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

preexisting, unmeasured differences between the types of caregivers that became paid workersand those that remained unpaid. For example, healthier informal caregivers may have been morelikely to become paid workers, and therefore report fewer emotional or physical problems thanthose who did not become paid. (We did not have baseline measures of the caregivers’emotional or physical well-being.)Also, since spouses cannot be hired underIndependentChoices, the two groups of informal caregivers differ on this dimension as well. Ifspouses feel more strain than other unpaid caregivers, then this could lead to the finding thatinformal caregivers who do not become paid experience more strain than those who do.Finally, those primary informal caregivers who became paid workers provided similar totalhours of care as the primary informal caregivers for the control group. In contrast, those primaryinformal caregivers for the treatment group who remained unpaid provided significantly fewertotal hours of care than the primary informal caregivers for the control group. This suggests thatunder IndependentChoices, the consumers’ who did not hire their primary unpaid caregivershired other workers to relieve their primary unpaid caregiver of some responsibilities. This isconsistent with an ethnographic study conducted by Eckert et al. (2002) in whichIndependentChoices’ consumers reported that they liked the fact that the program allowed themto provide some relief to family members who had given them so much unpaid assistance. It isalso possible, however, that those unpaid caregivers who became paid were providing more careat baseline than those who remain unpaid. Thus, some of the difference in the hours of careprovided by paid and unpaid caregivers could be due to preexisting differences between the twogroups in the amount of assistance they had been providing before the demonstration.52