In consumer directed services the client finds his/her caregiver who holds at least a HHA certificate in the state of Virginia. Quality Health Services then send out a Registered Nurse who goes out to the client's home and assess his/her needs based on physician orders, his/her functional ability, caregiver's and family schedules. We assist the family/client to complete the paperwork required to begin services and provide support with bimonthly visits to update assessment and plan of care. While this is our lowest cost option to our clients because there is no payroll or overhead involved, it will be one of highest margin options.