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The Gerontologist 48:93-104 (2008)
© 2008 The Gerontological Society of America

Does Mental Illness Affect Consumer Direction of Community-Based Care? Lessons From the Arkansas Cash and Counseling Program

Ce Shen, PhD1, Michael A. Smyer, PhD2, Kevin J. Mahoney, PhD1, Dawn M. Loughlin, PhD3, Lori Simon-Rusinowitz, PhD3 and Ellen K. Mahoney, DNS4

Correspondence: Address correspondence to Ce Shen, Graduate School of Social Work, 304 McGuinn Hall, Boston College, Chestnut Hill, MA 02467. E-mail: shenc{at}

Purpose: Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling—a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care—changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their well-being. Design and Methods: Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. Results: After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver's reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Implications: Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.

Key Words: Elderly • Mental health • Consumer direction • Cash and Counseling

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2008 by The Gerontological Society of America.