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Objective: To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program., Data Sources: Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program., Study Design: The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction., Principal Findings: Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care., Conclusions: The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.