The Experiences of Workers Hired Under Consumer Direction in ...

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Finally, results from a companion analysis suggest that consumers received satisfactoryhealth care under IndependentChoices (Foster et al. 2003a) in spite of their workers’ apparentlack of training. Directly hired workers’ access to the consumer’s family health care providercould partially account for why consumers received adequate health care. About 44 percent ofdirectly hired workers consulted the consumer’s doctor with health care questions, and12 percent consulted the consumer’s nurse (not shown). In contrast, 72 percent of agencyworkers consulted the home care agency with health care questions, while few consulted with theconsumer’s doctor or nurse (9 percent and 4 percent, respectively).6. Supervision and SchedulingThe supervision of agency workers and directly hired workers is somewhat different.Agency nurses periodically supervise agency workers in the home, while directly hired workersreport being supervised mainly by the consumer and consumer’s representative or family.Despite the differing nature of the supervision received, similar percentages of directly hiredworkers and agency workers (84 and 86 percent, respectively, Table 6) were satisfied with thesupervision they received. However directly hired workers expressed greater satisfaction withthe amount of feedback they received on how care was provided, and they were less likely toreport having been asked to do things to which they had not agreed. Compared to agencyworkers, directly hired workers’ may have been more satisfied with the feedback they receivedbecause they had closer (and perhaps better) relationships with the consumer. Finally, similarpercentages (approximately 3 percent) of both directly hired workers and agency workersreported that close supervision interfered with their work.Over 70 percent of workers in both groups were satisfied with the flexibility of theirschedules, and few reported scheduling disagreements with their client. However, directly hiredworkers were more likely to report having to hurry to meet the consumer’s needs, perhaps24
TABLE 6SUPERVISION AND SCHEDULING(Percentages)AgencyWorkersDirectly HiredWorkersSupervisionIs Satisfied with Supervision of CareStrongly agrees 84.3 86.4Disagrees 2.6 2.3Is Satisfied with Amount of Feedback on How Care Is ProvidedStrongly agrees 82.2 88.3**Disagrees 1.6 2.1Asked to Do Things Not Agreed to 7.5 1.8***Close Supervision Interfered with Work 2.6 3.1SchedulingHas a Lot of Flexibility in Scheduling CareStrongly agrees 72.7 77.1Disagrees 11.4 8.5Ever Disagreed About Schedule 3.2 2.1Must Hurry to Meet All Consumer’s NeedsStrongly agrees 16.0 21.4*Disagrees 68.7 63.9Back-Up CareIs Responsible for Arranging Backup Care — b 53.3Somewhat or Very Difficult to Arrange Backup Care — b 19.2SOURCE:NOTE:Caregiver survey conducted by Mathematica Policy Research, Inc. between February 2000 and May2002.Sample sizes vary from measure to measure due to item nonresponse. The maximum sample sizes are281 for agency workers and 391 for directly hired workers.aRespondents were asked whether they strongly agree, somewhat agree, somewhat disagree or strongly disagree.“Disagrees” includes those who somewhat disagreed or strongly disagreed. “Somewhat agrees” is not shown.bQuestion not asked of agency workers.*Significantly different from agency workers at the .10 level, two-tailed test**Significantly different from agency workers at the .05 level, two-tailed test.***Significantly different from agency workers at the .01 level, two-tailed test.25
Page 1 and 2: Subcontract No.: Q146901MPR Referen
Page 3 and 4: EXECUTIVE SUMMARYAn important consi
Page 5 and 6: While Medicaid supportive services
Page 7 and 8: 2. Cash and Counseling in ArkansasA
Page 9 and 10: hours and timing of care that worke
Page 11 and 12: members. During the nine-month foll
Page 13 and 14: • The worker’s physical and emo
Page 15 and 16: a paid caregiver by the time of the
Page 17 and 18: workers held jobs other than caregi
Page 19 and 20: worker was paid for less than one-t
Page 21 and 22: TABLE 3COMPENSATION AND SATISFACTIO
Page 23 and 24: workers might have viewed their pay
Page 25 and 26: TABLE 4TYPE OF CARE PROVIDED DURING
Page 27: TABLE 5TRAINING AND PREPAREDNESS FO
Page 31 and 32: TABLE 7WELL-BEING OF PRIMARY PAID W
Page 33 and 34: Overall, both related and non-relat
Page 35 and 36: provided many more hours of unpaid
Page 37 and 38: Notably, directly hired workers (bo
Page 39 and 40: were randomly assigned to the treat
Page 41 and 42: REFERENCESArkansas Medicaid Program
Page 43 and 44: APPENDIXIn this appendix, we presen
Page 45 and 46: TABLE A.1 (continued)______________
Page 47 and 48: TABLE A.3TIMING OF CARE PROVIDED(Pe
Page 49 and 50: TABLE A.4 (continued)Suffered Littl
Page 51 and 52: TABLE A.5COMPARISON OF ADJUSTED AND
Page 53 and 54: • The consumer’s health and fun
Page 55 and 56: average predicted probability that

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