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Study confirms people prefer 'consumer control' of in-home services

April 21, 2003 -- "Apparently, (participants) find that having intimate care, such as help with bathing and dressing, performed by a person of one's own choosing is much more satisfying that having it performed by a stranger." This seemingly obvious statement is the conclusion reached in a study of consumer-directed in-home services.

The just-released study, by the evaluation firm Mathematica, Inc., has found high consumer satisfaction with the "Cash and Counseling" project in Arkansas. Cash and Counseling, a demonstration grant funded by the Robert Wood Johnson foundation and the U.S. Dept. of Health and Human Services, has been in operation in Arkansas, Florida and New Jersey. (Read more about this program.)

"Our survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participantsŐ health and safety," said the report, released in mid-April, 2003.

The study is one of the first independent scholarly verifications of what disability rights activists have insisted for decades: that people do better -- and get better services -- when in charge of their own personal care.

But industry and medical professionals have argued that "consumer-direction" isn't "safe."

This study refutes that. The program in Arkansas "appears to have reduced the reported incidence of neglect by paid caregivers by 58 percent for consumers," says the study.

"Arkansas designed IndependentChoices as a voluntary demonstration for people age eighteen or older who were eligible for Medicaid personal care services," says the study. "Enrollment and random assignment began in December 1998 and continued until the evaluation target of 2,000 enrollees (about 11 percent of Arkansas users of personal care services) was met, in April 2001."

Those planning to enroll in the program were told what their monthly financial allowance would be, and that they could use the money to hire workers -- not spouses -- and "to purchase other services or goods related to their needs, such as supplies, assistive devices, and home modifications."

Read the study results "Improving The Quality Of Medicaid Personal Assistance Through Consumer Direction."

Read more about safety concerns that have dogged the concept of personal assistance.

Learn more about the Cash and Counseling programs from the University of Maryland Program on Aging.








The following sites contain information that may be of interest. Please bear in mind that the information at these sites is not controlled by the Center for An Accessible society. Links to these sites do not imply that the Center supports either the organizations or the views presented.
Consumer Choice and Control:
Personal Attendant Services and Supports in
Report of the National Blue Ribbon Panel on
Personal Assistance Services, August, 1999

Directory of Publicly Funded Personal Assistance Programs from the World Institute on Disability

"Understanding Medicaid Home and Community-Based Services: A Primer" -- from the U.S. Dept. of Health and Human Services, available at

Information on Home & Community-Based, Consumer-Directed, and Personal Assistance Services from the Office of Disability, Aging and Long-Term Care Policy at the U.S. Dept of Health and Human Services


How States' "Nurse Practice" Acts work against consumer direction -- from the January, 1999 Ragged Edge magazine






Expert sources

Nursing home data

Abuse of seniors under-reported, says study

The Institutional Bias of Public Policy

Consumer Direction in Personal Assistance

In-Home Services and Safety

In-home services: Implementing the Olmstead decision

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