Consumer direction in home and community-based long-term care systems

Abstract

One of the greatest challenges of our society is the provision of humane and affordable services in ways that empower, rather than disempower, its aging members (Minkler, 1985, 1996). The concept of “consumer direction, ” being the exercise of choice and control, is derived from the independent-living movement of the disability community (e.g. Gilleard & Higgs, 1998). Adults with disabilities have long articulated and acted upon a moral vision that maximizes the rights of disabled people to define their own destinies. The factors discussed as having contributed to a delay of consumer direction in the aging community are ageism, a narrow concept of autonomy, the biomedicalization of aging services, and fiscal and bureaucratic constraints (Minkler, 1987, 1990, 1997). Conceptual frameworks based upon the disability model that support the concept of consumer direction for the aging community, and its applicability to home and community-based (HCB) long-term care systems, are discussed. The central and interrelated themes of broadening the concept of autonomy, examining ageist assumptions in social policies and practices, articulating a vision statement, validating caregiving, providing a variety of services that are flexible and accessible, and implementing systems and policy changes are presented as elements of an integrative model of consumer direction for an aging population.