cash & counseling’s effects on the amount and quality of care received
DESCRIPTION
Cash & Counseling’s Effects on the Amount and Quality of Care Received. Barbara Lepidus Carlson. AcademyHealth Annual Research Meeting June 26, 2005 Boston, MA. Intended Effects. Medicaid consumers with disabilities direct their personal care Change use of goods and services - PowerPoint PPT PresentationTRANSCRIPT
Cash & Counseling’s Effects on the Cash & Counseling’s Effects on the Amount and Quality of Care ReceivedAmount and Quality of Care Received
Barbara Lepidus CarlsonBarbara Lepidus Carlson
AcademyHealth Annual Research MeetingAcademyHealth Annual Research MeetingJune 26, 2005June 26, 2005Boston, MABoston, MA
2
Intended Effects
Medicaid consumers with disabilities direct their Medicaid consumers with disabilities direct their personal carepersonal care
Change use of goods and servicesChange use of goods and services
Satisfaction and quality of life improveSatisfaction and quality of life improve
No adverse effects on healthNo adverse effects on health
3
9-Month Survey Sample
Arkansas Florida New Jersey
18-64
65+ 3-17 18-59 60+ 18-64
65+
Study Participants
556 1,452 1,002 914 904 817 938
9-Month Survey 9-Month Survey RespondentsRespondents
473473 1,2661,266 859859 811811 736736 682682 783783
Completion Rate
85.1 87.2 85.7 88.7 81.4 83.5 83.5
4
Selected Baseline Characteristics
15 to 40% dissatisfied with care15 to 40% dissatisfied with care 2/3 needed help to get out of bed2/3 needed help to get out of bed 0 to 1/3 live alone0 to 1/3 live alone 1/6 to 1/2 in poor health1/6 to 1/2 in poor health 1/6 to 1/3 Black1/6 to 1/3 Black Arkansas – 40% rural, few HispanicArkansas – 40% rural, few Hispanic New Jersey – few rural, 1/3 HispanicNew Jersey – few rural, 1/3 Hispanic
5
Receiving Monthly Allowance at 9 Months (Treatment Group Members Living in Community)
77
5461
72
39
6170
0
20
40
60
80
100Non-Elderly Adults
Percent
AR FL NJ AR FL NJ FL
Elderly Adults Children
6
Monthly Allowance Amounts at Enrollment
ArkansasArkansas FloridaFlorida New JerseyNew Jersey
18-6418-64 65+65+ 3-173-17 18-5918-59 60+60+ 18-6418-64 65+65+
2525thth Percentile Percentile $291$291 $216$216 $ 418$ 418 $ 753$ 753 $ 509$ 509 $ 604$ 604 $ 608$ 608
MedianMedian 359359 301301 870870 1,4651,465 817817 1,0911,091 1,0971,097
7575thth Percentile Percentile 441441 414414 1,6631,663 2,5962,596 1,1581,158 1,3641,364 1,4131,413
7
Receiving Paid Assistance at 9 Months
95
76
92 94 94 94
80
68 64
79 79
65
91
82
0
20
40
60
80
100
Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**** ** **
****
8
Hours of Paid Care at 9 Months (During Past Two Weeks)
33
39
23
39
23
4039
28
23
18
3031
33
29
0
10
20
30
40
50
Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Hours
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
*
**
**** **
9
Hours of Unpaid Care at 9 Months (During Past Two Weeks)
107 112
94
198
101
148
74
126
160
117 112
217
115
97
0
25
50
75
100
125
150
175
200
225
250
Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Hours
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
* *
**
10
Total Hours of Care at 9 Months (During Past Two Weeks)
145158
97
188
124
237
133140
120133
247
143150
189
0
25
50
75
100
125
150
175
200
225
250
Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Hours
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
*
*
11
Summary of Results on Satisfaction with, and Quality of, Paid Care
ArkansasArkansas FloridaFlorida New JerseyNew Jersey
18-6418-64 65+65+ 3-173-17 18-5918-59 60+60+ 18-6418-64 65+65+
Reduced Unmet Reduced Unmet Needs (4)Needs (4)
33 22 44 33 00 33 44
Caregiver Caregiver Reliability and Reliability and Behavior (9)Behavior (9)
88 66 66 33 11 77 55
Satisfaction with Satisfaction with Assistance (5)Assistance (5)
55 55 55 55 00 44 55
Overall (18)Overall (18) 16/1816/18 13/1813/18 15/1815/18 11/1811/18 1/181/18 14/1814/18 14/1814/18
12
Had an Unmet Need for Help with Personal Care
41
34
55
37
47
58
4543
3633
4446
2726
0
10
20
30
40
50
60Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**
**
*
*
13
Paid Caregiver Neglected Client
19
24
34
26 25
12
16
11
21
14
34
232323
0
10
20
30
40 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**
*
****
14
Very Satisfied with Overall Care Arrangements
68
505657
68
52
71
27
54
42
35 37
4748
0
10
20
30
40
50
60
70
80 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**** **
****
15
Very Satisfied with Way Spending Life These Days
43
64
38
56
36
4752
29
23
50
21
37
2825
0
20
40
60
80 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
****
**
****
**
*
16
Contractures Developed or Worsened
26
14
2022
27
13
9
2018
16
9
2528
25
0
10
20
30
40 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**
17
Conclusions
Cash & Counseling increases satisfactionCash & Counseling increases satisfaction More people receive paid careMore people receive paid care Fewer total hours of careFewer total hours of care Works for elderly as well as disabledWorks for elderly as well as disabled No adverse health outcomesNo adverse health outcomes Programs need to help consumers with steps Programs need to help consumers with steps
necessary to receive allowancenecessary to receive allowance