Consumer Directed Care

There are several reasons why consumer-directed care has taken so long to develop in the field of aging services. First, the overarching goal of home care for older adults has been simply to keep seniors out of nursing homes, rather than to foster choice and self-determination. A second reason is the general paternalistic bias in long-term care toward the safety and protection of clients, as evidenced by current regulatory practices, which assumes that consumer autonomy— including the right to make poor choices—is of lesser importance (Scala and Mayberry).

However, underlying some of professionals' concerns about consumer-directed care are legitimate tensions between the balance of autonomy and risk for their clients. Most professionals generally respect consumers' desires and preferences for choice and autonomy; however, they also feel very real professional responsibility to assure their clients' well-being and quality of care as well as to protect their agencies/states from liability in the event that consumers make poor choices (Scala, Mayberry, and Kunkel; Micco, Hamilton, Martin, and McEwan).

Finally, one of the biggest barriers to consumer-directed care is concern on the part of professionals and states about quality assurance—especially about fraud and abuse. This is especially the case in programs that allow the use of independent providers who are trained and monitored by consumers, rather than by home care agencies. In their survey of state administrators, Robert Lagoyda and colleagues found this to be a leading concern.