The relative effects of home care client characteristics on the resource allocation process: do personality and demeanor matter?

Abstract

This study measures the differential effects of home care client characteristics typically included in standardized needs assessment protocols, and client characteristics such as attitude or demeanor that arise from the case manager-client interpersonal dynamic during the assessment process, on care plan decisions. Three hundred fifty-five case managers in Massachusetts' state-funded home care program for elderly persons selected care plan eligibility levels for 2,054 vignette clients generated in accordance with a previously devised factorial vignette survey methodology. Robust regression models estimated the effects of standardized and nonstandardized elderly client characteristics on care plan eligibility level. Client characteristics of physical functioning, psychological functioning, and resources best predicted care plan generosity, in accordance with home care program policy to match services with standardized cues of client need. Nonstandardized client characteristics, however, also significantly predicted care plan generosity. Clients who denied needing home care services were allocated less generous care plans than clients who were passive and appreciative service recipients. This finding persisted when controlling for client disability level and cognitive status. Social work licensure increased this effect. Results indicate the importance of considering how both standardized and nonstandardized cues of client need affect home care policy implementation. Findings suggest that, although case managers recognize the importance of integrating client care preferences into care planning, additional training is needed to support complex considerations of client autonomy.