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a Department of Social Welfare, School of Public Policy and Social Research, University of California–Los Angeles
b Center for Child and Family Policy Studies, School of Public Policy and Social Research, University of California–Los Angeles
Correspondence: A. E. Benjamin, PhD, Department of Social Welfare, School of Public Policy and Social Research, UCLA, 3250 Public Policy Building, Los Angeles CA 90095-1656. E-mail: tedbenj{at}ucla.edu.
Decision Editor: Laurence G. Branch, PhD
Purpose: Supportive services at home are essential for older people with severe chronic impairments. Newer "consumer-directed" models of organizing home-based services rely heavily on service recipients rather than home care agencies to arrange and direct care at home. This study examined differences in service experience and outcomes between recipients over and under age 65 who direct their own services in one large Medicaid program. Design and Methods: A random sample of 1,095 recipients of In-Home Supportive Services in California was selected and interviewed by telephone. Interviews were conducted in English, Spanish, and three Asian languages; those with severe cognitive impairment were excluded from the study. Results: Findings indicate that although younger recipients embrace self-direction more enthusiastically than older ones, age dif-ferences are small on a majority of service outcomes. On average, older users embrace this model and manage within it much like younger users. Some differences emerge between the young-old (65–74) and old-old (75+), but these are neither consistent nor determinative. Implications: Old age is far from an inevitable barrier to self-direction. As with other age groups, there are opportunities and obstacles to be addressed as this newer approach to home care is disseminated.
Key Words: Home care • Consumer direction • Service outcomes
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