Impact of a Voucher Programon Consumer Choices ofPersonal Assistance Providers:Unintended Consequences
Impact of a Voucher Programon Consumer Choices ofPersonal Assistance Providers:Unintended Consequences
Hongdao Meng, Ph.D., Stony Brook University
Brenda Wamsley, Ph.D. West Virginia State University
Acknowledgments
Acknowledgments
•Funding agency: Centers for Medicare andMedicaid Services (# 95-C-90467/2-01)
•Monroe County Long Term Care Program,Inc., Rochester, NY.
•Center for Aging and Healthcare in WV,Inc., Parkersburg, WV.
Key Findings
Key Findings
•Voucher increased probability of usingagency-employed as well as privately-hired personal assistance workers.
•Voucher promoted use of agency-employed workers in urban areas and ofprivately-hired workers in rural areas.
Background
Background
•Personal Assistance Services (PAS)help people with long-term care needsto live independently in their homes.
•PAS is delivered via:
–“Agency-directed” model (ADM)
–“Consumer-directed” model (CDM)
Background
Background
•Benefits of CDM:
–Flexibility
–Autonomy
–Potential cost-savings
–Expanded care worker pool
•Concerns of CDM:
–Cognitive impairment
–Hiring of family members
–Quality assurance
Objectives
Objectives
•To examine the impact of a voucherprogram on consumer choices of PASproviders (ADM or CDM).
•To assess urban-rural differences inthese choices.
Study Design
Study Design
•Randomized controlled trial:
–Control group: regular Medicare
–Nurse group: health promotion nurse homevisit
–Voucher group: $200 monthly PAS benefits
–Combination group: Nurse + Voucher
Sample
Sample
•1605 participants who meet the inclusioncriteria of this study:
–Community-dwelling (NY, WV, OH)
–Medicare Parts A and B enrollee, and
–2+ ADLs or 3+ IADLs, and
–Had prior health services use (ER, hospital,NH, or home care)
Data
Data
•Baseline assessment data
–Socio-demographics
–Health and functional status
–Prior health services use
•PAS utilization data over two years
–Personal care aide
–Home health aide
–Respite care
Analytical Strategies
Analytical Strategies
•Descriptive statistics
•Multivariate logistic regression
Baseline Descriptive Results
Baseline Descriptive Results
•Mean age 77
–27% age 85+
•69% female
•96% White
•33% income < $10k
•73% had caregiver
•38% lived alone
•11% had Medicaid
•3% had LTCinsurance
•Mean # of ADLs 2.3
•Mean # of IADLs 3.5
•Mean # of chronicconditions: 4.4
•Prior service use:
–Hospital 63%
–ER23%
–Nursing home 10%
–Home care52%
PAS Use Over Two Years
PAS Use Over Two Years
PAS Use, Control Group
PAS Use, Voucher Group
Odds Ratio for PAS Use, byProvider
Adjusted for covariates
Odds Ratio for PAS Use, byProvider and Urban-Rural
Odds Ratio for PAS Use, byProvider and Urban-Rural
**: p < 0.01, adjusted for covariates
Summary
Summary
•Voucher increased probability of usingagency-employed as well as privately-hired personal assistance workers.
•Voucher promoted use of agency-employed workers in urban areas and ofprivately-hired workers in rural areas.
Policy Implication
Policy Implication
•Financial subsidy for PAS would promote itsuse moderately.
•Differences in consumer choices in urban andrural areas should be taken into account toachieve intended goals of promoting consumer-directed model.
•Differences in the supply of PAS in urban andrural areas need to be considered.