Consumer-directed services at home: a new model for persons with disabilities.

The past decade has produced a wave of new state programs that have introduced consumer direction into home-based services for persons with chronic impairments. Building upon earlier models developed for younger adults with physical disabilities, consumer-directed models are now being adapted to recipients of all ages with federal, state, and foundation support. These models shift responsibility for key service decisions from professionals to recipients and challenge the traditional home care agency model. Research evidence on the impact of consumer direction is just becoming available to policymakers. This paper reviews what we have learned from program and research activity so far, and what key issues and challenges remain.