INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Cash and Counseling: Consumers' Early Experience In Arkansas and New Jersey

Leslie Foster, Randall Brown, Barbara Carlson, Barbara Phillips and Jennifer Schore
Mathematica Policy Research, Inc.

Broad Questions Addressed by Evaluation

  • Effects of C&C on consumers and their caregivers?
  • Effects of C&C on public spending?
  • Who participates in C&C?
  • How was C&C implemented?

Outcomes for Consumers and Caregivers

  • Consumers
    • Personal assistance services (PAS) used
    • Unmet needs and satisfaction with PAS
    • Life quality
    • Functioning and health
  • Caregivers
    • Assistance they provide
    • Well-being

Evaluation Methodology: Random Assignment

  • Interested consumers sign consent form
  • Consumers complete baseline telephone survey
  • MPR randomly assigns consumers to either
    1. C&C (treatment group), OR
    2. traditional Medicaid PAS (control group)
  • Regression-adjusted comparisons of outcomes for treatment and control groups provide estimates of C&C effects
ENROLLMENT TARGETS
  AR NJ FL Total
Elderly Adults (age 65+) 1,000 1,000 1,000 3,000
Non-Elderly Adults (age 18-64) 1,000 1,000 1,000 3,000
Children (age <18) --- --- 1,000 1,000
Total 2,000 2,000 3,000 7,000
Totals include treatment and control group members.

Preliminary Descriptive Analysis

  • Early experience in Arkansas' Independent Choices and New Jersey's Personal Preference programs
    • Uses of cash
    • Caregivers hired and assistance received
    • Satisfaction with program and assistance
  • Sample: Approximately 200 Early Treatment Group Members
  • Data: Follow-Up Surveys at 4 or 6 Months and at 9 Months with Early Cohort
ENROLLMENT STATUS
Status at 9 Months Percent of Respondents
Arkansas New Jersey
Enrolled 67 76
     Ever received cash benefit 65 49
     Never received cash benefit 2 27
Disenrolled 33 24
     Involuntarily 13 17
     Voluntarily 20 7
Number of Respondents 194 240

 

REASONS FOR DISENROLLING
Reason Number of Respondents
Arkansas New Jersey
Involuntary Disenrollment 23 16
     Deceased (died while enrolled) 6 8
     Other Reason 17 8
Voluntary Disenrollment 41 22
     Problem with Employer Responsibilities 18 8
     Problem with Fiscal Responsibilities 8 7
     Problem with Program in General or Changed Mind 21 8
Monthly Payment Too Small 12 3
Health and Family Problems 8 1
Disenrollees at 4 or 6 Months 64 38

 

USE OF PAID CAREGIVERS
Status at 9 Months Percent of Respondents
Arkansas New Jersey
Had Paid Caregiver(s) in Last 2 Weeks 92 90
     Hired with cash benefit 70 43
     Paid for some other way 30 57
Among Clients Who Hired with Cash Benefit
     Number of Paid Caregivers    
          1 61 64
          2 25 25
          3 or more 14 10
     Had Visiting Paid Caregiver(s) 84 74
     Had Live-in Paid Caregiver(s) 31 37
     Had Paid Caregiver Who Was a Relative 73 71
Overall Respondents (at Home for Last 2 Weeks) 172 223
Respondents Who Hired with Cash Benefit 109 87

 

HIRING METHODS
  Percent of Respondents
Arkansas New Jersey
Family Member 69 63
Friend, Neighbor, or Church Member 20 20
Worker Recommended by Family or Friend 9 12
Former Agency Worker 10 16
Through an Advertisement 4 6
Through an Employment Agency 1 1
Respondents Who Had Hired 123 93

 

TYPES OF ASSISTANCE FROM PAID CAREGIVERS
Status at 9 Months Percent of Respondents
Arkansas New Jersey
Health Care
     Taking medicine 64 79
     Other routine health care 56 70
Personal Care
     Bathing/showering 90 92
     Eating 58 76
Household/Community Chores
     Light housework 97 100
     Transportation 57 52
Respondents Who Hired with Cash Benefit 109 87

 

USE OF CASH FOR EQUIPMENT AND MODIFICATIONS
Status at 9 Months Percent of Respondents
Arkansas New Jersey
Performed
Activity
Used Cash
Benefit
Performed
Activity
Used Cash
Benefit
Obtained/Repaired Equipment 42 18 41 12
Modified Home 29 12 17 7
Modified Vehicle 4 2 1 0
Number of Cash Recipients 152 135
Equipment may be for meal preparation, housekeeping, personal activities, communication, or personal safety.

 

USE OF AND SATISFACTION WITH PROGRAM SERVICES
Status at 4 or 6 Months Percent of Respondents
Arkansas New Jersey
Got Help with Cash Management Plan* 75 64
     Found Help Useful 93 94
Got Help Recruiting or Hiring** 49 42
     Found Help Useful 96 84
Got Help Managing Fiscal Tasks*** 84 93
* All Respondents 255 231
** Those Who Tried to Hire 203 166
*** Those Who Received Cash 191 84

 

SATISFACTION WITH PERSONAL ASSISTANCE
Status at 9 Months Percent of Respondents
Arkansas New Jersey
Overall Satisfaction
     Satisfied with help with transportation 90 83
     Would recommend program to others 93 86
Among Those Who Hired with Cash Benefit:
     Satisfied with how caregiver:    
          Fulfills personal care duties 100 100
          Helps with medication/routine health care 100 100
          Fulfills duties in house or community 98 99
     Satisfied with times of day gets help 98 94
     Satisfied with relationship 100 99
     Paid caregivers complete tasks always or almost always 81 76
     Would have difficulty changing caregiver's schedule 48 49
Overall Respondents 194 240
Respondents Who Hired with Cash Benefit 94 71

Summary

  • Programs are Working Well, but Some Early Delays in New Jersey
  • Large Majorities Hire Family Members
  • Consumers Received Assistance With Wide Range of Activities
  • Substantial Minorities Used Cash for Home Modifications and Equipment
  • Large Majorities Use Bookkeeping Services
  • Consumers Love the Program
    • Happy with care received and relationship
    • Flexibility
    • Control over who gives care and when
  • Over 85 Percent Would Recommend Program to Others
REPORT SCHEDULE
  Due Dates
AR NJ FL
Implementation Analysis 6/01 10/01 4/02
Survey Outcomes
     Use of PAS and quality of care 1/03 3/04 3/04
     Informal caregivers/paid workers 1/03 3/04 3/04
Claims Outcomes
     Medicaid and Medicare costs 6/03 9/04 9/04
Participation 7/03 10/04 10/04
Cross-state/Cross-topic   1/05  
Some staggering of reports will be necessary.