Office of the Assistant Secretary for Planning andEvaluation, US Department of Health andHuman Services inWashington, DC, USA.
Health Aff (Millwood). 2010 Jan-Feb;29(1):49-56. doi: 10.1377/hlthaff.2009.0521.
Consumer-directed long-term care service programs give participants the flexibility they want, while reducing unmet need for home and community-based services and supports. States' efforts to expand such programs under Medicaid, including those supported by federal Cash and Counseling demonstration and evaluation grants, are often hindered by challenges related to costs, staffing and organizational issues, new infrastructure requirements, and resistance from stakeholders. Yet states have developed a number of successful strategies for overcoming these challenges, even in financially trying times. Their experiences offer valuable insights, guidance, and encouragement to other states contemplating consumer-directed service expansions.
消费者导向的长期护理服务计划为参与者提供了他们想要的灵活性，同时减少了对家庭和社区为基础的服务和支持的未满足需求。各州在医疗补助计划下扩大这类计划的努力，包括那些得到联邦现金和咨询示范和评估赠款支持的计划，往往受到与成本、人员配备和组织问题、新基础设施要求以及利益相关者抵制相关的挑战的阻碍。然而，各州已经制定了许多成功的策略来克服这些挑战，即使在财政困难时期也是如此。它们的经验为其他考虑扩大消费者导向服务的州提供了宝贵的见解、指导和鼓励。
