Comparing consumer-directed and agency models for providing supportive services at home

Area of Science:

• Health Services Research
• Disability Studies
• Public Health Policy

Background:

• Home-based personal assistance services are crucial for low-income individuals with disabilities.
• Two primary models exist: agency-directed and consumer-directed services.
• Medicaid beneficiaries with disabilities often rely on these services for independence.

Purpose of the Study:

• To compare service experiences and outcomes between agency-directed and consumer-directed models.
• To evaluate the effectiveness of different organizational structures for home-based care.
• To inform policy regarding Medicaid personal assistance benefits for individuals with disabilities.

Main Methods:

• Survey of 1,095 low-income Medicaid beneficiaries with disabilities in California's In-Home Supportive Services (IHSS) program.
• Stratified sampling by service model, age, and disability severity.
• Multiple regression analysis to assess the impact of service model on safety, unmet needs, and service satisfaction.

Main Results:

• Recipients in the consumer-directed model reported more positive outcomes than those in the agency-directed model.
• Statistically significant improvements were noted in recipient safety, unmet needs, and service satisfaction.
• Family members serving as paid providers within the consumer-directed model were associated with better outcomes.

Conclusions:

• The consumer-directed service model is a viable and potentially less costly alternative to the agency model for organizing home-based supportive services.
• Findings suggest a need to reassess Medicaid personal assistance benefits, considering the advantages of consumer-directed care.
• Limitations include potential generalizability issues due to the natural experiment design and exclusion of individuals with severe cognitive impairments.