Consumer and Counselor Experiences in the Arkansas IndependentChoices Program. Characteristics of IndependentChoices Consumers


Arkansas’s Cash and Counseling demonstration program was open to elderly and nonelderly adults eligible for Medicaid PAS and enrolled beneficiaries for its evaluation from December 1998 to April 2001. (Beneficiaries continued to enroll in the demonstration after April 2001, but were not part of the evaluation.) The program provided treatment group members, referred to in the remainder of this report as consumers, a monthly allowance based on the number of hours of PAS for which they had been assessed. It also provided, at no direct cost to consumers, supportive services: counseling (for example, to help consumers develop an allowance spending plan) and optional bookkeeping services (for example, to pay and withhold taxes for workers hired with the allowance). The IndependentChoices allowance and support services were offered to 1,004 consumers who had been randomly assigned to the evaluation treatment group. The typical consumer was elderly (age 65 or older), white, female, and living with someone other than a spouse. Just over a third of consumers reported living in a rural part of the state. Nearly all had paid or unpaid help with personal care and household activities when they enrolled in the program; however, about two-thirds reported they needed more help. Slightly less than half had been receiving publicly funded home care for more than a year when they enrolled in IndependentChoices. Many consumers were generally satisfied with the paid help they had been receiving; however, nearly a third were not (Table 1).

In addition to presenting data for all IndependentChoices consumers, we also compare the program experiences of elderly and nonelderly consumers. We hypothesized that elderly and nonelderly consumers might differ in their ability to manage the allowance, informal care resources, attitudes toward personal assistance, or desire to control that assistance.

TABLE 1: Consumer Characteristics at Enrollment
Age 18 to 64 27.8%
Age 65 to 79 36.4%
Age 80 or Older 35.9%
Female 77.7%
Race Self-Identified as White Only 61.2%
Race Self-Identified as Black 32.9%
Self-Identified as Some Other Racea 5.9%
Lived Alone 32.1%
Lived With Spouse Only 8.4%
Lived With Others 59.6%
Lived in Rural Area 38.2%
Had Paid or Unpaid Help With Personal Careb 88.1%
Had Paid or Unpaid Help With Household Activitiesc 95.7%
Needed More Help With Personal Careb 62.5%
Needed More Help With Household Activitiesc 66.6%
Had Been Receiving Public Home Care For 1 Year or Mored 43.7%
Was Satisfied Overall With Paid Help and Related Goods 71.7%
SOURCE: Age and sex come from IndependentChoices program records. All other data come from MPR baseline interviews conducted with IndependentChoices participants between December 1998 and April 2001.
NOTE: Table includes responses for 1,004 consumers in evaluation treatment group.
  1. Only 12 of the 1,004 consumers considered themselves of Hispanic (or Latino) origin when asked in the baseline interview.
  2. Personal care includes bathing, transferring from bed, eating, and using the toilet. Questions refer to week before baseline.
  3. Household activities include light housework, yard work, meal preparation, and shopping. Questions refer to week before baseline.
  4. Public home care includes help at home from someone who was paid by Medicaid or some other public program.

As a basis for understanding differences (if any) in program experiences between elderly and nonelderly consumers, we examined differences in the two groups at enrollment. While elderly and nonelderly consumers were similar on most dimensions at enrollment, they did differ in a few. Elderly consumers had less formal education, were less likely to be new to publicly funded home care, and were more likely to be satisfied with current PAS (Appendix Table A.1 and Table A.2). In addition, proxy respondents to the baseline interview were much more common for elderly consumers than nonelderly consumers (57 versus 25 percent).

Of the 1,004 consumers, 924 responded to the evaluation’s four-month interview and 885 to the nine-month interview. The baseline characteristics of the responding consumers were nearly identical to those of the original 1,004 enrollees. As for the baseline interview, proxy respondents for the follow-up interviews were much more common for elderly than nonelderly consumers.5

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