Experiences of Workers Hired Under Cash and Counseling: Findings from Arkansas, Florida, and New Jersey

A growing number of Medicaid beneficiaries receiving disability-related assistance in their homes hire workers and manage the services themselves under consumer-directed care. Although consumer direction clearly benefits beneficiaries, it is sustainable only if workers are satisfied with their experiences. Directly hired workers in this study were almost always the consumers' friends or relatives; compared with agency workers, these individuals provided comparable amounts of care and reported similar levels of physical injury, but they were more likely to report emotional strain and want more respect from the consumer's family. States may be able to reduce emotional strain and injury through educational materials and counseling.