Payments to Informal versus Formal Home Care Providers: Policy Divergence Affecting the Elderly and Their Families in Michigan and Illinois

State policies vary widely on paying friends and family rather than home care agencies to care for the elderly. We explore two state programs that exemplify different payment options: Michigan, which pays clients' informal caregivers, and Illinois, which generally pays agencies to provide services. We ask how different payment policies affect clients, specifically exploring program structure (division of labor and bases for need determination) and financing incentives created by Medicaid (centralization, means testing, and quality assurance). These factors shape provider and client preferences, well-being, and assessment of care quality. Comparatively, Illinois's approach favors professionalism, high cost/quality, documentation, and an orientation toward medical and physical needs. It has experienced high worker turnover and less regard for caregiver-client relationships. Michigan's approach favors informality, casual accountability, long-term stability of helping relationships, and respect for client preferences and autonomy. Both approaches offer important client benefits, but state precedents and incentives to administering agencies have shaped their overall directions. The recent rapid growth of the home care industry in Illinois could proscribe a fuller range of provider options. We recommend greater flexibility in considering states' payment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66882/2/10.1177_073346488800700403.pd

Consumer Preferences for a Consumer Directed Cash Option Versus Traditional Services

This article examines the findings of a telephone survey inquiring into the preferences of Florida elders and adults with physical disabilities with regard to various options for receiving assistance and service

GOVERNMENT PARTICIPATION IN LONG-TERM CARE OF THE ELDERLY: ANALYSIS OF A POLICY TO PAY FAMILY CAREGIVERS.

GOVERNMENT PARTICIPATION IN LONG-TERM CARE OF THE ELDERLY: ANALYSIS OF A POLICY TO PAY FAMILY CAREGIVERS

Consumer Preferences for a Consumer Directed Cash Option Versus Traditional Services

This article examines the findings of a telephone survey inquiring into the preferences of Florida elders and adults with physical disabilities with regard to various options for receiving assistance and service

Determining Personal Care Consumers' Preferences for a Consumer-Directed Cash and Counseling Option: Survey Results from Arkansas, Florida, New Jersey, and New York Elders and Adults with Physical Disabilities

OBJECTIVE: To assess Medicaid consumers' interest in a consumer-directed cash option for personal care and other services, in lieu of agency-delivered services. DATA SOURCES/STUDY SETTING: Telephone survey data were collected from four states from April to November 1997. Postsurvey focus groups were conducted in four states in 1998. Early implementation experiences are drawn from three states from 1999 to 2002. STUDY DESIGN: Participants (N=2,140) were selected for a structured telephone survey interview from a probability-sampling frame of current Medicaid consumers in Arkansas, Florida, New Jersey, and New York. Key variables include interest in the cash option, demographic and background characteristics of consumers, as well as previous experience and training needed. Postsurvey focus groups were also conducted with current Medicaid consumers. DATA COLLECTION/EXTRACTION METHODS: Interviewers read the telephone survey from computer screens and entered responses directly into the database of the Macintosh Computer Assisted Telephone Interview software. Data were analyzed using SPSS 10.0 () for Windows. PRINCIPAL FINDINGS: Cash option interest was positively associated with experience hiring and supervising workers, more severe levels of disability, having a live-in caregiver, living in Florida, and minority status. Age of the client was also a significant factor. CONCLUSIONS: There is significant interest in the cash option, although interest varies among subgroups of consumers. Future research should continue to evaluate interest in the cash option among different groups of consumers, as well as actual experience with the option when the Cash and Counseling Demonstration and Evaluation (CCDE) evaluation findings are completed