More InformationJHHSA Articles 
The Interests Of Three Stakeholders In Independent Personal Care For Disabled Elders
SHARON M. KEIGHER
JHHSA, Vol. 23 No. 2,
(2000)
There is concern throughout developed countries about how sufficient services can be
mounted in this century to care for all older, disabled persons who want to
remain at home. With declining availability of family care and high turnover among
paid workers, cost, care supply, and quality dilemmas abound. Therefore, how can
home care be improved? One suggestion is to revise the care "contract" by simply
eliminating the costly bureaucratic and controlling dimensions of agency oversight
and management.
In consumer-directed or self-managed care, independent workers are hired directly
by consumers or their family members. Consumers spend their own private money or
government provides authorization for them to "hire" their own workers. Such
arrangements may be more responsive to the needs of consumers, more directly
accountable to them, and less costly for both individuals and government.
This article examines 41 cases of consumer-directed care in Milwaukee. Extended
interviews with three "stakeholders" in care—the disabled, older client, the family
caregiver, and the personal assistant—were conducted, including both private pay and
government subsidized arrangements. This analysis identifies some essential, but
disparate interests of the three partners in care.
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