Abstract
The idea of participant-directed care for people who require personal assistance in performing activities of daily living is an old concept that became energized through public policy changes in the United States during the 1990s. Participant-directed care went from what seemed like a European idea to a 1970s and 1980s priority for mostly nonelderly advocates in the Independent Living Movement to a “normal practice” supported by public policies related to Medicaid and Veterans Administration services starting in the 1990s. In addition, private payers generally now allow for participant-directed care through cash payments for people qualifying for personal assistance. This paper focuses on where the field of participant-directed care is likely to go next from its current status in the American health care system. First, the paper takes a quick look backward to review how participant-directed care made it to where it is today and it reviews where this approach fits into the American system (or nonsystem) of health care payment and insurance policy. The paper then considers how the current changes in health care payment and insurance policy and the growing consolidation and integration of care delivery may impact the future of participant-directed care.
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