A Cochrane review [Abstract] 1 included one study with a total of 817 adult subjects with physical impairments living in the community who require assistance to perform tasks of daily living. Eligible Medicaid beneficiaries were randomly assigned to receive a monthly payment (personal assistance) in lieu of other Medicaid services or to receive usual care. Personal assistance participants received more paid care than control participants, who often paid for care out of pocket (38.8 versus 33.2 hours over two weeks). In the intervention and control groups, 38% and 21% (p<0.01) were 'very satisfied' with the way they were spending their lives. Overall, participants appeared satisfied with personal assistance, though personal assistance was not clearly superior to other models of care.
Another Cochrane review [Abstract] 2 included one study (another arm of the same study as above) with a total of 1002 children and adolescents with intellectual impairments living in the community. Eligible Medicaid beneficiaries were randomly assigned to receive a monthly payment (personal assistance) in lieu of other Medicaid services or to receive usual care. Participants in the intervention group received more paid care than control participants, who often paid for care out of pocket (20 versus 15 hours per week). In the intervention and control groups, 52% and 29% (p<0.01) of parents indicated that participants were 'very satisfied' with the way they were spending their lives. Overall, participants appeared satisfied with personal assistance, though personal assistance was not clearly superior to other models of care. Near complete dependence on proxy respondents raises concerns about the validity of the results.
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