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Home Health Care Services: Management and Effectiveness in Changes Times

Author: ROBERT SHICK and WARREN BALINSKY
Published in JHHSA, Vol. 28 No. 3

New York City has the largest Medicaid personal care
program (a form of home health care which includes many of the
activities of daily living) in the country with approximately 45,000
clients and an annual budget of $1.5 billion. During the late 1980s and
into the 1990s, New York State was experiencing budget difficulties,
and established savings targets for local governments providing
personal care services. In response, New York City, through its Home
Attendant Program, began using different means of assessing clients’
service needs to produce these savings.
This article examines Task Based Assessment (a new service
assessment methodology), and determines the degree to which it was
successful, organizational issues that were faced by New York City and
the 60 nonprofit and profit making companies contracted to deliver the
service, legal challenges that were raised by advocacy groups and
another alternative to the delivery of personal care services, a capitated
long term care program. Task Based Assessment did not achieve its
goals and the authors suggest, based on the positive experience from
the capitated long term care program in controlling personal care hours,
that it is more effective to expand these capitated programs than to seek
to achieve further cost savings through the Home Attendant Program.

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