title: Lessons from the Arkansas Cash and Counseling program: how the experiences of diverse older consumers and their caregivers address family policy concerns.
abstract: This paper addresses four family policy questions that policy makers often ask about consumer-directed services, examining issues such as quality, suitability, and fraud and abuse. Responses to these questions evolved from the experiences of diverse elder consumers and their caregivers who participated in IndependentChoices, the Arkansas site of the Cash and Counseling Demonstration and Evaluation (CCDE) program. Building on CCDE evaluation survey data, this analysis of in-home interviews with participants discussing their experiences of receiving, giving, and managing care demonstrates how the program allows consumers choices so they receive the services they want. At the same time, program flexibility allows policy makers to safeguard both consumers and program resources through the use of supports such as representatives, state consultants, and fiscal intermediaries. This article demonstrates how the Cash and Counseling model can address the needs of both consumers with diverse disabilities and policy makers.
authors.affiliation: CSR, Incorporated, Arlington, Virginia 22201, USA. sananton@verizon.net
authors.forename: Patricia
authors.initials: P
authors.lastname: San Antonio
authors.forename: Lori
authors.initials: L
authors.lastname: Simon-Rusinowitz
authors.forename: Dawn
authors.initials: D
authors.lastname: Loughlin
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Eckert
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Mahoney
authors.forename: Kathleen Ann Depretis
authors.initials: KA
authors.lastname: Ruben
mesh_terms: D000369:Aged, 80 and over; D001131:Arkansas; D017028:Caregivers / Q000191:economics* / Q000458:organization & administration; D003256:Community Participation; D003258:Consumer Behavior; D003376:Counseling; D006233:Persons with Disabilities; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States