Intimate partner violence, health status, and health care access among women with disabilities.

BACKGROUND: Evidence suggests that intimate partner violence (IPV) against women with disabilities is more pervasive than against women without disabilities. However, little is known about the relationship between IPV, health status, and access to care among women with disabilities. OBJECTIVES: This study 1) describes the prevalence of IPV among women with disabilities and compares IPV prevalence among women with and without disabilities, 2) examines if health status and health care access differ between women with disabilities experiencing IPV and those not experiencing IPV, and 3) examines the association between IPV, health status, and health care access among women with disabilities. METHODS: We conducted secondary analyses of data from 23,154 female respondents to the 2006 Behavioral Risk Factor Surveillance System in 7 states administering the IPV module in 2006. Of these respondents, 6,309 had a disability. We performed chi(2) and logistic regression analyses to address the study objectives. RESULTS: Women with disabilities are significantly more likely to have experienced IPV as compared with those without disabilities (33.2% and 21.2%, respectively). Women with disabilities who have experienced IPV are 35% less likely to report their health as good to excellent and are 58% more likely to report an unmet health care need owing to cost than their disabled counterparts not experiencing IPV, when holding selected sociodemographic factors constant. IMPLICATIONS: Practitioners should be aware of the increased risk of IPV among women with disabilities and its association with health status and access to health care. Practitioners, policy makers, and disability advocates should work together to remove barriers to accessing the health care system for women with disabilities, particularly those experiencing IPV.

Effects of Cash and Counseling on personal care and well-being.

OBJECTIVE: To examine how a new model of consumer-directed care changes the way that consumers with disabilities meet their personal care needs and, in turn, affects their well-being. STUDY SETTING: Eligible Medicaid beneficiaries in Arkansas, Florida, and New Jersey volunteered to participate in the demonstration and were randomly assigned to receive an allowance and direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). The demonstration included elderly and non-elderly adults in all three states and children in Florida. DATA SOURCES: Telephone interviews administered 9 months after random assignment. METHODS: Outcomes for the treatment and control group were compared, using regression analysis to control for consumers' baseline characteristics. PRINCIPAL FINDINGS: Treatment group members were more likely to receive paid care, had greater satisfaction with their care, and had fewer unmet needs than control group members in nearly every state and age group. However, among the elderly in Florida, Cash and Counseling had little effect on these outcomes because so few treatment group members actually received the allowance. Within each state and age group, consumers were not more susceptible to adverse health outcomes or injuries under Cash and Counseling. CONCLUSIONS: Cash and Counseling substantially improves the lives of Medicaid beneficiaries of all ages if consumers actually receive the allowance that the program offers.

How do hired workers fare under consumer-directed personal care?

PURPOSE: This study describes the experiences of workers hired under consumer direction. DESIGN AND METHODS: Medicaid beneficiaries who volunteered for the Cash and Counseling demonstration were randomly assigned to the treatment group, which could participate in the consumer-directed program, or the control group, which was referred to agency care. Paid workers for both groups were surveyed about 10 months after demonstration enrollment. RESULTS: Directly hired workers for the treatment group were nearly always the consumers' friends or relatives. The two groups received similar wages and both were highly satisfied with their working conditions and the supervision they received. Compared with agency workers, directly hired workers who lived with or were related to the consumer were more likely to report emotional strain and a desire for more respect from the consumer's family; however, no such differences were observed for directly hired workers who were not relatives. Directly hired workers and agency workers providing comparable amounts of care reported similar levels of injury and physical strain, although directly hired workers received less formal training. IMPLICATIONS: The Cash and Counseling model does not appear to cause adverse consequences for the hired workers. Directly hired workers report high levels of job satisfaction and do not suffer physical or emotional hardship beyond what might be expected for individuals providing care to relatives. However, states might be able to reduce emotional strain and injuries by providing educational materials and referrals for consumers, their families, and workers, and by having counselors monitor workers' well-being.

Easing the burden of caregiving: the impact of consumer direction on primary informal caregivers in Arkansas.

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.

Improving the quality of Medicaid personal assistance through consumer direction.

As states seek to improve home and community-based services for people with disabilities, many are incorporating consumer-directed supportive services into their Medicaid programs. The national Cash and Counseling Demonstration uses a randomized design to compare an innovative model of consumer direction with the traditional agency-directed approach. This paper presents findings from the first demonstration program to be implemented, in Arkansas. Our survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participants' health and safety.

The effects of cash and counseling on personal care services and Medicaid costs in Arkansas.

The Cash and Counseling Demonstration gives Medicaid beneficiaries who are eligible for personal care services a consumer-directed allowance in lieu of traditional agency services. Using survey and Medicaid claims data on 2,008 adult applicants randomly assigned to treatment or control groups, we find the program increased the receipt of paid care but reduced unpaid care. The treatment group had higher Medicaid personal care expenditures than controls did, because many controls received no paid help, and recipients obtained only two-thirds of entitled services. By the second year after enrollment, these higher personal care expenditures were offset by lower spending for nursing homes and other Medicaid services.