Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.
The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.
Mahoney
Kevin J
KJ
Center for Study of Home and Community Life, Boston College Graduate School of Social Work, Chestnut Hill, MA 02467, USA. Kevin.Mahoney@bc.edu
Simon-Rusinowitz
Lori
L
Simone
Kristin
K
Zgoda
Karen
K
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D003153:Community Health Services / Q000191:economics*; D003258:Consumer Behavior; D003376:Counseling / Q000191:economics*; D006233:Persons with Disabilities / Q000523:psychology*; D016330:Frail Elderly / Q000523:psychology*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008484:Medicaid; D026684:Personal Autonomy; D016730:Program Development; D011632:Public Assistance; D012944:Social Support; D012947:Social Work / Q000458:organization & administration*; D013221:State Health Plans; D014481:United States