Consumer Directed Care

A number of other factors have combined to bring consumer-directed care to the forefront within the world of aging services at the beginning of the twenty-first century. The 1990s brought increased emphasis on consumer preferences and autonomy (and how these relate to consumers' quality of life) within the field of aging services. Consumers have become more involved in all aspects of their care, from participating in the care planning process to expressing their opinions about their care through consumer satisfaction surveys administered through home care programs and nursing facilities alike. In addition, there has been increasing concern over the quality of agency-provided services received by home care consumers. The need to cut the rising costs of long-term care has also contributed to the current interest in consumer-directed care (Simon-Rusinowitz et al.).

Another driving factor behind the movement toward consumer-directed care has been the dramatic shortage of frontline workers, which plagues the field of long-term care. By allowing consumers to hire family and friends as independent providers, consumer-directed care may be able to infuse new workers into the system and alleviate this shortage. Also contributing to the increased emphasis on consumer-directed care is the aging of the baby boomers, who are viewed as more likely than the current generation to demand more autonomy and control over the management and delivery of their long-term care services when they eventually need them.

Finally, legislative efforts and judicial decisions have also fueled the drive toward consumer-directed care. In 1998 the MiCASSA (Medicaid Community Attendant Services and Supports Act) was introduced in Congress. This bill offered Medicaid-eligible persons with disabilities the option of choosing personal assistance services and supports in their own communities, rather than placement in a long-term care facility. The year 1999 brought even more attention to the issues of consumer choice and control with the Supreme Court decision in Olmstead v. L.C., which stated that "unnecessary segregation of persons in long-term care facilities constitutes discrimination under the Americans with Disabilities Act" (Rosenbaum). This decision is leading many states to examine (and potentially to expand) their home and community-based options. In the event of increases in home and community-based options, disability advocates will likely argue for such options to incorporate consumer direction.