Consumer Direction

1
Consumer Direction

• Describes programs that offer maximum choice
  and control for people who use services or other
  supports to help with daily activities.
• Consumer direction does not necessarily mean
  cash and counseling, nor is it limited to
  services provided through a Medicaid Waiver.
  Consumer direction does not imply one program
  model, but includes a range of approaches.

2
CD programs may permit consumers to

• Select, manage and dismiss their workers
• Hire neighbors and friends
• Hire family members
• Decide what services they will use
• Determine when/ how services will be provided
• Use vouchers or cash
• Set up "personal budgets"
• Substitute items such as home home modifications
  or assistive devices

3
Cash Counseling Experience

• Higher satisfaction with paid caregivers - 60
  fewer reports of workers failing to complete
  tasks
• Less likely to report unmet needs for assistance
• Care provided is at least as safe agency-directed
  care, in terms of reports of adverse events,
  health problems and general health status
• Program participants were almost 20 more likely
  to report satisfaction with their lives

4
Growth in consumer-directed services

• 139 consumer-directed service programs were
  identified by NCOA in a 2001 survey.
• Many programs are small, serving less than 1,000
  persons.
• An estimated half a million elders, adults of
  working age, and children with physical and/or
  mental disabilities are served by these programs.
• 2/3 of the programs were started since 1990, 17
  within 2 years of the survey date.

5
Increased state interest in consumer direction

• 10 states participated in NASUAs Independent
  Choices Project (1997-2000) AR, FL, ME, MD, MA,
  NH, ND, PA, RI, WI
• 9 states are involved in the NASUA/NCOA project,
  Promoting Consumer Direction in Aging Services
  IA, MO, NV, NC, OK, PA, SC, WA, WV
• 19 states were identified by NASUA as offering
  consumer direction in some OAA services AL, DC,
  GA, HI, IL, IN, IA, MA, MI, MO, NV, NY, NC,
  PA, SC, TN, VT, WA

6
Consumer Direction in OAA Services

• Title III-E Respite 16 states
• Home care services (homemaker/chore, other
  in-home services) 6 states
• Adult day care 4 states
• Home delivered meals other nutrition
  services 3 states
• Transportation 3 states
• Other OAA services (e.g., medications,
  prescription drugs, medical supplies, lawn care,
  home modifications) 3 states

7
Consumer direction in OAA services

• Consumers select, manage and dismiss their
  workers 8 states
• Consumers hire independent providers (neighbors
  or friends) 8 states
• Pay family members 6 states
• Consumers select the services they want
• 9 states
• Consumers determine when and/or how often their
  services will be provided 11 states

8
Consumer direction in OAA services

• Consumers substitute items such as home
  modifications or repairs for hours of direct
  service 4 states
• Personal budgeting for participants, who decide
  how the funds will be spent 3 states
• Use vouchers or cash 7 states

9
Challenges/barriers toconsumer direction

• Balancing protection with consumer choice
  independence
• Tax issues/workers comp when the consumer is the
  employer
• Limits to provider choice criminal background
  checks, worker training
• Supporting consumers who take on new
  responsibilities
• Emergency back-up

10
Advantages of consumer direction

• Increased consumer satisfaction
• Adds new workers who would never work for a
  provider agency
• Cost neutrality
• Responsive to diversity
• Consumers want it!
• Freedom, independence and the free exercise of
  individual initiative in planning and managing
  their own lives. (OAA Objective 10)