The Future of Cash and Counseling: The Framers' View

Abstract

Objective. This paper reflects on the progress of the original Cash and Counseling states, and shows how this model has spread, how it has evolved over time, and what is left to improve. It then discusses the generalizability of the Cash and Counseling approach beyond long-term care and ventures some thoughts on what still needs to be learned. Finally, this paper suggests some of the contingencies that could affect the diffusion of this innovation. Data Sources/Study Setting. Drawing from ten years of experiences with the fifteen Cash and Counseling states, plus their analyses of current trends and future opportunities and threats, the framers of the Cash and Counseling model reflect on future directions. Study Design. This paper is essentially a policy-driven analysis of how the Cash and Counseling model has been sustained and disseminated, how it is likely to develop, and what still needs to be learned. Principal Findings. The basic Cash and Counseling model appears adaptable to different state environments and populations, but that hypothesis will be severely tested as more and more states seek to replicate. As one step to promote flexibility while capturing and preserving the essence of the model that led to such promising research results, the Cash & Counseling National Program Office developed a ''Vision Statement''. Conclusions. The Cash and Counseling approach is not for everyone, but it is clearly a choice many participants desire. Its development merits monitoring.Key Words. Consumer direction, federal and state policy, cash and counselingThe Supreme Court's 1999 Olmstead decision made it clear that state longterm care systems must provide a continuum of services that allows people to live where and how they want. But how do we achieve this reform?Cash and Counseling appears to be part of the solution. Already this promising model is spreading--spurred

Australia's Individualised Disability Funding Packages: When Do They Provide Greater Choice and Opportunity?

“…Two randomised controlled trials provide some answers. In the USA, Mahoney and his team evaluated “ Cash and Counseling” programs in 15 states over a ten‐year period Mahoney, Wieler Fishman, Doty and Squillace (). Participants held the funds and employed support workers, and costs were similar to agency‐funded services.…”

Analysing Choice in Australian Individual Funding Disability Policies

“…This background section introduces the arguments for and tensions about individual funding, followed by a description of how it has evolved internationally. A single definition or name for individualised approaches to organising disability funding has not been developed, however the approach is argued to promote individual choice over support, empower people with all types of disabilities (Hutchison et al ; Leece ; Mahoney et al ; Stainton and Boyce ; Fisher et al ; Stevens et al ), and improve outcomes (Baxter et al ; Leece ; Stainton ). Being able to select support workers is considered a major attraction of individualised packages (Bogenschutz et al ).…”

The disability self‐direction movement: Considering the benefits and challenges for an Australian response

“…Some strategies that have been employed to manage this issue are: excluding those persons deemed unable or unsuitable to manage their own budgets (Duffy 2007a); consumers to undergo skills assessment and agree to training in skills relevant to managing their own services (Ministry of Health 2003); and restricting a portion of the budget to 'traditional services' to ensure that important services are being received (Cook et al 2008). In particular, this was found to be a suitable option for those with cognitive and developmental disabilities who experienced difficulty in managing their budgets independently, as they were still able to benefit from expressing their personal preferences in relation to their support and the flexibility that self-direction allows (Mahoney et al 2007). In particular, this was found to be a suitable option for those with cognitive and developmental disabilities who experienced difficulty in managing their budgets independently, as they were still able to benefit from expressing their personal preferences in relation to their support and the flexibility that self-direction allows (Mahoney et al 2007).…”