Consumer-directed home care: client profiles and service challenges

This article presents the results of a study that sought to develop a profile of potential consumer-directed clients in a countywide home care program. In order to develop this profile, clients were assessed by the telephone case manager and the in-home assessor, each of whom made an independent decision about the appropriate level of case management for the client. Of the 278 clients assessed, 16.5% were identified by both professionals as candidates for consumer-directed care; for another 42.1%, the case manager and assessor agreed that a more intense level of care was appropriate. For the remaining clients (41.4%), there was disagreement between the two assessments about the appropriate level of case management. Clients identified as consumer-directed candidates were more likely to be female, to have fewer impairments, to receive fewer services, to have low incomes, and to live alone. Case managers' and assessors' comments indicated that the consumer-directed group consisted of those more likely to have stable health and a good support system, along with an understanding of the service system and a willingness to make contacts in case of problems or status changes. The article also explores the implications for service providers.