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Consumer-Directed Home Care: Washington State and Beyond Joshua M. Wiener, Ph.D., Wayne L. Anderson, Ph.D., and Galina

Consumer-Directed Home Care: Washington State and Beyond Joshua M. Wiener, Ph.D., Wayne L. Anderson, Ph.D., and Galina Khatutsky, M.S. e-mail: jwiener@rti.org , Address: 1615 M Street, NW, Suite 700, Washington, DC 20036, Phone: (202) 728-2094.

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Consumer-Directed Home Care: Washington State and Beyond Joshua M. Wiener, Ph.D., Wayne L. Anderson, Ph.D., and Galina

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  1. Consumer-Directed Home Care:Washington State and BeyondJoshua M. Wiener, Ph.D., Wayne L. Anderson, Ph.D., and Galina Khatutsky, M.S. e-mail: jwiener@rti.org, Address: 1615 M Street, NW, Suite 700, Washington, DC 20036, Phone: (202) 728-2094 RTI International is a trade name of Research Triangle Institute

  2. Outline of Presentation • Report on research on consumer-directed services in Washington state and its effect on satisfaction with care • Research agenda for home and community-based services

  3. Study of Medicaid Home and Community-Based Services Study funded by the U.S. Centers for Medicare and Medicaid Services (Contract no. 500-96-05) RTI International is a subcontractor to The Lewin Group Principal investigator: Lisa Maria B. Alecxih Project officer: Susan Radke The statements contained in this study are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services, The Lewin Group, Mathematica Policy Research or RTI International.

  4. Consumer Direction • Consumer-directed home care lacks normal quality assurance mechanisms, such as formal training/licensure, supervision by professionals, inspection by state, etc.? • Is quality adequate?

  5. Prior research on CD • California’s In-Home Supportive Services (Benjamin, Matthias & Franke, 1998) • Cash and counseling (Foster et al., 2003)

  6. Study Goals • Any difference in satisfaction between persons using agency-directed and CD services? • Any difference in satisfaction in CD for older people and younger persons with disabilities?

  7. Consumer Direction in Washington • Dominant model: Over half of Medicaid home care beneficiaries use CD • CD available through state plan and waiver • Client responsible for hiring, orienting, supervising, and finding replacements • Worker a direct employee of the client • State pays workers and taxes

  8. Study Sample • 513 younger and older Medicaid beneficiaries receiving home care • Self-respondents and unpaid caregivers serving as proxy respondents • Survey response rate in WA: 73.2%

  9. Satisfaction with Paid Personal Assistance Scale (SPPAS) • 8 items: • Overall satisfaction • Interpersonal aspects of care provided by paid caregivers • Communication with PC • How problems with PC get resolved • How often PC get impatient or angry • How well PC are trained • Range 0-100; mean =93.9

  10. Methods • Regression models predicting SPASS: total sample, under 65, and 65+ • CD or agency-directed care • Other independent variables include: demographics, health and functional status and social characteristics and residence

  11. SPPAS: Descriptive Findings • Very happy with paid care: • CD .80 vs. AD .73 • Difficult to get problems resolved or fixed • CD .11 vs. AD .16 • Paid helper competent and well trained • CD .95 vs. AD .87

  12. Sample Descriptive Findings • Satisfaction with Paid Personal Assistance Scale: Total • CD 94.1 vs. AD 91.3* • Under Age 65 • CD 91.7 vs. AD 88.7 • Age 65+ • CD 96.8 vs. AD 92.8*

  13. Multivariate Findings • SPPAS Total Sample • CD 2.60 (NS) • SPPAS Under Age 65 • CD -2.67 (NS) • SPPAS Age 65+ • CD 8.25 (S)

  14. Conclusions for Study • Satisfaction with CD no worse than with agency-directed home care • Older people using CD more satisfied than those using agency-directed care • No statistically significant difference in satisfaction for younger persons with disabilities

  15. Research Agenda for Home and Community-Based Services • Quality Assurance • Has should the government monitor/regulate the quality of HCBS? • How should quality be measured?

  16. Research Agenda for HCBS (cont.) • Workforce and Quality • What are determinants of recruitment and retention for home and community-based services? • Does retention affect quality? • Does training affect quality? • Does “culture change” affect quality?

  17. Research Agenda for HCBS (cont.) • General HCBS • What is the impact of HCBS on well being? • What is the responsiveness of HCBS to price (“woodwork effect)? • Has 20 years of experience made HCBS cost-effective?

  18. Research Agenda for HCBS • Interaction with the health care system • Can capitated systems reduce institutionalization? • How can end-of-life care be improved?

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