Much of the discussion of consumer direction and self-determination focuses on issues, models, and policies. Consumer direction as a philosophy emphasizes consumers' capacity to "assess their own needs, determine how and by whom these needs should be met, and monitor the quality of services they receive." As a practice, consumer-direction consists of consumers making decisions and managing delivery of long-term-care services. Self-determination represents a much broader concept related to individuals' overall control of their lives and ability to participate fully in society and rests on four basic principles: (1) freedom to exercise the same rights as other citizens, (2) authority to control the funding needed for services and support, (3) support through the organization of resources as determined by the person with the disability, and (4) responsibility to use public dollars wisely.
However, at the heart of the movements toward consumer direction and self-determination are, of course, people--the individuals with disabilities who are directing and receiving services and support. In this article, we will discuss four populations that have been involved in the struggle toward consumer direction: older adults, younger adults with physical disabilities, people with developmental disabilities, and those with cognitive disabilities. We will focus on the history of each group in the area of consumer direction, strategies, and supports needed to enhance consumer direction in each community, and special issues to consider for each population.