Consumer direction in caregiving is a system where the patient and their family determine what type of care is necessary. They can select and manage their caregivers and control payment to a limited extent. This system also allows individuals to control how, when, and from whom they receive care from. Additionally, the flexibility and power give the consumer a higher satisfaction and it saves money to care providers. This is because certain forms of care are only administered on request, tailoring the type of care that is needed.
The concept of consumer direction began with active disabled youth as a part of the independent living movements in the late 1960s to early 1970s and has recently increased in popularity over the past decade.
Consumer-directed services shift the decision-making from the provider to consumers and their families. Some consumer-directed programs also offer complete control over how their care dollar is spent. Including the ability to pay relatives to respite, purchase equipment and other goods, and other miscellaneous services. Lastly, this system allows families to play a much larger role in their loved one’s care. From assuming different roles such as information-gatherer to a coordinator of care.
Factors Driving the Expansion of Consumer Direction
States are constantly experimenting with new ways to increase consumer satisfaction and the overall quality of care. Meanwhile, consumer-directed programs have found success in achieving these goals. In recent years, consumer direction has proven to be effective, finding popularity among older consumers, families, providers, and policymakers.
Policymakers and administrators have noted consumer-directed programs’ ability to save money. They do it by increasing efficiency and filtering what methods of care and equipment are being administered. With that, providers can save resources by only administering a streamlined care program tailored to the specific consumer. Consumers also save money as most consumer-directed programs discount the actual dollar per care amount compared to traditional care packages. Further savings are caused by the reduction of administrative costs that would normally occur in a regular service-package program.
Due to the recent COVID-19 pandemic, there has been a growing shortage of frontline workers to deliver care. Consumer direction is a method that facilitates more flexibility in hiring workers by allowing the utilization of family members. This, in turn, increases the pool of caregivers available to providers. Family members also aid with the assistance of special patients that require a continuity of care. They help patients that have a language or communication barrier, allowing effective high-quality care to be administered without a specialist.
Research has proven that when given the choice between traditional care and consumer-directed care, patients choose consumer-directed care. It is reported that consumers experience greater well-being and higher satisfaction rates compared to their traditional counterparts. Older patients enjoy the freedom of choice in matters such as daily living, personal assistance services, and home settings. With that, consumer-directed care enables consumers’ freedom to hire and spend time with a family member or friend. Therefore, it is a more pleasant alternative to staying in a nursing home.
Barriers to the Expansion of Consumer-Directed Programs
A philosophical shift is necessary to expand the way services have been traditionally delivered towards senior citizens and their families. For expansion to occur in these programs, the implementation of empowerment and choice is practiced. Clinical staff must be trained on how to educate and explain to their consumers the positives and negatives. They must also abandon their intent on assuming a biased point of view and stick to ethics.
This is done by handing the resources to older adults based on their age, disability, and their ability to function. Then, they are given the power of choice. This would enable them to have a non-biased outlook and instead choose what they think is best for them. It hands them the power to decide on what would essentially and long-term wise be beneficial for them.
Additionally, the barrier of concern lies among policymakers and providers who are in a position of power among the consumers. Concerns on susceptibility to fraud, abuse, and liability and accountability in monetary payments drive consumers to think negatively. Although, research has shown that no major negative instances have occurred within these Medicaid beneficiaries or their families. Moreover, the risk of such a problem is at an all-time low especially due to the amount of support and guidance presented by such providers.
Furthermore, there is a controversy on the offering of direct cash payments. Concern about public-private responsibility and increased expenditures on the money of the public is seen as a drawback. Moreover, critics question whether enough compensation is handed to caregivers.
The question remains on whether they receive proper health care or enough job security for them to thrive within this field. Proponents also argue that these caregivers remain successful since it is mutually beneficial in their case as well. It is a line of work that is rapidly growing thus expanding the limited direct care worker supply. Additionally, the natural support system is sustained.
Lastly, challenges are posed of matters such as fiscal intermediary services, including the use of vouchers, worker compensation, and taxes. Therefore, it requires a system to be able to efficiently access the information whenever these cases arise. Caregivers also need to be trained on how to deal with such instances. This will ensure there is a flawless system that meets and monitors these consumer-directed services.
Benefits and Effects of Consumer Directed Services
State evaluations have supported positive findings for consumer-directed caregiving programs. Results from research regarding the preferences for consumer-directed programs and agency-managed programs show that Caregivers prefer consumer-directed payment. Compared to the traditional agency-based group, caregivers using the direct-pay option from consumer direction reported a notable increase in choice. There is also an increase in freedom over decisions related to the day-to-day management of respite workers.
On top of this, they also reported being more satisfied with their quality, a possible outcome of increased flexibility. The use of consumer-directed care allowed for more hours of respite per caregiver. Moreover, it significantly reduced the cost per hour of the service in comparison to a traditional agency-based respite.
Another study compared results from traditional care systems to consumer-directed programs. It was found that consumer-directed care reduced large amounts of pressure on low-income caregivers, especially those living in rural areas. These self-directed caregivers reported financial, physical, and emotional relief. In turn, this translated into better abilities to provide care. They were significantly more satisfied with overall services and reported that it allowed them to spend more time providing care. Therefore, this prevents patients from being transferred to nursing homes.
Why it is a Good Method
Consumer-directed care has proven itself as a viable method of caregiving in recent years. This is shown through the popularity among both its patients and the caregivers involved. Patients enjoy the freedom of choice to decide how they receive care. They also appreciate the ability to utilize family and spend extra time with those that they love.
The tailoring of care and employment of family takes the stress from caregivers. As a result, this gives them the freedom and space to provide higher quality care to the consumer. Financially consumer-directed care has proven to save money for all parties involved. Most consumer-directed care programs provide a discounted dollar-to-care rate compared to traditional agency-based programs. Caregivers also save money on resources due to the tailored nature of consumer-directed care.
Barriers to administering this type of program are seen mostly in the training of caregivers in educating consumers on how to go about receiving and instructing consumer-directed care. Overall, studies have shown positive results for consumer-directed care, as evident in its growing use and popularity in recent years.