Cash

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Cash Counseling An Option of Participant
DirectionAlzheimers Disease Supportive Services
ProgramAnnual Meeting, Arlington, VA

• June 3, 2009
• Kevin J. Mahoney, PhD, Director
• Sandra Barrett, Consultant

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National Resource Center forParticipant-Directed
Services Offerings

• Individual Consulting Our team of subject
  matter experts are available to help you design
  programs, evaluate existing programs, and
  recommend improvements in all aspects of
  operationalizing participant direction, including
  the areas of policy development, quality
  management, financial management services,
  participant involvement, data management and
  information systems, and more.
• Membership Programs Individuals and
  organizations will have the opportunity to gain
  membership status to receive access to a wide
  range of critical information resources, and the
  latest developments pertaining to self-direction.
  Members can interact with peers, troubleshoot
  problems, and improve operations.
• Training We currently offer training modules
  for support services, additional training modules
  are in development.
• Research Our research focuses on promising
  practices and the impact of
  participant-directed programs.

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NRCPDS Offerings (Continued)

• Public Policy To ensure the growth of
  participant direction opportunities across the
  country, public policy that directly or
  indirectly impacts the expansion of participant
  direction must be informed by existing research,
  knowledge, and practice. We have created
  comprehensive strategies to ensure public policy
  is informed by lessons learned and a
  well-established stakeholder involvement process.
  
• National Participant Network Recognizing the
  important voice those who receive
  participant-directed supports play in the design
  of our models, NRCPDS has developed the National
  Participant Network (NPN). The NPN plays a
  critical role in developing participant
  involvement strategies in participant-directed
  models at the local level while also providing
  essential input into NRCPDS design of tools and
  products. This ensures that all of our work
  is ultimately by the needs of those for which
  participant-directed supports are
  intended.

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Original and Expansion Cash Counseling States
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Nursing Home Diversion and Veterans Directed
Home and Community Based Services States
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Basic Model for Cash Counseling

• Step 1 Participants receive traditional
  assessment and care plan
• Step 2 A dollar value is assigned to that care
  plan
• Step 3 Participants receive enough information
  to make unbiased personal choice between managing
  individualized budget or receiving traditional
  agency-delivered services

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Basic Model for Cash Counseling

• Step 4 Participant and counselor develop
  spending plan to meet participants personal
  assistance needs
• Step 5 Cash allowance group provided with
  financial management and counseling services
  (supports brokerage)

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Receiving Paid Assistance at 9 Months
Non-Elderly Adults
Percent
Elderly Adults
Children






T C NJ
T C FL
T C NJ
T C FL
T C AR
T C FL
T C AR
, Significantly different from control group
at .05, .01 level, respectively.
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Very Satisfied with Overall Care Arrangements
Percent
Non-Elderly Adults
Children
Elderly Adults






T C NJ
T C NJ
T C FL
T C AR
T C FL
T C AR
T C FL
, Significantly different from control group
at .05, .01 level, respectively.
10
Had an Unmet Need for Help with Personal Care
Percent
Non-Elderly Adults
Children
Elderly Adults





T C NJ
T C FL
T C NJ
T C FL
T C AR
T C FL
T C AR
, Significantly different from control group
at .05, .01 level, respectively.
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Contractures Developed or Worsened
Percent
Non-Elderly Adults
Children
Elderly Adults



T C NJ
T C FL
T C NJ
T C FL
T C AR
T C FL
T C AR
, Significantly different from control group
at .05, .01 level, respectively.
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Very Satisfied with Way Spending Life These Days
Percent
Non-Elderly Adults
Children
Elderly Adults







T C NJ
T C FL
T C NJ
T C FL
T C AR
T C FL
T C AR
, Significantly different from control group
at .05, .01 level, respectively.
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Informal Caregivers Very Satisfied with Overall
Care
Adults
Children
Percent




T
T
T
C
C
C
T
C
AR
FL
FL
NJ
,, Significantly different from control
group at .10 (), .05 (), or .01 () level.
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Effect on Total Medicaid Costs

• In Arkansas, no significant difference by end of
• year 2
• Reductions in NF and other waiver costs off-set
  increase in personal care costs
• In New Jersey and Florida, costs up 8-12, but
  states learned how to control costs
• Higher costs in Arkansas and New Jersey due to
  failure of traditional system

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Update

• Arkansas satisfied CMS measure of budget
  neutrality throughout the 9 years that
  Independent Choices operated under 1115
  waivers, saving 5.6 million.
• The take-up rate in AR grew from 4.6 of those
  eligible to 11 (largely through
  word-of-mouth).

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Policy Implications

• Can increase access to care
• Greatly improves quality of life (all ages)
• Caregivers also benefit greatly
• States may be concerned about costs
• But have learned how to control them

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Other Participant-Directed ProgramEvaluation
Results

• Ohio Area Agency on Aging
• Illinois Cash Counseling Program

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Characteristics of Traditional and
Participant-Directed Participants
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Characteristics Continued
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Ohio AAA - Satisfaction with Choice and Control
over Services for Traditional ESP and
Participant-Directed ESP Client
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Illinois CC Participant Satisfaction

• Workers
• Spends majority of time working 92.5
• Respect from worker 96.9
• Worker listens 93.9
• Case managers
• Case manager helpful 85.1
• Can you talk to your CM when you need to 88.7
• Case manager respectful 97.0
• Fiscal intermediary
• Can talk to FI when need to 82.3
• Get info from FI that you need 58.5
• FI staff treat with respect 91.1
• (N 69)

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Illinois CC Service Description and Use of
Budget

• Average allocated budget (month) 1,049
• Type of worker ()
• Family 51.4
• Friends 31.8
• Other 3.3
• Missing 12.6
• Service use ()
• Home Care 100.0
• Emergency response 31.3
• Goods 20.3
• Examples microwave, glasses, lift chair,
  washer

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Lessons Learned

• Older, more frail and cognitively impaired
  participants can succeed in participant-directed
  services
• Program serves families
• Case managers play a key role
• Program planning and design can preempt some of
  the challenges
• Political processes, leading for change within
  the agency are crucial

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Ms. Ruthie Crutchfield

• Mother cannot always tell us what she needs or
  wants. She begins telling us something, but
  forgets and says too bad or regardless. We
  know what she means.

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Mr. Efrain Gonzales

• Dad doesnt speak much English and is frustrated
  and more confused when he does not understand.
  He is happier and more comfortable with family
  taking care of him.

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• For more information, please visit us at
  www.participantdirection.org