Evaluation of the Veterans Administration Housebound and Aid and Attendance Allowance Program

摘要

The Veterans Administration administers the only Federal program of cash disability grants for long-term care and this is the first outside evaluation of the program. These grants are called 'attendance' or 'attendant care' allowances in recognition of the need for assistance by another person. Recipients who qualify on the basis of medical need, and, in most cases on the basis of financial need as well, receive unrestricted cash grants which can be spent on anything they wish. The project had two major goals: to describe the workings of a successful, large-scale, cash disability allowance program from an administrative perspective and to examine the question of whether recipients of a cash allowance for long-term care are worse off than similar persons who receive in-kind subsidies. The study does so by examining the life circumstances of 139 recipients of the Veterans Administration Housebound Allowance or Aid Assistance Allowance. The health, functional needs, and use of services of these persons were compared with those of 610 persons interviewed in the 1983 National Long-Term Care Survey who receive in-kind services. The findings suggest that recipients of the cash disability allowance received similar levels of long-term care and were no worse off than the comparison group with regard to acute health care utilization. Evidence on hours of care per week and the direct (non-administrative costs) of the VA cash allowance program suggest that the cash benefit may be the more cost-effective alternative for many beneficiaries.