Personal Care: A Matter of Choices

Personal Care: A Matter of Choices

BC's Mahoney envisions alternatives for elderly, disabled persons

By Sean Smith
Chronicle Editor

The way Assoc. Prof. Kevin Mahoney (GSSW) sees it, people with age-related or other disabilities face enough of a challenge every day. So at the very least, he says, they should be able to choose the help they want and need to perform the tasks of everyday life.

Assoc. Prof. Kevin Mahoney (GSSW): "The 'one-size-fits-all' philosophy in elderly and disabled care services just doesn't work." (Photo by Mike Mergen)
But choice is a rare commodity for the nearly 1 million Americans who receive Medicaid-funded personal assistance services. States usually contract with home care agencies to provide such care, Mahoney says, and while recipients may be able to select an agency, they seldom have a say in anything else.

"Most home care aides come only during the day, and only during the week," he said. "Those who receive the care, therefore, only get it when it's available, not when they actually need it. That means someone requiring assistance to get out of bed and prepare meals, for example, may have to wait until later in the morning to rise and eat. And what happens on weekends, if the aide doesn't work then?"

A three-state pilot program directed by Mahoney could dramatically change the nature of care for the elderly and persons with disabilities.

Through the Cash & Counseling Demonstration and Evaluation Program, some Medicaid recipients in New Jersey, Florida and Arkansas are given cash allowances to purchase their own services instead of receiving them from an agency. The participants can use the funds to compensate family members or friends for providing care, pay for modifying their homes or vehicles or for other resources that help them to live independently.

Although the programs are administered separately in each state, all are centered on the principle of consumer-directed care, says Mahoney. The national office, headed by Mahoney, monitors the three programs, under the sponsorship of the US Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation, The Robert Wood Johnson Foundation and the centers for Medicare and Medicaid Services.

By June, approximately 7,000 people in the three states will be participating in the study, according to Mahoney, half of whom are randomly selected to receive the cash option and others the traditional Medicaid services.

In Arkansas, where the program began in December of 1998, investigators found that those in the cash option group received personal assistance services in 91 percent of the months during which they were eligible, compared to 60 percent for persons in the traditional services group. Institutional costs were 18 percent higher for the traditional services group, Mahoney said, but the overall Medicaid costs per recipient per month were virtually identical for both groups.

The study also found that, among those in the cash allowance group, 93 percent said they would recommend the program to others, 82 percent said the program improved their lives, with 65 percent saying their lives had been improved "a great deal." No one reported being worse off than they were before enrolling in the cash option program.

Mahoney says the data is not yet in on the programs in New Jersey and Florida, which were more recently implemented - although he notes that Florida has already passed legislation making their cash option permanent. But preliminary evidence indicates consumer-directed care has generated strong satisfaction for those receiving it.

Beyond the statistics, Mahoney points to anecdotal evidence of the Cash & Counseling alternative's success: a family who customized a bathroom and obtained massage therapy for their severely disabled teenage daughter, for example, or a widow who was able to provide home care, medication management and other needed personal services for her elderly parents.

"The program is unique in that it is testing the limits of consumer choice," he said. "The 'one-size-fits-all' philosophy in elderly and disabled care services just doesn't work. Families and individuals want to have control over the quality of their lives, no matter their age or physical or mental health."

The CCDE Program is one of several ongoing Mahoney-directed initiatives that reflect his strong interest in the role of social work in addressing issues of aging and disabilities. In 1999, his first year at the Graduate School of Social Work, he established the Resource Network for Home and Community Based Services to work with states in developing innovative collaborations to provide high quality, cost-efficient care for the elderly and persons with disabilities.

Earlier this year, Mahoney received a two-year $60,000 grant from the John A. Hartford Foundation that will be used to strengthen the aging and intergenerational elements in the GSSW curriculum.

"Issues surrounding aging or persons with disabilities are very appropriate areas for social work," said Mahoney, "because they have to do with empowering the client, or in this case, the consumer. At the same time, social work education is moving toward more evidence-based practice, looking at how a particular program or approach works from the consumer's point of view, and the impact on the families and workers involved.

"When you look at the other work being done here, it's exciting to see how BC is at the forefront of age-related issues," said Mahoney, citing the scholarship of College of Arts and Sciences Dean Joseph Quinn, Associate Vice President for Research and Graduate School of Arts and Sciences Dean Michael Smyer, the Center for Retirement Research and the recently launched Initiative on Aging, as well as the Jesuit Institute's Aging and Ethics seminar.


Return to April 11 menu

Return to Chronicle home page