In the last 15 years, there have been a number of studies conducted on different person-driven models of service.  These studies range from small qualitative studies to large sample quantitative studies.  This research should inform policy and practice here in Pennsylvania.  To help build the evidence base for person-driven services, the Institute on Disabilities is compiling and summarizing the findings from this research.

Case Studies from Other States:

Person-driven services can produce better outcomes and save money:


  • After nine years of implementing a cash and counseling demonstration in Arkansas, the state reported a cumulative savings of $5.6 million.  These savings do not reflect the additional savings the state reported from reduction of nursing home utilization.1
  • A cash and counseling program in Rhode Island was reported as “a cost effective alternative,” and “will undoubtedly remain.”2
  • People directing their own care in the Kansas Physical Disability Waiver program spent 3% less on services than individuals in an agency directed program and hospital long-term and inpatient costs were 38-64% lower for the same individuals.3

Satisfaction and Quality of Life:

  • People directing their own care via programs like cash and counseling are overwhelmingly more satisfied with services than those who do not direct their own services.4
  • Consumers participating in cash and counseling programs reported higher quality of life than people taking part in traditional care.5

Met versus Unmet Needs:

  • Individuals in consumer directed programs were more likely to report that their personal assistance needs were met, and that there was more flexibility than in traditional care models.6
  • More people acquired the equipment they needed in cash and counseling programs than in traditional care programs.7

1. [Dale, Stacy B. and Randall S. Brown. “Reducing Nursing Home Use through Consumer-Directed Personal Care Services.” Med Care 44.8 (2006): 760-7.]
2. [Doty, P., K.J. Mahoney, and M. Sciegaj. “New State Strategies to Meet Long-Term Care Needs.” Health Affairs 29.1 (2010): 49-56.]
3. [Kim, K.M., G.W. White, and M.H. Fox. “Comparing Outcomes of Persons Choosing Consumer-Directed or Agency-Directed Personal Assistance Services.” Journal of Rehabilitation 72.2 (2006): 32-43.]
4. [Carlson, Barbara Lepidus, et al. “Effects of Cash and Counseling on Personal Care and Well-Being.” Health Services Research 42.1 (2007): 467-487. Hagglund, Kristofer J., et al. “A Comparison of Consumer-Directed and Agency-Directed Personal Assistance Services Programmes.” Disability & Rehabilitation 26.9 (2004): 518-527. Schore, J., Foster, L., & Phillips, B. “Consumer Enrollment and Experiences in the Cash and Counseling Program.” Health Services Research 42.1 (2007): 446-466.]
5. [Fleming-Castaldy, Rita P. “Are Satisfaction with and Self-Management of Personal Assistance Services Associated with the Life Satisfaction of Persons with Physical Disabilities?” Disability & Rehabilitation 33.15-16 (2011): 1447-1459. Powers, Laurie E., Jo-Ann Sowers, and George HS Singer. “A Cross-Disability Analysis of Person-Directed, Long-Term Services.” Journal of Disability Policy Studies 17.2 (2006): 66-76. Young, Heather M., and Suzanne K. Sikma. “Self-Directed Care: An Evaluation.” Policy, Politics, & Nursing Practice 4.3 (2003): 185-195.]
6. [Schore, Jennifer, and Barbara Phillips. “Consumer and Counselor Experiences in the Arkansas Independent Choices Program.” Princeton, NJ: Mathematica Policy Research, Inc (2004).]
7. [Lombe, Margaret, Michelle Putnam, and Jin Huang. “Exploring Effects of Institutional Characteristics on Saving Outcomes: The Case of the Cash and Counseling Program.” Journal of Policy Practice 7.4 (2008): 260-279.]