How do hired workers fare under consumer-directed personal care?

Purpose: This study describes the experiences of workers hired under consumer direction. Design and Methods: Medicaid beneficiaries who volunteered for the Cash and Counseling demonstration were randomly assigned to the treatment group, which could participate in the consumer-directed program, or the control group, which was referred to agency care. Paid workers for both groups were surveyed about 10 months after demonstration enrollment. Results: Directly hired workers for the treatment group were nearly always the consumers' friends or relatives. The two groups received similar wages and both were highly satisfied with their working conditions and the supervision they received. Compared with agency workers, directly hired workers who lived with or were related to the consumer were more likely to report emotional strain and a desire for more respect from the consumer's family; however, no such differences were observed for directly hired workers who were not relatives. Directly hired workers and agency workers providing comparable amounts of care reported similar levels of injury and physical strain, although directly hired workers received less formal training. Implications: The Cash and Counseling model does not appear to cause adverse consequences for the hired workers. Directly hired workers report high levels of job satisfaction and do not suffer physical or emotional hardship beyond what might be expected for individuals providing care to relatives. However, states might be able to reduce emotional strain and injuries by providing educational materials and referrals for consumers, their families, and workers, and by having counselors monitor workers' well-being.