RESUMEN
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.
Asunto(s)
Cuidadores/economía , Servicios de Salud para Ancianos/economía , Medicaid/organización & administración , Anciano de 80 o más Años , Arkansas , Cuidadores/organización & administración , Participación de la Comunidad , Comportamiento del Consumidor , Consejo , Personas con Discapacidad , Encuestas de Atención de la Salud , Servicios de Salud para Ancianos/organización & administración , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Medicaid/economía , Calidad de la Atención de Salud , Estados UnidosRESUMEN
OBJECTIVE: To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program. DATA SOURCES: Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program. STUDY DESIGN: The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction. PRINCIPAL FINDINGS: Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care. CONCLUSIONS: The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.
Asunto(s)
Comportamiento del Consumidor , Familia , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Participación del Paciente , Adulto , Anciano , Anciano de 80 o más Años , Manejo de Caso/organización & administración , Personas con Discapacidad , Femenino , Administración Financiera , Investigación sobre Servicios de Salud , Humanos , Relaciones Interinstitucionales , Masculino , Medicaid/organización & administración , Persona de Mediana Edad , Investigación Cualitativa , Estados Unidos , United States Dept. of Health and Human Services/organización & administraciónRESUMEN
This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.