Home health care services: management and effectiveness in changing times

New York City has the largest Medicaid personal care program (a form of home health care which includes many of the activities of daily living) in the country with approximately 45,000 clients and an annual budget of $1.5 billion. During the late 1980s and into the 1990s, New York State was experiencing budget difficulties, and established savings targets for local governments providing personal care services. In response, New York City, through its Home Attendant Program, began using different means of assessing clients' service needs to produce these savings. This article examines Task Based Assessment (a new service assessment methodology), and determines the degree to which it was successful, organizational issues that were faced by New York City and the 60 nonprofit and profit making companies contracted to deliver the service, legal challenges that were raised by advocacy groups and another alternative to the delivery of personal care services, a capitated long term care program. Task Based Assessment did not achieve its goals and the authors suggest, based on the positive experience from the capitated long term care program in controlling personal care hours, that it is more effective to expand these capitated programs than to seek to achieve further cost savings through the Home Attendant Program.