Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives.
An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.
Simon-Rusinowitz
Lori
L
University of Maryland, Center on Aging, College Park, MD 20742, USA. ls119@umail.umd.edu
Marks
Lori N
LN
Loughlin
Dawn M
DM
Desmond
Sharon M
SM
Mahoney
Kevin J
KJ
Zacharias
B Lee
BL
Squillace
Marie R
MR
Allison
Ann Marie
AM
D000368:Aged; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D011640:Public Policy; D044469:Racial Groups