Where Are They Now? Cash and Counseling Successes and Challenges Over Time

Abstract

The positive results of the Cash & Counseling Demonstration and Evaluation (CCDE) led to the funding of a replication project that included 12 more states in 2008. Since then, the political and economic environments have changed. The authors sought to investigate how well the three original and 12 replication CCDE programs are coping with current challenges, and how their experiences may inform the growth and sustainability of emerging participant-directed programs. Semistructured telephone interviews were conducted with the 15 Cash & Counseling state program administrators. Key topics addressed included: successful aspects of state programs, biggest challenges for each program, and information program administrators would like to learn from state colleagues. Themes related to budget issues (e.g., staff shortages and program funding cuts) and non-budget related issues (e.g., understanding of program operations) emerged from the interviews. State program administrators also discussed program successes. To promote the sustainability and growth of participant-directed programs, existing participant-directed programs should be tied to national policy trends as well as review whether or not the programs address participant-directed principles. The development of new participant-directed programs should be based on other states’ experiences as discussed in this paper.

Comprehensive support of family caregivers: Are there health system cost offsets?

“…Beyond the important and basic goals of being able to identify and expand training for caregivers, only 7 percent of whom report having received any training to fulfill their caregiving role, 3 increasingly programs allow payments to caregivers as a form of support. These payments arise most commonly as beneficiary‐directed home‐based care programs, the largest of which are operated by Medicaid in over 25 states (eg, in California it is called In‐Home Support Services) and by the US Department of Veterans Affairs (VA) nationally (Veteran‐Directed Home and Community‐based Services) 4‐7 . In these programs, funds are allocated to the beneficiary and then the beneficiary decides whether to pay a friend/relative or to pay a formal, agency‐provided home health care provider.…”

The Cost of Caring: Economic Vulnerability, Serious Emotional Distress, and Poor Health Behaviors Among Paid and Unpaid Family and Friend Caregivers

“…Studies suggest that consumer-driven caregivers are as satisfied, if not more satisfied in their caregiving role (and generally had lower emotional strain and limitations to their personal social lives), than agency-based workers (Benjamin & Matthias, 2004;Simon-Rusinowitz et al, 2014). Also payment for informal caregiving may translate to reduced emotional distress associated with lost wages and employment opportunity (Benjamin & Matthias, 2004;Foster et al, 2007;Simon-Rusinowitz et al, 2014). Care recipients also tend to more highly rate their safety and overall satisfcation with care quality when they receive care from consumer-driven rather than agency-based caregivers (Benjamin et al, 2000).…”

“…There are reasons to believe the programs may benefit both caregiver and care recipient—because a care recipient can retain the services of an informal caregiver they know and trust, while the Medicaid reimbursement may allow a caregiver to avoid the economic losses associated with caregiving (Butrica & Karamcheva, 2014). Caregivers may also financially and emotionally benefit, due to the Medicaid reimbursement and because they are able to help a loved one (Benjamin & Matthias, 2004; Foster et al, 2007; Simon-Rusinowitz et al, 2014). Further, reimbursement could increase resources for self-care such as physical exercise or other health behaviors.…”

Innovation in a Learning Health Care System: Veteran‐Directed Home‐ and Community‐Based Services

“…To align budgetary priorities with veterans’ preferences, the VHA began offering VD‐HCBS in 2009 through several Veterans Affairs Medical Centers (VAMCs) to veterans at risk of placement in a long‐term care facility. The VD‐HCBS program is modeled after Medicaid's Cash and Counseling demonstration, which was associated with fewer unmet needs for assistance with daily activities and greater satisfaction with care . The VHA's early experience with VD‐HCBS suggests that it may allow veterans to remain safely at home for longer and improve their and their caregivers’ quality of life, but early VD‐HCBS evaluation did not include a control group or collect systematic data on healthcare use and costs.…”

“…The VD-HCBS program is modeled after Medicaid's Cash and Counseling demonstration, which was associated with fewer unmet needs for assistance with daily activities and greater satisfaction with care. [4][5][6] The VHA's early experience with VD-HCBS suggests that it may allow veterans to remain safely at home for longer and improve their and their caregivers' quality of life, 7 but early VD-HCBS evaluation did not include a control group or collect systematic data on healthcare use and costs.…”