"Human beings, by changing the inner attitude of their minds, can change the outer aspects of their lives." (William James, philosopher-psychologist, 1842-1910). According to Javier Robles, the Deputy Director of the New Jersey Division of Disability Services, this quotation defines what consumer-directed services are all about.

'Consumer direction' is a model in which there is a wide range of service options available to the individual, and the individual is in control of how and when services are delivered. Service options differ from state to state. Consumer directed services allow the individual to select, manage, and dismiss workers such as attendants, choose which service providers to use, what time of day to have them come, whether or not to hire family members, and whether to spend funds on things other than services.

In the Driver's Seat in New Jersey
New Jersey is one of several states currently offering a consumer directed program, says Robles. It is different than the traditional medical model of service, he says, because you can hire anyone including your family, friends or neighbors. You can also fire them, if needed, and decide when they will come to work and what tasks they will perform. In the medical model, it is strictly up to the service provider agency to find and hire the personal attendant, set the work hours and the plan of service.

Consumer directed services, not surprisingly, are enjoying a rapid increase in popularity as more people with disabilities are learning they can have control over their lives. According to Robles, in 1968, there were no consumer directed service programs. Today, 55 percent of the programs are consumer directed.

New Jersey, one of the first states in the nation to offer consumer directed services, currently offers two programs: the Personal Preference Program, and the Personal Assistant Services Program. The Personal Assistant Services Program serves 525 people between the ages of 16 and 64 who are either working, in school or actively volunteering. It is a program of last resort for those who are not Medicaid eligible, and has a sliding fee scale.

In order to qualify for New Jersey's Personal Preference Program, on the other hand, a person must have a disability, be at least 18-years-old, be Medicaid eligible and qualify to receive personal assistant services.

The challenges in creating Consumer Directed Services programs, says Robles, are that people don't like change, and providers are concerned that the change will cut into their bottom line. However, says Robles, the benefits to implementing consumer directed programs are many. Increasing personal responsibility and economic empowerment, as well as allowing states to save money on service provision are two of the many benefits of offering a consumer directed services program.

Continuum of Options in Lone Star State
Other states are on board with consumer directed services, as well. Elizabeth Jones, Special Projects Coordinator of the Texas Department of Aging and Disability Services, says Texans with disabilities can currently participate in a Consumer Managed Personal Assistant Services pilot program, an initiative that started in 1997. It is a sliding scale fee program subsidized by general revenue funds. Other legislation in the state has expanded consumer choice in Texas, including SB 1586 (1999) expanding attendant and respite services, and SB 1188 (2005) that addresses increasing the provider base.

Texas, says Jones, has two consumer directed service options and a third agency with choice option. Under the consumer directed services options, the consumer recruits, hires, trains, and fires the personal attendant, though the agency still controls the financial management part. The individual with a disability can select the option and provider, and can change it at any time. This method gives the consumer the highest measure of control over their services.

Under the service responsibility option – the agency with choice option – the goal is to develop a continuum of options depending on the level of responsibility and control an individual desires. If a consumer chooses this option, they still hire their personal attendant, but they aren't responsible for recruiting potential providers as they are in the consumer directed option.

Says Jones, the goal in offering options is a recognition that people with disabilities are not all the same. They are individuals with their own thoughts about how much control and responsibility they want and can handle. The Texas model aims to address the varying levels of need, choice and responsibility through the options it offers its consumers.

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