Disabilities
In Brief: Personal Care Services: A Four State Comparison
Research Report
Enid Kassner, AARP Public Policy Institute
March 2001
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Table of Contents: Introduction and Background | Findings | Conclusions
Introduction and Background
This In Brief summarizes the findings of the AARP Public Policy Institute issue paper, Personal Care Services: A Comparison of Four States. 1 Older people with disabilities often require "long-term care," a general term used to describe an array of medical or supportive services that help people perform basic life activities. Within this very broad framework of long-term care, there is a set of services referred to as "personal care." This term generally is used to describe "hands-on" or individualized assistance with basic life activities (sometimes called "activities of daily living" or ADLs) such as eating, bathing, dressing, toileting, and transferring (e.g. to or from a bed or chair). Some programs also define personal care as assistance with "instrumental activities of daily living," or IADLs. These IADLs generally include activities such as shopping, preparing food, managing money, using the telephone, and performing housework. Medical care typically is not considered personal care.
The manner in which a state designs its total mix of personal care services will have an impact on who may eligible to receive services, the type and amount of services they receive, and the cost of these services, both to the state and to the individual. For this reason, AARP commissioned a study of the different ways in which four states (Arkansas, Indiana, Massachusetts, and Washington), using a variety of approaches, design and deliver personal care services to older people with disabilities. The report analyzed personal care services delivered through Medicaid home and community-based "waiver" programs, the personal care option under the Medicaid state plan, and programs funded entirely with state dollars.
Findings
- Definition of Personal Care — States have wide latitude in defining personal care: it may be limited to activities of daily living (ADLs) or expanded to cover instrumental activities of daily living (IADLs). Definitions of personal care are quite broad in three states (Arkansas, Indiana, and Massachusetts) and focused primarily on "hands-on" ADL tasks in the fourth state (Washington).
- Eligibility Criteria — States may decide to offer services broadly or to target services to a particular group of beneficiaries. States vary in the type of functional eligibility criteria they use for providing personal care services, yet all states have at least one program that provides personal care based strictly on ADL needs.
- Eligibility and Cognition — Often people with cognitive impairments are physically capable of performing ADLs and IADLs but, because of their impairment, need supervision and reminding to complete a task. Unless functional eligibility requirements allow for this level of assistance and the assessment process measures this need, people with cognitive impairments will not be eligible for personal care services. Eligibility criteria in Indiana, Massachusetts and Washington's waiver programs allow people with dementia to qualify for services due to the need for supervision. In Arkansas, the need for supervision due to dementia alone is not considered a basis for an impairment.
- Family Members, Independent Providers, and Other Supports — Historically, home care services are provided by staff that are hired, trained and supervised by home care agencies. However, several states allow beneficiaries to receive services from family members or other individuals who are not employed or supervised by an agency. Arkansas allows reimbursement for adult children of the client or other family members who are not a spouse or guardian. Under waiver and state-funded programs, Indiana and Washington reimburse family members (except a spouse or a parent of minor child) to provide personal care services.
Conclusions
State differences among programs covering personal care may be artificial and misleading when focusing on a single program. Each service has to be seen in the context of the state's total long-term care system. This report concluded that services that may seem narrow and limited, when viewed on their own, are likely to be part of a larger system. In general, the larger system in these four states provides a similar scope of care, whether delivered through a combination of programs, or through a single program that provides a broad personal care service.
That said, the adequacy of the overall system may still leave gaps in coverage from the perspective of a person with disabilities. While the full range of personal care services may be available through the various programs offered in a state, an individual may not be eligible for all the different programs. States should examine the extent to which both their overall systems and individual programs provide adequate personal care services to people with disabilities.
Top of PageFootnote
1 AARP Public Policy Institute Issue Paper #2001-04 (March 2001)
Prepared by Enid Kassner, AARP Public Policy Institute
March 2001
©2001 AARP
May be copied only for noncommercial purposes and with
attribution; permission required for all other purposes.
Public Policy Institute, Public Affairs, AARP, 601 E Street, NW,
Washington, DC 20049
Pub ID: INB36