The special issue of HSR, Putting Consumers First in Long-Term Care: Findings from the Cash and Counseling Demonstration and Evaluation, contains the following articles:

1. "Putting the Consumer First: An Introduction and Overview." A.E. Benjamin and Mary L. Fennell. Reviews the historical context for consumer direction in health care and the origins of the cash and counseling concept.

2. "The Public/Private Partnership Behind the Cash and Counseling Demonstration and Evaluation: Its Origins, Challenges and Unresolved Issues." James R. Knickman and Robyn I. Stone. Recounts the forces that brought consumer direction to the attention of a large foundation and a federal agency with long histories of supporting long-term care reform and research; describes the collaboration that developed between these private and public partners. Abstract.

3. "Designing the Cash and Counseling Demonstration and Evaluation." Pamela Doty, Kevin J. Mahoney, and Lori Simon-Rusinowitz. Describes the process of fielding the demonstration, challenges associated with random assignment, key elements of the intervention, and design decisions. Abstract.

4. "Commonalities and Variations in the Cash and Counseling Programs Across the Three Demonstration States." Barbara Phillips and Barbara Schneider. Details program implementation in the three demonstration states, within the context of national guidelines that gave states some choice in eligibility and other key features. Abstract.

5. "The Research Design and Methodological Issues for the Cash and Counseling Evaluation." Randall S. Brown and Stacy B. Dale. Reviews key elements of the evaluation design and resolution of methodological issues. Includes a discussion of research questions, data sources, random assignment, measurement, analytic methods, and design limitations. Abstract.

6. "Consumer Enrollment and Experiences in the Cash and Counseling Program." Jennifer Schore, Leslie Foster, and Barbara Phillips. Presents consumer characteristics and describes consumers' experiences, including who received the cash allowance, how they spent it, and their satisfaction with the program. Discusses how program features addressed key policy concerns about consumer direction in the Medicaid program. Abstract.

7. "Effects of Cash and Counseling on Personal Care and Well-Being." Barbara Lepidus Carlson, Leslie Foster, Stacy B. Dale, and Randall Brown. Examines how a new model of consumer-directed care changes the way that consumers with disabilities meet their personal care needs and, in turn, affects their well-being. The analysis yielded estimated program effects that were large, compelling, consistent across numerous types of measures, and widespread across subgroups. The results provide unambiguous evidence that Cash and Counseling substantially improved the amount and quality of paid personal assistance from the perspective of consumers, with no discernible adverse effects on safety or health. Abstract.

8. "How Does Cash and Counseling Affect Costs?" Stacy B. Dale and Randall S. Brown. Addresses program effects on Medicaid costs in the three states. Because access to personal care increased, costs were higher for the treatment group but partially offset by other Medicaid savings. Abstract.

9. "How Caregivers and Workers Fared in Cash and Counseling." Leslie Foster, Stacy B. Dale, and Randall Brown. Looks at effects on informal caregivers and the experiences of hired workers. Caregivers for consumers in the treatment group reported more satisfaction, less worry, and less physical and emotional strain than caregivers for the control group. Directly hired workers received wages comparable to those of agency workers and had similar amounts of physical strain and injuries. Abstract.

10. "Case Histories of Six Consumers and Their Families in Cash and Counseling." Patricia M. San Antonio, Lori Simon-Rusinowitz, Dawn Loughlin, J. Kevin Eckert, and Kevin Mahoney. Helps put a face on the data from the evaluation by describing in detail the experiences of specific consumers in the treatment group and the issues they faced during their participation. Abstract.

11. "The Future of Cash and Counseling: The Framers' View." Kevin J. Mahoney, Nancy Wieler Fishman, Pamela Doty, and Marie R. Squillace. Describes policy developments at the end of the demonstration and evaluation, as a second round of funding extended the demonstration to additional states. Considers challenges and opportunities for consumer direction in long-term care. Abstract.

12. "Commentary: Cash and Counseling in an International Context." Joshua M. Wiener. Places the cash and counseling model in a comparative perspective by discussing European approaches to expanding long-term care.

13. "Commentary: Social Experimentation at Its Best: The Cash and Counseling Demonstration and Its Implications." Peter Kemper. Reflects on the meaning, significance, and limitations of the findings reported in this special issue.