Lessons From the Arkansas Cash and Counseling Program: How the Experiences of Diverse Older Consumers and Their Caregivers Address Family Policy Concerns

Abstract

This paper addresses four family policy questions that policy makers often ask about consumer-directed services, examining issues such as quality, suitability, and fraud and abuse. Responses to these questions evolved from the experiences of diverse elder consumers and their caregivers who participated in IndependentChoices, the Arkansas site of the Cash and Counseling Demonstration and Evaluation (CCDE) program. Building on CCDE evaluation survey data, this analysis of in-home interviews with participants discussing their experiences of receiving, giving, and managing care demonstrates how the program allows consumers choices so they receive the services they want. At the same time, program flexibility allows policy makers to safeguard both consumers and program resources through the use of supports such as representatives, state consultants, and fiscal intermediaries. This article demonstrates how the Cash and Counseling model can address the needs of both consumers with diverse disabilities and policy makers.

KEYWORDS:

• Cash and Counseling
• consumer direction
• family policy
• flexibility and choice
• older consumers
• quality of care

Acknowledgments

The authors acknowledge the guidance of Pamela Doty in developing this paper. Her assistance in identifying key policy maker issues was most valuable.

Notes

1. The consumers represented in this report were part of a purposive sample based on four selection criteria; age 18–64/65+, race (White/African American), type of directly hired caregiver (family/nonfamily), and representative/no representative. Other variables taken into consideration to ensure maximum variability in those interviewed included age, sex, relationship to caregiver, rural/urban residence, variations in use of the cash benefit, disability level (determined by level of Medicaid benefit, but above $200 per month), and high counselor intervention.