, open containers, take correct amounts at correct times?
• Meal preparation — can they plan meals, operate a stove safely, prepare food?
• Light housekeeping — can they maintain a safe living environment?
• Laundry — can they sort, wash, dry, and fold clothing?
• Shopping and errands — can they get to a store, make purchases, carry items home?

Cognitive and behavioral factors:

• Orientation — do they know where they are, what day it is, who their family members are?
• Memory — can they recall recent events, remember to turn off the stove, find their way home?
• Judgment and safety awareness — do they leave the stove on, wander outside, fall frequently?
• Behavioral patterns — agitation, sundowning, resistance to care, sleep disruption

The Preparation That Makes the Difference

Keep a Two-Week ADL Log Before the Visit

This is the single most important preparation step. For 14 consecutive days before the scheduled assessment, write down exactly what your parent needed help with each day. Be specific and honest:

Instead of: "Mom needed help bathing" Write: "8:15 AM — Mom couldn't step over the tub edge. I held her arm while she stepped in. She couldn't reach her back or feet. She forgot to rinse shampoo out of her hair. She couldn't operate the faucet to adjust temperature. Total time: 35 minutes."

Instead of: "Dad had trouble with meals" Write: "12:30 PM — Dad opened the refrigerator and stood there for 4 minutes, couldn't decide what to eat. I reheated soup. He couldn't open the container. He spilled twice while eating with a spoon. He ate about half and pushed the bowl away. I checked at 2:00 PM and he had forgotten he'd eaten."

The log accomplishes two things: it gives the nurse concrete data points (not generalizations), and it reveals patterns that a single visit can't capture. Your parent might have a clear morning on assessment day and appear more capable than their baseline.

Document the Bad Days, Not Just the Average

Families consistently underreport limitations during the assessment. This happens for understandable reasons — your parent is trying to appear competent in front of a stranger, you feel protective about their dignity, and the cultural instinct is to minimize rather than amplify problems.

But the assessment determines care hours based on what the nurse observes and what you report. If your parent needs 30 hours of care per week but the assessment only captures 15 hours of need, they'll be authorized for 15 — and the gap between authorized care and actual need falls on you as unpaid labor, or it goes unmet and your parent is unsafe.

Report what actually happens on difficult days:

• Falls in the past month (dates, circumstances, injuries)
• Incontinence episodes (frequency, whether they can manage cleanup)
• Wandering incidents or attempts to leave the house
• Forgotten meals, medications, or appointments
• Burns, cuts, or near-misses from unsafe cooking or appliance use
• Nighttime disruptions (getting up confused, needing assistance at 2 AM)

Have Medical Documentation Ready

The assessor will review medical records, but having organized documentation strengthens the assessment:

• Recent physician progress notes documenting decline in function
• Hospital discharge summaries from the past year
• Medication list (many medications cause drowsiness, confusion, or balance issues that affect ADLs)
• Physical therapy or occupational therapy evaluations
• Any cognitive testing results (MMSE, MoCA scores)
• Specialist reports (neurologist, cardiologist) documenting conditions that limit daily function

Be Present During the Assessment

If you're the primary caregiver, be in the room during the assessment. The assessor will ask your parent questions, and your parent may minimize their limitations ("Oh, I can dress myself just fine") while you've been helping them button shirts and tie shoes every morning for six months. When this happens, speak up respectfully: "Mom, I've been helping you with buttons and shoes since March. You asked me for help this morning."

The assessor expects family input. Your observations aren't contradicting your parent — they're providing clinical context that a single visit can't capture.

Document Home-Safety Concerns Before the Visit

Keep the home safe for the visit, but note recurring hazards in your log and describe them to the assessor. Do not rely on leaving the home unclean or unsafe to demonstrate functional decline; specific examples of falls, wandering, unsafe cooking, or difficulty with daily activities are more useful.

After the Assessment: What Happens Next

The ARIA assessment records functional findings used to determine authorized care hours. You'll receive a notice detailing:

• Whether your parent qualifies for the ARChoices waiver
• The specific number of personal care hours authorized per week
• What types of services are covered (personal care, respite, companion)
• Whether IndependentChoices (consumer-directed, where you hire and manage the caregiver, including family members) or Agency-directed care is recommended

If the authorized hours are insufficient, you have the right to request a fair hearing within 35 calendar days of the notice. The ADL log you kept becomes evidence in that hearing — another reason to document thoroughly before the assessment.

Who This Is For

• Families whose parent needs help with daily activities and wants to remain at home rather than enter a nursing facility
• Adult children who will be present during the ARChoices assessment and want to ensure the evaluation captures the full picture
• Family members who are currently providing unpaid care and want the ARChoices waiver to authorize (and potentially pay for) that care through IndependentChoices
• Anyone whose parent has cognitive decline that fluctuates — good days and bad days make a single assessment unreliable without supporting documentation

Who This Is NOT For

• Families whose parent is already in a nursing facility and applying for institutional Medicaid — the ARChoices waiver is for home-based care only
• Parents who are fully independent in all ADLs and IADLs — the waiver requires nursing-facility level of care to qualify
• Families looking for help with the financial eligibility side of Medicaid (income cap, asset limits, Miller Trust) — those are separate from the clinical assessment, though both must be satisfied

Tradeoffs: ARChoices Home Care vs. Nursing Facility

ARChoices home care: Your parent stays in their own home. Care hours are limited to what the ARIA assessment authorizes. You manage the care schedule — either through an agency or through IndependentChoices (where you hire the caregiver, potentially a family member). Medicaid pays for the authorized hours. You remain responsible for any care needs beyond authorized hours.

Nursing facility: 24/7 care coverage. Medicaid pays the full daily rate after eligibility is established. Your parent gives up their home environment. Nursing homes in Arkansas cost $6,200–$7,500/month at private-pay rates — Medicaid rates are lower, but the facility absorbs the difference.

The assessment determines which clinical path your parent may qualify for. If it finds an intermediate nursing-facility level of care, your parent may meet the clinical criterion for either option, subject to each program's financial rules and, for a waiver, enrollment availability. A skilled level of care can qualify for nursing-home placement but is excluded from HCBS waivers. If the assessment determines a lower level of care, the nursing facility is not covered and home-based options may be more limited.

The Arkansas Medicaid Long-Term Care & Asset Protection Guide includes a dedicated ARChoices assessment preparation worksheet — a structured two-week ADL log organized by the functional categories you need to document, so your notes map directly to the assessment.

Frequently Asked Questions

Can a family member get paid as my parent's caregiver through ARChoices?

Yes, through the IndependentChoices program. Under IndependentChoices (consumer-directed care), the Medicaid recipient or their representative hires, trains, and manages their own caregiver — including adult children, other family members, or friends. The caregiver is paid through a fiscal intermediary, and the pay rate and hours are set by the waiver authorization. This is one of the most sought-after features of the ARChoices program for families already providing unpaid care.

What if my parent seems fine during the assessment but is normally much worse?

This is exactly why the two-week ADL log matters. Present it to the assessor and say, "Here's what a typical two weeks looks like." Specific dates, times, and descriptions carry more weight than general statements like "she usually has trouble." If the assessment results still don't reflect your parent's actual needs, you have 35 days to request a fair hearing with the documented log as evidence.

How many hours per week does ARChoices typically authorize?

Hours vary based on the ARIA assessment and the services authorized; there is no single weekly amount to assume in advance.

Can the assessment be done if my parent has dementia and can't answer questions accurately?

Yes. The assessor expects that cognitively impaired individuals may not accurately self-report. That's why your presence as the caregiver is important — you provide the observational data that the person cannot. Bring the ADL log, any cognitive test results, and be prepared to describe specific incidents that demonstrate the level of supervision and assistance required.

What's the difference between ARChoices and Living Choices?

ARChoices in Homecare covers care provided in the person's own home or a family member's home. Living Choices Assisted Living covers care in a licensed assisted living facility. Both require nursing-facility level of care and financial eligibility through Medicaid. The ARIA tool is retained for both ARChoices and Living Choices. The financial eligibility rules (income cap, asset limit, Miller Trust) are the same for both.

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