A pivotal issue in the design of home and community services programs is the extent to which clients control their services. A major innovation in long-term care in many states in the United States and in a number of European nations is the development of publicly-funded, consumer-directed home care programs. These programs give consumers control over who provides services, when they are provided, and how these services are delivered.
How these programs have evolved in the Netherlands, England, and Germany, and how they "fit" into the larger long-term care systems in these nations are explored in this AARP Public Policy Institute Issue Paper by Joshua M. Wiener of RTI International, Jane Tilly of the Urban Institute, and Alison Evans Cuellar of the Columbia University School of Public Health. (86 pages)