New York’s Consumer Directed Personal Assistance Program (CDPAP), which was renamed in 1995 and has received statewide expansion, has been touted as ‘the textbook example for innovation’[i]through its cost-effective and personal approach to home care. By allowing self-directing seniors, people with disabilities or their designated representatives to recruit, hire, train, supervise and terminate their choice of personal assistant home care worker’[ii], the patient has a greater sense of control over the personalized care they receive. This ensures optimum care and generates significant savings due to a unique cost structure which uses Medicaid funding while allowing consumers to manage their care and reducing the costs typically associated with the use of medical professionals in home care. If there is to be a complaint regarding New York’s CDPAP, indeed, it would be that implementation is somewhat lagging, with a mere 9,105 recipients statewide in 2008[iii].
The implementation of consumer-directed personal assistance programs has become increasingly common in recent decades, starting with an initial 19 US states in the mid-1990s. As programs such as these continue to permeate, spreading as far as Australia, the implementation and results there of have been consistently positive, particularly in consumer satisfaction and cost savings. Specifically, in addition to the success witnessed by NY’s CDPAP program, Arkansas and Virginia serve as notable examples of successes in the application of this Medicaid-funded program design[iv],[v]. Each of these implementations has recognized not only the financial benefits to consumer-directed care, which particularly saves on administrative and nursing costs, but also the benefit of improved satisfaction among patients and helping ease the burden incurred by typical caregiving techniques. As an example, a study of Arkansas’ program has demonstrated that ‘about 60 percent fewer’ patients felt their caregivers failed to complete tasks than those not enrolled in a consumer-directed program[vi].
With the budget for these types of programs determined on a case-by-case basis, the expenses are based upon a ‘person-centered planning process’ through which an individual’s personal‘ strengths, capacities, preferences, needs, and desired measurable outcomes’[vii] are specifically catered to. Thus, such plans are fully customized with the patients’ specific needs in mind, amplifying individual responsibility for care and promoting the independence of such individuals as well as supporting the personal caregivers who, especially in the case of family members, too often fulfill these roles without Medicaid support. Predominately, the benefit to the patient is in the personal level of care and the feeling of independence and freedom of choice which comes from the responsibility of choosing one’s own caregivers and deciding on a suitable match in approach, as has been asserted by case after case since the onset of New York’s program[viii].
Whether the story is that of Monica, Margie, or Michelle[ix], the example of renewed independence, improved satisfaction with care, and a renewed level of comfort with the level and type of care received is a consistent lesson to be learned from the implementation of the CDPAP. In all, thus, these programs, whether in NewYork, Arkansas, Virginia, or any number of other states and countries, offers adiverse set of benefits through the improved financial efficiency, independence, and level of care implemented for individuals in need of consistent help. These programs not only recognize the economic benefits of restructuring care, but also the personal benefits to the patient through independence, satisfaction, and comfort, not to mention support for personalized caregivers. With a sustainable funding structure, highly-personalized care, and a high degree of satisfaction from the renewed independence and comfort experienced, thus, consumer-driven programs have witnessed significant success in the past two decades and, as implementation becomes more-universal, the importance of these practices will only become more evident.
[i]Consumer Directed Personal Assistance Association of New York State (CDPAANYS).(2011). New York’s Consumer Directed Personal Assistance Program (CDPAP). CDPAANYS Position Paper, p. 1. Retrievedat http://edlitcher.hypermart.net/CDPAANYS%20Position%20Paper%20FINAL%202-11-11.pdf.
[ii]CDPAANYS. (2011). Ibid.
[iii]CDPAANYS. (2011). p.2.
[iv]Foster, L., et al. (2003). Improving the Quality of Medicaid Personal Assistance Through Consumer Direction. HealthAffairs. Retrieved at http://content.healthaffairs.org/content/early/2003/03/26/hlthaff.w3.162.full.pdf.
[v]Beatty, P.W., et al. (1998). Personal Assistance for People With Physical Disabilities: Consumer-Direction and Satisfaction With Services. Arch Phys Med Rehabil. Retrieved at http://www.archives-pmr.org/article/S0003-9993(98)90043-0/pdf.
[vi]Foster, L., et al. (2003).
[vii]Medicaid.gov. (2017). Self Directed Services. Long Term Services and Supports. Retrieved at https://www.medicaid.gov/medicaid/ltss/self-directed/index.html.
[viii]Margie. (2017). Margie’s Story. Consumer Directed Personal Assistance Asssociation of New York State (CDPAANYS) Personal Stories. Retrieved at http://cdpaanys.org/margies-story/.
[ix]CDPAANYS. (2017). Personal Stories. Consumer Directed Personal Assistance Association of New York State (CDPAANYS).Retrieved at http://cdpaanys.org/personal-stories/.