Easing the burden of caregiving: the impact of consumer direction on primary informal caregivers in Arkansas.
OBJECTIVE
We assess the effect of consumer-directed care on the emotional, physical, and financial well-being of the primary informal caregivers of the Medicaid beneficiaries who voluntarily joined Arkansas's Cash and Counseling demonstration.


METHODS
The demonstration randomly assigned beneficiaries to a program in which they could direct their own disability-related supportive services (the treatment group) or rely on traditional agency services (the control group). We constructed outcome measures from telephone interviews with 1,433 caregivers who provided beneficiaries with the most unpaid assistance at baseline, and we used multivariate regression models to estimate program effects. Interviews occurred between February 2000 and April 2002, 10 months after beneficiaries' random assignment.


RESULTS
At follow-up, treatment group caregivers provided fewer hours of assistance than did their control group counterparts, on average, and they reported better emotional, physical, and financial well-being.


CONCLUSIONS
Permitting interested Medicaid beneficiaries to direct their own in-home supportive services reduces burden on informal caregivers, which may help reduce beneficiaries' nursing home use.
Foster
Leslie
L
Mathematica Policy Research, Inc., P.O. Box 2393, Princeton, NJ 08543, USA.
Brown
Randall
R
Phillips
Barbara
B
Carlson
Barbara Lepidus
BL
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas; D017028:Caregivers / Q000523:psychology*; D003256:Community Participation; D003258:Consumer Behavior; D005260:Female; D006701:Home Nursing / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D017063:Outcome Assessment, Health Care