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The Gerontologist 45:474-485 (2005)
© 2005 The Gerontological Society of America

Easing the Burden of Caregiving: The Impact of Consumer Direction on Primary Informal Caregivers in Arkansas

Leslie Foster, MPA1, Randall Brown, PhD1, Barbara Phillips, PhD2 and Barbara Lepidus Carlson, MA1

Correspondence: Address correspondence to Randall Brown, Vice President, Mathematica Policy Research, Inc., P.O. Box 2393, Princeton, NJ 08543. E-mail: rbrown{at}

Purpose: We assess the effect of consumer-directed care on the emotional, physical, and financial well-being of the primary informal caregivers of the Medicaid beneficiaries who voluntarily joined Arkansas's Cash and Counseling demonstration. Design and Methods: The demonstration randomly assigned beneficiaries to a program in which they could direct their own disability-related supportive services (the treatment group) or rely on traditional agency services (the control group). We constructed outcome measures from telephone interviews with 1,433 caregivers who provided beneficiaries with the most unpaid assistance at baseline, and we used multivariate regression models to estimate program effects. Interviews occurred between February 2000 and April 2002, 10 months after beneficiaries' random assignment. Results: At follow-up, treatment group caregivers provided fewer hours of assistance than did their control group counterparts, on average, and they reported better emotional, physical, and financial well-being. Implications: Permitting interested Medicaid beneficiaries to direct their own in-home supportive services reduces burden on informal caregivers, which may help reduce beneficiaries' nursing home use.

Key Words: Cash and Counseling • Long-term care • Family caregivers • Medicaid

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