by Bob Kafka, ADAPT
 The disability community has not had good experiences with agencies that provide personal attendant services. Traditional home health agencies use a medical focus and tend to want to control what goes in the home of the service recipients. These negative experiences have deterred us from looking at alternative contract agency models -- models that are different from traditional home health and provide consumer choice and control although the agency remains the employer of record.
The "Agency with Choice" model instills the "Independent Living" principles in the contracts of all agencies that provide personal attendant services. These principles would be made requirements or minimum standards of the contract that would require consumer choice and control fundamentals. The ability to control the person who provides your personal attendant services is fundamental to the principles of independent living.
The disabled person would be able to select, manage and dismiss personal attendants. Service recipients would be encouraged to find their own attendants and send them to the contract agency for employment. If an individual cannot find an attendant, the contract agency would be required to send several people from among whom the disabled person can choose an attendant. Service recipients would also be able to dismiss the attendant if they cannot work together; however, the attendant would remain an employee of the contract agency -- available for referral to other people, unless abuse or neglect was the cause of the dismissal.
 Assessment of hours and services would be negotiated between the consumer and the contract agency, and an appeal process would be available if agreement cannot be made. Management of the hours and tasks, once assessed, would be the responsibility of the disabled person. Services would be available 24 hours a day, 7 days a week. Consumers would coordinate the schedule unless they requested that the contract agency act as scheduler.
The contract agency would be required to have back up and emergency systems in place as a fail-safe if the consumer's back up system fails.
Taxes, workers compensation, insurance and benefits would all be administered by the contract agency.
If multiple contract agencies provide the services in a given area, consumers would be allowed to choose any agency and to change agencies if they desire."
Concerns about the "Agency with Choice" model include:
- Will the contract agency cost more because of profit motive and administrative costs?
- Will people with disabilities and families truly have choice and control?
- What about bureaucratic rules and regulations?
- Can contract agencies really provide all the choices the independent living principles require?
There is no perfect model of personal attendant service delivery. We must assess the trade-offs and understand the implications of choosing one model over another.
One final point, the various models are not mutually exclusive and can be provided side by side or in combination. There are variations on the pure voucher, fiscal intermediary and "agency with choice" models that combine facets of each. This is called the Spectrum model. These variations and different options can meet the diverse consumer direction and self-determination needs of people with disabilities and family members regardless of these individual's ages, disabilities or skill levels.
- Bob Kafka
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