Models of bureaucratic behavior: Sustaining family caregiving in Ohio's mental retardation and developmental disabilities home care program.
Fisher, Amber L.
2002
Abstract
<italic>Objectives</italic>. This study compared the fit of two models of organizational control: a rationale choice based agency theory perspective focusing on incentives, and a human relations school perspective focusing on organizational culture. The research examined Anti-Substitution effort, attempts to limit the funding of services that would otherwise be provided by informal family caregivers. The units of analysis were the public organizations that administer Ohio's mental retardation and developmental disabilities (MR/DD) home care program. The research objectives were to: (1) measure Anti-Substitution effort, (2) evaluate and compare the impact of organizational incentives and culture on Anti-Substitution Behavior, and (3) evaluate the relationship between measures of Anti-Substitution effort and policy outcomes involving individual plan cost and program enrollment. <italic>Methods</italic>. A 30-item, Likert scale survey was administered to the contact person from 80 of Ohio's 88 county MR/DD boards. Composite variables were created from survey items to measure Anti-Substitution Incentives, Culture and Behavior, respectively. Measures of central tendency were used to evaluate the level of Anti-Substitution effort. Ordinary Least Squares regression models were estimated to test hypotheses involving the determinants of Anti-Substitution Behavior and related policy outcomes. A qualitative analysis of commentary provided by survey participants was performed in order to evaluate the policy environment and enhance the interpretation of quantitative results. <italic>Results</italic>. The data supported the existence of no more than a 'moderate' level of Anti-Substitution effort. Anti-Substitution Culture and Anti-Substitution Incentives each had a significant positive association with Anti-Substitution Behavior; there was not a significant difference in the magnitude of the effect of Incentives or Culture. The analyses did not show a significant relationship between measures of Anti-Substitution effort and policy outcome variables. <italic>Conclusion</italic>. Both organizational culture and incentives influence employee behavior. The finding of a low overall level of Anti-Substitution effort supports the contention that tension is associated with compelling family caregiving. Because Anti-Substitution effort did not have a significant impact on policy outcomes, the use of individual cost caps and/or guidelines for use by case managers in making resource allocation decisions may be indicated as an alternative means for home care cost containment.Subjects
Behavior Bureaucratic Developmental Disabilities Family Caregiving Home Care Mental Retardation Models Ohio Program Sustaining
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