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International Consumer-Directed Programs: Implications for Beneficiaries, Caregivers, and Workers

International Consumer-Directed Programs: Implications for Beneficiaries, Caregivers, and Workers. Jane Tilly and Joshua Wiener supported by The Commonwealth Fund. Research Design. Case studies of programs 2+ years old serving 65+. Austria, France, Germany, Netherlands, US.

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International Consumer-Directed Programs: Implications for Beneficiaries, Caregivers, and Workers

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  1. International Consumer-Directed Programs: Implications for Beneficiaries, Caregivers, and Workers Jane Tilly and Joshua Wiener supported by The Commonwealth Fund

  2. Research Design • Case studies of programs 2+ years old serving 65+. • Austria, France, Germany, Netherlands, US. • Interviews with government, beneficiary, agency, and worker representatives.

  3. Overview of Programs • Eligibility: assessment of ADLs & IADLs. Austria & Germany -social insurance, Netherlands - non-means-tested. France & US - means-tested. • Benefits: limited by hours of care or dollar limits. • Program scope: country-wide in Austria, Germany, Netherlands, & France. Varies by state in US.

  4. Overview (cont.) • Consumers: can receive assistance with management tasks in most countries. • Workers: can hire family, generally with exception of spouses. Individual workers often receive fewer fringe benefits than agency workers. • Quality assurance: generally minimal monitoring.

  5. Who wants to direct services? • Govt & consumers: all ages who are assertive w/ informal support. • Agencies & unions: older people can’t handle CD. • People w/ CI need assistance.

  6. How does CD affect Beneficiaries? • Govt. & consumers: CD consumers have more control and get better quality; agencies are unresponsive due to scheduling & staffing. • Agencies & unions: quality of CD and agencies equivalent; CD increases consumer burden.

  7. How does CD affect Caregivers? • Beneficiaries often hire family workers. These workers provide better care but are overburdened. • Agencies and unions: family workers need same training, benefits, and oversight. • Some agencies believe that hiring family is not good policy.

  8. What are workers’ experiences in CD? • Individual workers have better relationships w/ consumers than agency workers. • Individual workers have more control over their work, schedules, and tasks. Some union disagreed. • Individual workers are isolated, lack backup and fringe benefits.

  9. What about quality and fraud? • No reports of major quality or fraud problems in CD. • Govt. & consumers: consumer ability to fire workers assures quality. • Agencies & unions: consumers more vulnerable to abuse under CD.

  10. Caveats • Data are expert opinion only. However, survey results from Germany, the Netherlands, and the US indicate better quality of life for beneficiaries with consumer-directed services compared to those with agency services. • Case study sites have well-established programs. Results could vary in other sites.

  11. Policy Implications • We cannot assume that older people do not want or are not capable of CD. • Consumers who are cognitively intact, assertive, and have informal support networks are likely to do well with CD. • Experiences of caregivers need further investigation because of potential overburden.

  12. Policy Implications (cont.) • Individual workers are at a financial and perhaps emotional disadvantage compared to agency workers. • Quality may not be a major problem but insufficient data to determine if quality problems exist.

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