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A Cross-Disability Analysis of Person-Directed, Long-Term Services

Person-directed service models have emerged as important initiatives in improving long-term care. Person-directed services typically have been targeted to particular groups, such as persons with mobility or developmental disabilities or elders with disability. Few attempts have been made to analyze the commonalties, differences, and relative efficacy of the various models. This article presents a cross-disability review of the common elements of person-directed services, describes three primary types of models (personal assistance services, brokered support, and cash and counseling), and summarizes the research evidence related to their efficacy. The major barriers that impede the expansion of person-directed services are discussed. Emerging research findings across disability groups suggest that person-directed services have a positive impact on factors such as quality of life, control, productivity, unmet need, use of preventative health care, and cost. The need to build the evidence base for person-directed services, to address barriers to the expansion of these service models, to support advocacy efforts, and to bolster the political will required for directing substantial resources to person-directed long-term services is emphasized.