The biggest difference is who gets paid. Home Help lets an eligible family member become a paid caregiver, while PACE (Program of All-Inclusive Care for the Elderly) is a coordinated, provider-run program built around a care team and, often, a PACE day center — it generally isn't a mechanism for paying a specific family member directly.
How PACE actually works
PACE enrolls participants — who must be 55 or older, certified to need a nursing-facility level of care, and living in a PACE service area — into one comprehensive Medicare/Medicaid program that coordinates all medical care, therapy, and in-home or center-based services through a single interdisciplinary team. Michigan has more than a dozen independent PACE organizations, including coverage in parts of the Detroit area.
The self-direction gap
Home Help's defining feature is self-direction — choosing and paying a trusted family member directly. PACE centers on a professional care team instead; family members stay closely involved, but they generally aren't the ones drawing a paycheck the way a self-directed Home Help caregiver is.
Where PACE has an edge
PACE bundles medical care, transportation, therapy, and social or day-center services into one coordinated benefit — a real advantage for a senior with more complex medical needs who'd benefit from one integrated team rather than piecing services together separately.
Which one actually fits
If keeping a specific family member as the paid caregiver is the priority, Home Help is the better structural fit. If your loved one has complex medical needs that would benefit from an all-in-one coordinated care team, it's worth asking whether a PACE organization serves your area. Our Home Help vs. MI Choice Waiver guide covers a third comparison point worth knowing about too.
