1. Creating a Consumer Direction Program for an Area Agency on Aging Creating a Consumer Direction Program for an Area Agency on Aging The National Association of Area Agencies on Aging Scripps Gerontology Center, Miami University, Oxford Ohio

2. Choice for Independence Survey of all AAAs Survey of all AAAs Majority wanted more information about Choices for Independence initiatives Majority wanted more information about Choices for Independence initiatives 48% ranked consumer direction as one of their top technical assistance/training priorities 48% ranked consumer direction as one of their top technical assistance/training priorities

3. Designing and implementing a consumer directed program at a AAA

4. Motivations  Labor shortages in home care  Political pressure to spend local dollars or lose them  Increased options for older adults and caregivers

5. Challenges  Societal values/paying family members  Role of case manager  Universal concerns about fraud, abuse, health and safety, quality of service  Provider concerns

6. Design solutions to some of the challenges  Care plan costs  Limits on who can be hired  Agency-wide trainings  Implementation team  Meetings with provider network  Independent evaluation

7. Consumer Direction Model  Consumer as employer of record  Supports in place  Fiscal intermediary  Case managers  Consumer training  Authorized reps

8. Evaluation of the program  Baseline and follow-up information about participants  Comparison to consumers who stayed in traditional program  Results  Consumer profiles  Consumer impacts  Caregiver impacts

9. Characteristics of Traditional and Consumer- directed consumers Consumer- Directed N= 168 Traditional N= 407 Average age81.9680.68 Percent female83.979.4 Living alone47.667.6 % with a representative 41N/A % with Alzheimer’s7.52.3 % with dementia18.68.3

10. Consumer- Directed N= 165 Traditional N= 407 Percent with 4 or more ADL impairments 20.45.1 Average # of ADL impairments 1.781.24 Percent with 4 or more IADL impairments 85.574.5 Average # of IADL impairments 5.054.23

11. Satisfaction with Choice and Control over Services for Traditional ESP and Consumer-directed ESP clients Percent saying they are definitely satisfied with the ability to… CD Baseline N= 165 CD 6 Months N= 84 Tradi- tional N= 157 Choose the person who takes care of me 52.690.070.1 Choose the types of services needed 62.490.074.2 Choose the day and time of services 51.679.771

12. Additional findings Caregivers for consumer-directed participants spend an average of 7 hours a day providing unpaid care Caregivers for consumer-directed participants spend an average of 7 hours a day providing unpaid care Every caregiver said they would recommend the program to others Every caregiver said they would recommend the program to others Consumer-directed participants used more of their authorized care plan costs Consumer-directed participants used more of their authorized care plan costs Self-directed participants received nearly 3 times as many units of service as participants in the traditional program Self-directed participants received nearly 3 times as many units of service as participants in the traditional program

13. Lessons Learned  Older, more frail and cognitively impaired consumers can succeed in consumer directed services  Program serves families  Case managers play a key role  Program planning and design can preempt some of the challenges  Political processes, leading for change within the agency are crucial

14. Contacts National Association of Area Agencies on Aging (n4a) National Association of Area Agencies on Aging (n4a) –www.n4a.org www.n4a.org –rlogan@n4a.org logan@n4a.org Scripps Gerontology Center Scripps Gerontology Center –www.scrippsaging.org www.scrippsaging.org –kunkels@muohio.edu kunkels@muohio.edu