Beggars can’t be choosers: the rhetoric and reality of person-centered disability services in the United States

Abstract

This article examines the gap between the theory and practice of person-centered services for adults with intellectual disabilities in the United States. It explores the rhetoric of personalized services—it gives a history of social care, rehearses the logic of person-centered planning and outlines the tension of conflicting disability policies. Then it defines the nature of choice and explains how limited alternatives undermine choice. Next the article describes the reality of restricted service options, summarizing the conclusions of a survey of American families and a meta-review of the effectiveness of person-centered planning. After recapping the contrast between rhetoric and reality, objections to the analysis are addressed. Finally, the article offers solutions for service system transformation. While the thesis pertains to the United States, its lessons are applicable to other nations.