Age, Consumer Direction, and Outcomes of Supportive Services at Home

Abstract

Purpose: Supportive services at home are essential for older people with severe chronic impairments. Newer "consumer-directed" models of organizing home-based services rely heavily on service recipients rather than home care agencies to arrange and direct care at home. This study examined differences in service experience and outcomes between recipients over and under age 65 who direct their own services in one large Medicaid program. Design and Methods: A random sample of 1,095 recipients of In-Home Supportive Services in California was selected and interviewed by telephone. Interviews were conducted in English, Spanish, and three Asian languages; those with severe cognitive impairment were excluded from the study. Results: Findings indicate that although younger recipients embrace self-direction more enthusiastically than older ones, age differences are small on a majority of service outcomes. On average, older users embrace this model and manage within it much like younger users. Some differences emerge between the young-old (65-74) and old-old (75 ϩ ), but these are neither consistent nor determinative. Implications: Old age is far from an inevitable barrier to self-direction. As with other age groups, there are opportunities and obstacles to be addressed as this newer approach to home care is disseminated.

Online Health Information Tool Effectiveness for Older Patients: A Systematic Review of the Literature

“…We consider 65 years of age and older as the older age group because this cutoff point has been used in other studies that have considered diseases in older patients (Benjamin & Matthias, 2001;Silliman, Troyan, Guadagnoli, Kaplan, & Greenfield, 1997) while also being used by individuals themselves to identify older age (Staudinger & Bluck, 2001). The review provided by Marschollek and colleagues (2007), although focused on elderly individuals, did not identify studies on patient populations with a mean age of 65 years and older.…”

Long-Term Care in the United States: Policy Themes and Promising Practices

“…For example, the In-Home Supportive Services (IHSS) program that started in California includes a consumer-directed model that allows recipients to hire, supervise, and fire their care provider, who could be an agency worker, family member, friend, or neighbor. In 2001, 62% of IHSS program participants were age 65 and older (Benjamin & Matthias, 2001).…”

“…Although these results are promising, there are a number of concerns about the provision of long-term care to older adults through consumer-directed care. For example, IHSS offers very little in the way of training to consumers as to how to hire and supervise an in-home worker (Benjamin & Matthias, 2001). In addition, the beliefs of policymakers about the lack of interest in consumer-directed care among older adults may not be groundless.…”

Case-management for Patients with Schizophrenia in Iran: A Comparative Study of the Clinical Outcomes of Mental Health Workers and Consumers’ Family Members as Case Managers

“…We could not find any article in this regard. In developed societies, new programs have been developed in which consumers participated in the CM teams as counselors; aids of CM to provide these services (Solomon and Draine 1994b;Paulson et al 1999;Benjamin et al 2000;Manning and Suire 1996;Felton et al 1995).…”

“…Utilization of the consumers as staff, have resulted in a range of benefits including job creation for the consumers, vocational rehabilitation, generation of financial resources, support, and better rapport among the consumers (Solomon and Draine 1995;Solomon and Draine 1994a;Solomon 2004;Felton et al 1995;Manning and Suire 1996;Mowbray et al 1998;Paulson et al 1999;Chinman et al 2000;Benjamin et al 2000;Rivera et al 2007).…”