Reducing nursing home use through consumer-directed personal care services.

Area of Science:

• Health Services Research
• Public Health Policy
• Gerontology

Background:

• Personal Care Services (PCS) aim to support independent living for individuals with impairments.
• Traditional agency-provided PCS may lack the flexibility needed for some beneficiaries.
• Home-based care is a critical alternative to institutionalization.

Purpose of the Study:

• To evaluate consumer-directed PCS via Arkansas's Cash and Counseling demonstration.
• To compare nursing facility use and expenditures against traditional Medicaid PCS.
• To assess the impact on total Medicaid costs.

Main Methods:

• Randomized controlled trial involving 2008 adult Medicaid beneficiaries in Arkansas.
• Treatment group: received a personal care allowance for consumer-directed PCS.
• Control group: received traditional agency-provided PCS.
• Data collected on nursing facility use, PCS costs, and total Medicaid costs.

Main Results:

• Consumer-directed PCS led to an 18% reduction in nursing facility use over 3 years.
• For existing PCS users, savings in nursing facility and other long-term care costs offset higher PCS expenditures.
• Savings did not fully offset increased PCS costs for new applicants due to higher service utilization.

Conclusions:

• Consumer-directed PCS in Arkansas is more effective at reducing nursing facility use and costs than traditional models.
• The positive impact on nursing facility costs was significantly greater in Arkansas compared to New Jersey and Florida.
• This model offers a promising alternative for long-term care support, enhancing beneficiary autonomy.