Brenda R. Wamsley, PhD, Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, 304-422-2853, bwamsley@cah-wv.org and Gerald Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc, P.O. Box 429, East Rochester, NY 14445.

Consumer-direction is increasingly being incorporated as an option in personal care programs for older adults. A key feature is the option to hire in-home workers directly as an alternative to using agency services. Additionally, consumers are given greater flexibility in obtaining supplies and equipment to help them with activities of daily living (ADLs). Over the past decade, several demonstrations have tested consumer-direction within Medicaid and other state programs. Only one demonstration has tested consumer-direction with a Medicare population.1 Results indicate that Medicare beneficiaries in a rural sample who received a consumer-directed Medicare waiver benefit had significantly better ADL outcomes than randomly assigned controls2 and were highly satisfied with the model.3 Although these results are encouraging, it is important to better understand how the model can be strengthened for replication. This paper presents findings from a qualitative study in which 24 in-depth personal interviews were conducted with beneficiaries, informal caregivers, physicians, and project staff from the Medicare demonstration to identify the facilitators and barriers of implementing consumer-direction in rural areas. Transportation, worker supply, payment to family members, access to vendors of supplies and equipment, and staff sensitivity to local culture emerged as issues to be addressed. Specific recommendations to tailor the model to better meet the needs of rural beneficiaries are explored with emphasis on maintaining functional status. The study has implications for designing regulations for a Demonstration Project for Consumer-Directed Chronic Outpatient Services established under Subtitle D, Section 648 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Articulate the major components of a consumer-directed model of personal care,
• Describe the facilitators and barriers of implementing consumer-direction in rural areas with chronically ill Medicare beneficiaries, and
• Incorporate the views of rural beneficiaries in Medicare models for consumer-direction designed to maintain functional status.

Keywords: Consumer Direction, Medicare

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.