"Cash and Counseling" Model a Good Option for Providing Long-Term Care

Studies of cash disability allowances for long-term care

As the cost of long-term care for the disabled and the elderly continued to rise during the early 1990s, policymakers and others sought new ways to control costs while maintaining or increasing satisfaction among those served.

One new strategy for paying for long-term care of disabled individuals is called "cash and counseling," in which the government provides regular cash allowances to disabled individuals as well as counseling about available services. Preliminary research by James P. Firman PhD, the principal investigator, found that 93 countries and several U.S. states were already using or experimenting with cash and counseling programs.

The investigators conducted on-site research in the United States and overseas at sites that had implemented or experimented with a cash-and-counseling or a similar approach.

Key Results

  • The primary result of the project was a monograph that described in detail the state of cash and counseling programs both here and abroad.

    • Researchers found that several European countries plus several states in the United States are either operating full-scale cash-and-counseling programs or are conducting small demonstrations.
    • The investigators concluded that the cash-and-counseling model is worthy of greater experimentation in the United States.

Afterward: Findings from the project set the stage for RWJF's national program to improve care for the disabled, called Independent Choices: Enhancing Consumer Direction for People with Disabilities.

The Robert Wood Johnson Foundation (RWJF) also developed a program, Cash and Counseling that expanded this proven model of consumer-directed supportive services to more states, allowing thousands more older adults and people with disabilities to have choice and control over the care they receive.