title: Are consumer-directed home care beneficiaries satisfied? Evidence from Washington state.
abstract: OBJECTIVE
  This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State.
  
  
  METHODS
  The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study, we developed an 8-item Satisfaction With Paid Personal Assistance Scale as the measure of satisfaction. In predicting satisfaction with personal assistance services, we estimated an ordinary least squares regression model that was right-censored to account for the large percentage of respondents who were highly satisfied with their care.
  
  
  RESULTS
  Among the older population, but not younger people with disabilities, beneficiaries receiving consumer-directed services were more satisfied than individuals receiving agency-directed care. There was no evidence that quality of care was less with consumer-directed services. In addition, overall satisfaction levels with paid home care were very high.
  
  
  CONCLUSIONS
  This study supports the premise that consumer satisfaction, an important measure of quality, in consumer-directed home care is not inferior to that in agency-directed care. The positive effect of consumer direction for older people underlines the fact that this service option is relevant for this population. In addition, this research provides evidence that home- and community-based services are of high quality, at least on one dimension.
authors.affiliation: Aging, Disability and Long-Term Care, RTI International, 701 13th Street NW, Suite 750, Washington, DC 20005-3967, USA. jwiener@rti.org
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Wiener
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Anderson
authors.forename: Galina
authors.initials: G
authors.lastname: Khatutsky
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003657:Decision Making; D006233:Persons with Disabilities / Q000523:psychology*; D005006:Ethnicity / Q000706:statistics & numerical data; D019538:Health Care Surveys; D018574:Home Care Agencies; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D011787:Quality of Health Care; D012044:Regression Analysis; D014481:United States; D014861:Washington