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Are Personal Budgets a Financially Sound Reform Option for the German Long-Term Care Insurance? By Melanie Arntz, Mannheim, and Stephan L. Thomsen, Magdeburg* JEL I38, I12, C93 Long-term care, long-term care insurance, consumer-directed home care, spending. Received: 30.10.2009 Revision received: 14.04.2010 Accepted: 03.05.2010 Summary In a long-run social experiment, personal budgets have been tested as an alternative home care program of the German long-term care insurance (LTCI). By granting the monetary value of in- kind services in cash, personal budgets are

-26. HIQA. (2012). National standards for better healthcare. Dublin: HIQA. Howes, C. (2008). Love, money, or flexibility. What motivates people to work in consumer-directed home care? The Gerontologist, 48 (1), 46-59. HSE. (2011). National service plan 2012. Retrieved from http://www.hse.ie/eng/services/Publications/corporate/nspexecutivesummary2012.pdf [2 February 2014]. HSE. (2014). National service plan 2015. Dublin: HSE. HSE. (2015). Office of the Head of Operations & Service Improvement Services for Older People. Unpublished Internal Document, Cork. INMO. (2015

97 This chapter reports on the effects of living wages and employer-pro- vided health insurance on job quality and workforce attachment among the home care workers in San Francisco who are employed through the Medicaid-funded In-Home Supportive Services (IHSS) program. When they work directly for consumers in their home, both publicly funded and privately paid consumer-directed home care workers are classifi ed as independent providers or contractors. As independent pro- viders, they are covered neither by the National Labor Relations Act nor by state public

Unionization. Berkeley: Institute for Research on Labor and Em- ployment, University of California. ——. 2005. “Living Wages and Retention of Homecare Workers in San Francisco.” In- dustrial Relations 44 (1): 139–63. ——. 2006. Building a High Quality Home Care Workforce: Wages, Benefi ts and Flexibil- ity Matter. Washington, DC: Robert Wood Johnson Foundation. ——. 2008. “Love, Money, or Flexibility: What Motivates People to Work in Consumer-Directed Home Care?” Gerontologist 48 (Suppl. 1): 46–59. Hughes, Everett C. 1971. The Sociological Eye: Selected Papers. Chicago

Embedded in Meaningful Nursing Practice.” Journal of Advanced Nursing 25: 434–41. Family Continuity Inc. 2013. “Governor Signs First Human Service Worker Safety Bill.” March eNewsletter. http://www.familycontinuity.org/index.php?name=News&fi le =article&sid=122. Faucett, Julia, Taewoon Kang, and Robert Newcomer. 2013. “Personal Service Assistance: Musculoskeletal Disorders and Injuries in Consumer-Directed Home Care.” American Journal of Industrial Medicine 56 (4): 454–68. Ferrarini, Tommy, and Ann-Zofi e Duvander. 2009. “Swedish Family Policy: Controversial Reform

of Care for the Frail and Disabled, 27 Int’l J. Health Services 753, 755–57 (1997) (describing an Austrian program, established in 1992, that provides fixed cash payments to individuals with disabilities to enable them to purchase attendant ser- vices); Joshua M. Wiener et al., Consumer-Directed Home Care in the Netherlands, England, and Germany (Oct. 2003) (unpublished manuscript), available at http:// research.aarp.org/health/2003_12_ eu_cd.pdf (discussing voucher- and cash-grant programs in the Netherlands, England, and Germany). 86. See Bob Kafka