Recipient Outcomes in Agency-based and Consumer-directed Home Care for People with Disabilities

A.E. Benjamin
Dept. of Social Welfare
UCLA
3250 Public Policy Bldg.
Los Angeles CA 90095-1656
310/206-6044
FAX: 310/206-7446
tedbenj@ucla.edu
 
Ruth Matthias
Lewis Center
UCLA
3250 Public Policy Bldg.
Los Angeles CA 90095-1656
310/825-1951
FAX: 310/825-8657
matthias@ucla.edu
Because a growing number of Americans receive long-term care at home, social workers face new challenges in referring clients with chronic health needs to either agency-based or consumer-directed care models.  Traditional agency-based home care is considered to provide high quality care to clients because workers are professionally trained and monitored, while newer client-directed home care models offer more autonomy and flexibility. This study examines differences in recipient outcomes across agency and consumer-directed models. Data come from a survey of 1,095 randomly-sampled low-income disabled clients in California's In-Home Supportive Services program. Analysis shows that on self-reported service satisfaction and quality of life, recipients who direct their own services have better outcomes than those receiving agency-run services. On safety and unmet need, there are no differences between the two groups. Family ties, race/ethnicity, social supports, language compatibility, and provider turnover also affect outcomes. Challenging views that agency-based care is safer and of higher quality, these findings suggest that clients in consumer-directed models are not at higher risk of negative service outcomes than agency clients. Implications are considered for social work practitioners, who frequently find themselves on both sides of the debate about stronger client roles and must weigh the presumed trade-off between client empowerment and client risk. Evidence is provided to highlight some of the risks of agency-based care and the promise of consumer-directed services. An argument is presented for expanding the  role of social work in research on consumer-centered service models as part of a larger commitment to creating new approaches to planning for the care of people with chronic care needs.