title: Consumer-directed home and community services programs in eight states: policy issues for older people and government.
abstract: This study assesses consumer-directed home and community services for older persons by examining public programs that serve this population in eight states. These programs give beneficiaries, rather than agencies, the power to hire, train, supervise, and fire workers. Most stakeholders interviewed, in addition to the quantitative research, indicate that many older beneficiaries want to and can manage their services, although significant issues arise for persons with cognitive impairments. Research results suggest better, or, at least, no worse, quality of life for beneficiaries when they direct their services, although quality of services remains a contentious issue. For workers, consumer-directed care has some disadvantages, including fewer fringe benefits. With exceptions, state agencies have not provided extensive consumer or worker support or aggressively regulated quality of care.
authors.affiliation: Urban Institute's Health Policy Center, 2100 M Street NW, Washington, DC 20037, USA. jtilly@ui.urban.org
authors.forename: J
authors.initials: J
authors.lastname: Tilly
authors.forename: J M
authors.initials: JM
authors.lastname: Wiener
mesh_terms: D000368:Aged; D003256:Community Participation; D006078:Government Programs / Q000458:organization & administration*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D018576:Home Health Aides; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration; D008484:Medicaid; D017146:Models, Organizational; D016134:Organizational Policy; D011635:Public Health Administration; D014481:United States