Abstract:

Elderly and younger persons with disabilities who require help from others to perform many of the most ordinary activities of daily living are said to require "long-term care." These services, when provided in the home or other non-institutional settings, may be termed personal assistance services (PAS), home and community-based services (HCBS), or in-home supportive services (IHSS). This report presents the findings of a study comparing alternative approaches to delivering such services. The purpose of the study was to determine whether there are significant differences, on a wide range of outcome indicators, when publicly-funded supportive services for the elderly and disabled are provided through a consumer-directed (CD) as compared to a professional management (PM) model of service financing and delivery.The main conclusion of the report is that, whereas both the consumer-directed and professional management models of delivering supportive services to the aged and disabled produce positive client outcomes overall, the consumer-directed model outperforms the professional management model on several key measures of client satisfaction, empowerment, and quality of life. Critics of consumer-directed models of service delivery have expressed concerns about client safety under this model and have generally taken the view that consumer direction should be restricted to a minority of clients (primarily younger adults) who social workers judge to be capable of hiring, firing and giving direction to their workers. This study provides no evidence in support of restricting availability of the consumer-directed model. Critics have also questioned the appropriateness of allowing public program clients to hire family members as providers. This study's findings support the option of hiring family members as providers because the data indicate that, on average, family providers are more likely to provide a higher quality of service than unrelated workers.