America's health at the millennium: imminent risks and long-range goals.
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Biomedical subjects
Publications and source records attributed to S M Keigher.
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There is concern throughout developed countries about how sufficient services can be mounted in this century to care for all older, disabled persons who want to remain at home. With declining availability of family care and high turnover among paid workers, cost, care supply, and quality dilemmas abound. Therefore, how can home care be improved? One suggestion is to revise the care "contract" by simply eliminating the costly bureaucratic and controlling dimensions of agency oversight and management. In consumer-directed or self-managed care, independent workers are hired directly by consumers or their family members. Consumers spend their own private money or government provides authorization for them to "hire" their own workers. Such arrangements may be more responsive to the needs of consumers, more directly accountable to them, and less costly for both individuals and government. This article examines 41 cases of consumer-directed care in Milwaukee. Extended interviews with three "stakeholders" in care--the disabled, older client, the family caregiver, and the personal assistant--were conducted, including both private pay and government subsidized arrangements. This analysis identifies some essential, but disparate interests of the three partners in care.
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This qualitative study examines relationships between adult daughters caring for elderly disabled mothers and the mothers' personal care workers (PCWs) paid directly by the Wisconsin Community Options Program (COP). A subset of a larger study, in these five cases PCWs provide substantial hands on care without substituting for the heavy care also provided by the daughters. Direct payment offers the daughters and workers freedom to schedule around their family obligations and other limits and tailor care to the abilities of all three participants. It also allows the daughter to be the paid provider when she chooses. Expansion of such supportive services could benefit many more low and middle income families.
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