Risk of Hospitalization Associated with Use of Consumer-Directed Attendant Care

ABSTRACT

Older people with disabilities living independently often use attendant care, also known as Personal Assistive Services (PAS). The aides providing care can come from a home health agency contracted by the state Medicaid authority, known as agency-directed PAS, or the Medicaid recipient can receive a monthly budget and arrange their own care, known as consumer-directed care. Consumer-directed care is hypothesized to have some possible benefits but could also potentially lead to health hazards. This study examined whether people receiving consumer-directed PAS versus people receiving agency-directed PAS faced a higher risk of hospitalization. The data for this study came from Pennsylvania Medicaid claims, enrollment files, standardized assessments, and hospitalization claims from Medicare and Medicaid. The analysis used two-stage least square regression, with the percentage of people in a county using consumer-directed care as an instrument for the type of PAS. People using consumer-directed care did not have a statistically significant difference in risk for hospitalization compared to people using agency-directed PAS (p = .976). Risk of hospitalization was not different for people using consumer-directed care compared to people using agency-directed care.

KEYWORDS:

• Acute inpatient hospitalization
• consumer-directed care
• long term services and supports
• Medicaid

Key Points

• The shortage of assistive personal care workers for older people poses a potential problem for people’s desire to age in their homes

• Consumer-directed personal assistive care, a system of giving a person an allotted amount of money every month and the charge to manage their own care, could address this labor shortage problem

• One possible issue with this system is that quality of care may diminish and recipients would face a higher risk of hospitalization

• This study examined hospitalization rates between people with consumer-directed PAS and agency-directed PAS, and found no difference in hospitalization between the two groups

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08959420.2024.2348426.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.