INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. IndependentChoices: An Experiment in Consumer-Direction

Sandra Barrett
Project Administrator, IndependentChoices

The Choice

An Opportunity to Exchange Agency Personal Care Services for A Monthly Cash Allowance

The Social Marketing

  • Open Enrollment
  • Direct Mail
    • Letters from the governor
    • Letters to participants requesting referrals
    • Notes with copies of news clippings
    • Letters from participants with information about their experience
  • Public Service Announcements
    • Television
    • Radio
  • News Releases

The Players

  • 18 Years Old or Older
    • 71% Age 65 or Older
    • 50% White/25% Black/25% Other
    • 62% Female
    • 75% Live in Rural Area
  • Receiving Medicaid
  • Need Personal Care
    • New to Continuing Ratio is 33%
  • Willing to Participate
  • Able to Make Responsible Care Decisions or Have a Representative Decision-maker
    • 43% Use a Representative

Closing the Deal

  • Request Information
  • Enter into Database
  • Telephone Contact by Enrollment Staff
  • Enrollment Home Visit
  • Completed Signed Consent Form

Show Me the Money!

  • Allowance
    • Based on Personal Assistance Needs
    • Approximately $8.00 per hour
    • Average Allowance is $375.00 a month
  • Uses of Cash
    • To meet Personal Care Needs
      • Hire Personal Care Assistant
      • Purchase Items and Services Related to Personal Care

The Pay Off
Attractive Program Features

  • 82% of the Allowance is used to hire a PSA
    • Family Member
    • Friend/Neighbor
  • 16% of the Allowance is used to Purchase Items Traditionally Unavailable Through Medicaid
    • Personal Care Items; Assistive Devices; Health and Safety Items
    • 2% is Saved

The Supporting Cast

  • Counseling
    • Training
    • Reassessments
    • Support Resource
      • Develop Cash Plan/Answer Questions
  • Bookkeeping
    • Accept Cash Allowance
    • Disperse Cash According to Plan
    • Serve as Fiscal Agent
      • Maintain Employee Files
      • Pay Payroll
      • Withhold/Pay Taxes

The Observations

  • Participants and family members express a high level of satisfaction with this program.
  • 100% of participants are satisfied with the attendant hired.
  • 80% are satisfied with their lives.
  • 93% would recommend the program to others.
  • 3 out of 4 are age 65 or older.
  • Most participants have chronic illnesses.
  • 98% know the person being hired as an attendant.
  • 95% are pleased with the attendant they have hired.
  • No one states that their life is worse since enrolling in IndependentChoices.

The Verdict

  • Consumer Direction Works
  • Consumer Direction is Not For Everyone
  • This Model Will Not Replace the Traditional Model
  • Respect for Preferences Should Be a Major Consideration in Program Design and Training


Debby Ellis, Program Manager
Arkansas Division of Aging and Adult Services, P.O. Box 1437, Slot 1412, Little Rock, AR 72203
Tel: 501-682-2441, E-mail:, Web site: