Cash and Counseling

Launched in 2004, Flexible Services and Supports (the Pilot) gave participants control in calculating an individual budget where they then purchased services and goods to meet their community living needs. What were the experiences that provide lessons for the design and implementation of this model on a larger scale? This report reviews: design issues and implementation barriers, makes recommendations for future work, and describes any financial impacts of the Pilot on Medicaid utilization.

This paper focuses on the experiences and perceptions of community liaisons and the managers of Consumer-Directed Agencies (managers) who participated in the Massachusetts Real Choice Pilot. The experiences of the Real Choice community liaisons and managers provide insight relevant for the larger implementation of the support brokerage component for an Independence Plus option that will be available within the Massachusetts Community First waiver.

This report describes the implementation of consumer directed care by synthesizing information from in-person discussions with program staff, a mail survey of program consultants, telephone interviews with consumers in the treatment group, and program records. It discusses the program’s goals and features, the ways beneficiaries managed their program responsibilities and took advantage of increased flexibility, and the degree to which beneficiaries were satisfied with the program.

Vermont is changing their long-term care systems and in a shift from nursing homes, the state has family members care for elderly relatives. A recent Wall Street Journal cover story details the changes. Some of the new home and community based services include the development of the Choices for Care program.

This report assesses the appeal of the Cash and Counseling demonstration by: (1) estimating the proportions of eligible beneficiaries that participated and comparing the characteristics of participants and nonparticipants; (2) describing beneficiaries’ most common reasons for agreeing or declining to participate; and (3) examining whether the demonstration affected the number of beneficiaries accessing personal care services or home and community-based services over time.

Assessing the well-being of workers hired under consumer direction and addressing their concerns is critical, because the model is sustainable only if workers are satisfied. While care recipients who manage their own care appear to be much more satisfied than others, the primary reason given for dropping out is difficulty finding or keeping a worker. Moreover, tapping consumers’ family members and friends as additional sources of labor could help solve the serious worker shortage.

The Arkansas IndependentChoices program developed two new tools. The Consumer-Directed training manual will provide users with ideas and suggestions on hiring, training, and managing a personal care attendant. The Personal Care Attendant handbook will provide users with training material that will help trainees do their job as a personal care attendant. Both manuals contain information about hiring, communication and management issues.

This publication summarizes and synthesizes some of the most important things that research and demonstration programs have learned about consumer direction. The paper provides leaders and practitioners with a common framework of understanding for our next challenge: To build upon current knowledge and to make “consumer direction” an integral part of the options available for all older persons who may need long-term care. Read the 12 common consumer direction myths and then learn the reality.

The State of Vermont was seeking proposals from individuals or organizations interested in becoming the Medication Assistance Consultant. The deadline for submission of proposals was June 23, 2006. This RFP serves as a great example when seeking out contract work.

This report describes the implementation of Personal Preference by synthesizing information from in-person discussions with program staff, a mail survey of program consultants, telephone interviews with consumers in the treatment group, and program records. It discusses the program’s goals and features, the ways consumers managed their program responsibilities and took advantage of increased flexibility, and the degree to which consumers were satisfied with the programs.