PAS Presentations

"Homecare" (or personal care or attendant services) is a primary mode of long-term care, providing essential support such as assistance in bathing, dressing, and grocery shopping for people with disabilities who live in community settings. An emerging trend is consumer direction, which allows recipients (not an agency) to select, hire, supervise, and schedule their supportive services. This approach is widely used in Medicaid personal care programs. Shifting from agency-based services to consumer direction has important consequences for both consumers/users and workers. In consumer direction, consumers assume the responsibilities of employing their attendants - for both self-directing their supportive services and being responsible for numerous fiscal/administrative responsibilities (e.g., payroll, personnel forms). States have eased the fiscal/administrative burden primarily through using Financial Management Services (FMS) organizations. However, there is more variation in how states support consumers and workers in addressing the persistent problems affecting workforce supply and development (e.g., low wages, lack of benefits or training). The question examined by this paper is the extent to which FMS organizations serve the needs of both consumers and workers in consumer-directed programs. We surveyed over 50 FMS used by Medicaid consumer-directed programs. The study focused especially on consumer and worker training, particularly on occupational safety, and access to workers' compensation coverage. We describe the major FMS approaches, and present data on the kinds of training and support provided to consumers and workers, comparing the FMS approaches. We conclude by providing examples of best practices for supporting both fiscal management and worker/workforce development.

Learning Objectives:

At the end of the session, participants will

• Identify the major FMS approaches
• Describe the strengths and challenges of each model in terms of supporting consumers/users
• Describe the strengths and challenges of each model in terms of supporting workers
• Keywords: Home Care, Policy/Policy Development