All In-Home services are provided after a required COSA assessment is completed to determine needs and eligibility.


Assessment Procedure

Each COSA assessment, generally conducted in the home, includes questions on the applicants' physical health, functional ability, mental and cognitive functioning, caregiver and other supports, physical environment, and financial resources.

  • A Community Assessment determines the need and eligibility for In-Home Services or Nursing Home Care.
  • A Pre-Admission Assessment is conducted to determine clinical eligibility for Nursing Home placement. This assessment is primarily intended for adults, 18 years and over, for whom placement in a nursing home is being considered and for whom state funding for a nursing home bed is being sought. Other groups appropriate for a nursing home evaluation are: Anyone considering a nursing home and who desires having an assessment completed; individuals, regardless of their financial situation, who have a primary or secondary diagnosis of mental illness, intellectual disability, or other related condition.

All In-Home Services require either a Community or Pre-Admission Assessment. 

Apply for Services

Adult Day Centers

Adult Day Centers provide a protective environment for older adults who are not capable of full-time independent living. During daytime hours, participants can receive supervised care in a supportive, safe, and structured environment. Services may include basic medical services, nursing services, nutrition, occupational therapy, physical therapy, recreation, transportation and more intensive personal care but vary by location.

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Adult Day Centers reduce stress on full-time caregivers by offering reassurance and time to meet other responsibilities.  Please click here to see Adult Day Centers under contract with COSA.

Community Health Choices (CHC) Waiver Program

Home and Community-Based Services Waiver

Under this program, home and community-based long-term care services can be provided as an alternative to nursing home care. It is called a "Waiver" program because services are funded through a special waiver of certain Medicaid restrictions, allowing payments typically used for nursing home care to be used for in-home services.

To be eligible for CHC Waiver, you must:

  • Be a resident of Pennsylvania
  • Be a U.S. citizen or a qualified Non-citizen
  • Have a Social Security Number
  • Be 21 years of age or older
  • Income and resource eligible
  • Meet the required level of care for a nursing facility

Effective 4/1/16, Maximus, the PA Independent Enrollment Broker (IEB), handles  the enrollment process for all of the Waiver programs. 

Click here for the Steps to Apply for Waiver:

Click here for a printable referral form:

There are several ways that you can make a referral to Maximus:

Participant Help Line can be reached by calling 1-800-757-5042.

 Once you are approved for the CHC Waiver Program, the Managed Care Organization (MCO) you select during the enrollment process will contact you to begin service.                                                                                                                                                                                                       


If you are determined to be eligible, the following services may be available at no cost to you, enabling you to live more comfortably at home:

  • Adult Daily Living Services
  • Assistive technology
  • Behavior therapy
  • Benefits counseling
  • Career assessment
  • Cognitive rehabilitation therapy
  • Community integration
  • Community transition services
  • Counseling
  • Employment skills development
  • Financial management services
  • Home adaptations
  • Home delivered meals
  • Home health aide
  • Home health-nursing
  • Job coaching
  • Job finding
  • Non-medical transportation
  • Nutritional counseling
  • Participant-directed goods and services
  • Participant-directed community supports
  • Personal assistance services
  • Personal emergency response system (PERS)
  • Pest eradication
  • Residential habilitation
  • Respite
  • Service coordination (including information and assistance in support of participant direction. Service coordination is furnished as a distinct activity to waiver participants as an administrative activity)
  • Structured day habilitation
  • TeleCare
  • Vehicle modifications


  • Home health-physical, occupational, and speech and language therapies
  • Specialized medical equipment and supplies

Once you are enrolled in the CHC Waiver Program, you will be assigned a Service Coordinator. An individual service plan is developed jointly by you and the Service Coordinator, after which services are authorized. You will then be able to choose any company or agency from a list of participating providers. All service providers are certified by the Pennsylvania Department of Human Services (DHS) to ensure that they meet Medicaid standards.

There are no cost sharing or contributions for CHC Waiver participants. However, you may be subject to Medical Assistance (MA) Estate Recovery

In order to qualify for CHC Waiver Services, you must meet eligibility requirements. This includes a level of care assessment and a determination of financial eligibility.

To view a flow chart showing the steps to Applying for Medicaid Funded Home Care when a referral is made to COSA first, click here.

Revised 7/1/20

Care Management

A variety of long term services are available to help you get the care you need to stay at home.
COSA staff is here to help you learn about the many resources that can help you learn what services are available where you live or plan on living.
A COSA Care Manger will help you:
  • Figure out what you need.
  • Understand which services are available in your community.
  • Identify which services you are financially and functionally eligible to receive.
  • Formulate a plan to meet your goals.
  • Arrange for services.
  • Follow-up to make sure you continue to receive appropriate, quality services.
Care management is an available service to Delaware County residents 60 or older of all income levels. A professional care manager has special training and knowledge about long term living options and can provide you with information that will help you plan for the future and meet your goals.
You may request a visit from COSA to discuss long term living options and choices. COSA may perform a comprehensive assessment of your care needs and develop a care plan for you to stay at home. A care manager would then coordinate In-Home Services and stay in touch with you to make sure your goals are effectively and efficiently met.


COSA staff can be contacted at 610-490-1300 Monday through Friday 8:30 am to 4:30 pm if you have questions or to initiate the COSA Assessment process. Apply for Services.

Community-Based Long Term Care

Home and community-based services describe a range of personal, support, and health services provided to individuals in their homes or communities to help them stay at home and live as independently as possible.
In-Home Services include but are not limited to the following: Adult Day Care, Care Management, Home Delivered Meals, Home Health, Medical, Equipment & Supplies, Personal Care and Respite.
All In-Home services are provided after a COSA assessment to determine needs and eligibility.  Apply for Services

Caregiver Support Program

 Providing care to a loved one is challenging, demanding and rewarding. The Pennsylvania Caregiver Support Program works to ease the stress of caregiving by focusing on the well-being of the caregiver. The program provides the primary caregiver with reimbursement for out-of-pocket costs associated with caregiving such as respite, caregiving-related services and supplies. The program offers education, training, counseling and more.

The program is administered by your local Area on Aging. Each caregiver is assigned a care manager who will come to the care receivers' home, conduct a comprehensive assessment of the needs of the caregiver, provide support, and work with them to develop a person-centered plan of care.

If you are a caregiver residing in Delaware County and you:

  • Are age 55+ and are caregiving for grandchildren under the age of 18
  • Are age 60+ and are caregiving for a disabled relative between the ages of 18-59
  • Are age 18+ and are caregiving for someone age 60+

you may be eligible for financial reimbursement for some expenses you incur in caring for your relative.

There are three categories of programs each with their own requirements.

To view a flyer with information on each program and its requirements, click here.

To request an Assessment for the Caregiver Support Program, contact COSA's Information and Referral Department at 610-490-1300 or click here to  Apply for Services

 Revised 1/21/21

Home Delivered Meals/ Senior Suppers

This program provides daily nutritious meals to home-bound older adults. Hot meals are delivered Monday thru Friday, with cold meals being available for evenings and weekends. Meals are supervised by a Registered Dietician. In emergency cases, home delivery can begin shortly after an In-Home Services Assessment.

Search for Home Delivered Meals

Nursing Home Transition (NHT)

Nursing Home Transition is a program that assists individuals to transition from Nursing Homes back in to the community.

The only criteria for referring someone to the Nursing Home Transition program is that the individual is in a nursing facility and wants to return to the community.  The protocol differs from a regular discharge plan because there are barriers identified that need to be overcome in order for the individual to go home.

Living in the community with supports allows people to remain in better health and thus reduce the costs incurred to care for them.  We are working to enable and empower older adults instead of just caring for them.

For example, an individual may need a place to live. Housing options may need to be explored. Furniture, household supplies, security deposit, or services may be needed to get started upon discharge. Without the help of the Nursing Home Transition coordination the discharge may not happen.

If you are interested in finding out more about Nursing Home Transition, contact your Managed Care Organization (MCO).

Personal Care

Personal Care is provided to those older adults needing assistance with activities of daily living such as bathing, dressing, grooming, and using the bathroom. Services are provided by trained, supervised personal care workers in the older adults’ home according to the individual service plan.

Protective Services

COSA's Protective Services Program investigates confidential reports of abuse, neglect, financial exploitation, or abandonment of county residents aged 60 or older. Services are initiated to protect victims, stop abuse, and prevent future incidents.
Reports can be made anonymously 24/7 - confidentiality is assured in all cases. If you believe someone is in need of  protective services contact COSA at: 610-490-1300. After business hours, please call 610-622-9284.  
For more information in Delaware County, contact the Delaware County District Attorney's Senior Exploitation Unit at or visit the PA Department of Aging website.

Respite Care

The primary purpose of respite is to relieve the caregiver by providing supervision for the consumer who cannot be left alone.