INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Comparing Consumer- and Agency-Directed Models: California's In-Home Supportive Services Program


Until recently, there has been little research to inform the debate about expanding consumer direction to the elderly and other populations with supportive services needs. Most paid supportive services at home are provided by homecare agencies. Critics of this agency approach argue that clients themselves should be organizing and directing their own home-based services, which are personal and mostly nonmedical and thus amenable to individualized design. This article describes a study funded by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services that was designed to examine the experiences of clients and providers under different supportive-service arrangements in the home. The study compares service experiences and outcomes for clients in a traditional homecare-agency model with those in a consumer-directed model. The locus of the study is California's In-Home Supportive Services (IHSS) program, a large and well-established program that offers both agency-based and consumer-directed services.