AERS performs personalized evaluations for community Medicaid recipients who are seeking Home and Community-based Services (HCBS) and for those who are seeking in-home care but do not qualify for HCBS. All evaluations are completed in the home by a nurse or social worker. The results of the personalized evaluations help the AERS team to make specific and appropriate care plan recommendations to Maryland Department of Health, the Office on Aging, and Department of Social Services. The team also identifies and recommends resources for the individual and family that will help the individual who is at risk for nursing facility placement remain living in the community.