,,,,Does Consumer Direction Affect the Quality of Medicaid Personal Assistance in Arkansas

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Does Consumer Direction Affect the Quality of Medicaid Personal Assistance in Arkansas

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Publication Date:

Publisher: Center on Aging, University of Maryland

Author(s): L. Foster; R. Brown; B. Phillips; J. Schore; B Carlson Lepidus

Research Area: Health

Type: Report

Abstract:

One of the major shortcomings of personal care service (PCS) administered under Medicaid is a lack of consumer control that can result in unmet needs, dissatisfaction with care and diminished quality of life. Consumer-directed supportive service programs are an increasingly popular solution to this problem. This study of Arkansas's Cash and Counseling demonstration program, IndependentChoices, examined how consumer direction affects care quality relative to agency-directed services. Enrollment in the demonstration occurred between December 1998 and April 2001, and included 2,008 adults, eligible for PCS under Medicaid. Demonstration participants were randomized into treatment and control groups. The treatment group consisted of individuals directing their own PCS as IndependentChoices consumers, with the opportunity to receive a monthly allowance to hire a chosen caregiver and purchase services and goods required for daily living. Nine months after baseline, the researchers queried participants on satisfaction with care, unmet needs for assistance, quality of life, health status, self care and ability to perform daily activities without help. The results indicated that relative to control, a greater proportion of IndependentChoices consumers were very satisfied with their PCS. This included satisfaction with timing and reliability of care, being less likely to feel neglected by caregivers and more likely to be satisfied with the manner in which caregivers performed. Areas for future research include examining factors such as relative costs of consumer direction programs. However, from a consumer satisfaction standpoint, states can consider including programs like IndependentChoices as an option for those who are eligible for publicly funded PCS.