Consumer-Directed Home Services for Seniors

1
Consumer-Directed Home Services for Seniors

• Marisa Scala
• Institute for the Future of Aging Services
• Washington, DC
• Jerry Lindsay
• Northwest Paralyzed Veterans of America
• Enumclaw, WA

2
Structure Of Session

• Background
• Policy and programs
• Current initiatives
• Consumer perspective

3
Defining consumer direction

• Consumer direction represents both a philosophy
  and orientation to service delivery
• Philosophy emphasis on consumer choice
• Practice decision-making and management of
  services more than just hiring and firing workers

4
Defining personal assistance services

• Tasksthat individuals would normally do for
  themselves if they didnt have a disability
  (Litvak, Zukas Heumann, 1987)
• Includes
• personal care (Activities of Daily Living)
• instrumental activities of daily living
• communication
• paramedical services

5
Barriers to consumer direction

• Overarching goal of home services to keep people
  out of nursing homes
• Bias of the field toward safety and protection
• Professional training
• Balancing autonomy and risk
• Concerns about quality assurance (i.e. fraud and
  abuse)

6
Language differences (Aging disability
communities)

• Home care vs. personal assistance services
• Consumer direction vs. self-determination
• Home care workers (or aides) vs. personal
  assistants (or attendants)

7
Other differences (Aging disability
communities)

• Goals of services differ (full participation in
  society vs. staying out of a nursing home)
• Consumer direction and choice not as widespread
  in aging services
• Movement has come from professionals more so than
  seniors themselves

8
Why consumer direction? Why now?

• More emphasis on consumer preferences and
  autonomy
• Concerns about quality of services
• Worker shortages
• Cutting costs
• Baby Boomers coming of age
• Legislation (MiCASSA bill)
• Olmstead vs. L.C. decision

9
Trends in consumer direction

• Consumer direction still new to aging services
• Some joint efforts between aging and disabilities
  communities
• Growth in Medicaid Personal Care Option (32
  states)
• Introduction of MiCASSA bill
• Olmstead vs. L.C. E.W.

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Trends in consumer direction (continued)

• Development of National Institute of
  Consumer-Directed Long-Term Services
• National Council on Aging survey

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National Council on Aging survey

• Survey of administrators in aging, Medicaid,
  MR/DD, vocational rehab.
• Original survey 1996, resurveyed 1999
• Increase in number of programs 103 in 96 to
  185 in 99
• Increased awareness of consumer dir.
• Decreased use of agency providers increased use
  of family as providers
• Barriers largely policy-related

12
Models

• Self-directed case management (agency with
  choice)
• Fiscal intermediary
• Supportive intermediary
• Direct pay (Cash and counseling)
• Spectrum intermediary services

13
Current initiatives

• Robert Wood Johnson Foundation initiatives
• Cash and Counseling Demonstration Program
• Independent Choices Program
• Other local programs showing interest
• Council on Aging of Southwestern Ohio levy
  program

14
Independent Choices projects

• Promoting State Policy Reform to Enhance Consumer
  Direction (DC)
• Consumer Support Training Grant (Minnesota)
• Elder Preferences and Consumer Direction
  (Brandeis University, MA)
• Making Hard Choices Respecting Both Voices
  (California)

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Independent Choices projects (continued)

• Incorporating Independent Living Philosophy into
  Home Health Agencies (Illinois)
• Consumer-Directed Personal Assistance for the
  Cognitively Impaired (New York)
• Consumer Direction in Ohios PASSPORT Program

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Where do we go from here?

• Continued growth of the field
• Aging and disability communities need to work
  together
• More input from consumers
• Policy changes

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Where do we go from here? (continued)

• Enhancing consumer direction for seniors
• training (consumers staff), supportive
  intermediary services, flexibility to accommodate
  surrogate decision-makers
• Targeted research
• consumer satisfaction, worker satisfaction,
  quality of services, costs (financial
  administrative)