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Case Management - Consumer-directed Care

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An innovation in publicly funded community-based long-term care services for older adults is consumer-directed care. Choice and control are key elements in this approach. Consumer direction ranges from the individual independently making all decisions and managing services directly, to using a designated representative to manage needed services. Although public long-term care programs generally employ case managers to arrange and monitor supportive services in the community, a number of programs provide significant opportunities for clients to direct their services rather than relying on case managers to do so.

The Cash and Counseling Demonstration (CCDE) is testing the direct cash payment approach to funding personal care assistance in the community. In the demonstration, Medicaid-eligible clients, having passed an initial screening, will be randomly assigned to the agencybased case management group (control) or to the cash option group (treatment). Persons assigned to the cash option group develop a care plan describing how they will use the funds. An assigned counselor approves the plan. If the care plan primarily involves hiring a personal care assistant, the consumer is then responsible for screening, hiring, scheduling, training, managing, and, if necessary, firing the assistant. The CCDE (based at the University of Maryland Center on Aging and evaluated by Mathematica) will provide important information and insights regarding the efficacy of agency-based, compared to consumerdirected, case management of personal care assistance (Simon-Rosinowitz et al.).

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