The Effectiveness of Participant-Directed Home and Community-Based Services for Young Adults with Long-Term Care Disabilities

Abstract

For young adults with disabilities, who face barriers in achieving markers of adulthood, a service gap has been identified during the transition to adulthood. Preliminary qualitative evidence suggests that participant-directed home and community-based services (PD-HCBS), which can be easily modified to meet an individual’s needs, might aid these young adults as they transition into adulthood and provide an option to fill the service gap. However, research was needed to determine if young adults are significantly affected by having the option to develop an individualized spending plan and manage their own budget. In this study, secondary data analysis was employed in evaluating the effectiveness of the Cash and Counseling budget authority model of PD-HCBS for young adults aged 18 to 35 with long-term care disabilities and eligible for Medicaid who were enrolled in the Cash and Counseling Demonstration and Evaluation randomized control trial (n = 831). Using a theoretical framework based on the developmental life stage of young adulthood, theories of self-determination and consumer direction, and past research on PD-HCBS, I examined young adults’ outcomes on community involvement, satisfaction ratings, unmet needs for assistance, and health status compared to peers through self-reports or through proxy respondents. Multivariate logistic regression results showed that Cash and Counseling significantly increased the likelihood of young adults attending school or college at a preferred level, being very satisfied with when care was received, care arrangement, transportation, help around the house and community, personal care, and getting along with paid attendants, and having fewer unmet needs with health care at home and with transportation than controls receiving agency-based care. Bivariate logistic regression models also showed Cash and Counseling members were significantly more likely to attend activities at a preferred level, be very satisfied with life, and have lower likelihoods of unmet personal care needs. These findings support the effectiveness of the Cash and Counseling model with young adults with disabilities and as an option to help fill the service gap for this population. Future research and intervention could address how other influential factors identified affect outcomes and test PD-HCBS during different aspects of the transition to adulthood.