| In general, policy-makers and program developers have viewed age as a deciding factor in the development of programs and services in the United States. The prevailing service philosophy of the aging network of services in the U.S. has been that older adults are, by virtue of age, in need of intervention. This network of services has evolved primarily as an agency model of services limiting the autonomy of the older person in favor of 'professional' judgments. This study was undertaken to examine older adults who were participating in a "consumer-directed" model of support that required consumer involvement in decision-making in order to explore the experiences of older adults in this service environment that contrasts to the existing network.;A secondary analysis of qualitative data collected across three states during the Cash and Counseling Demonstration and Evaluation was conducted. The Semi-structured face-to-face interviews that were conducted with care unit members (i.e., triads composed of consumers, careworkers, and consultants) during the original demonstration and evaluation were recorded and transcribed. For the present study, using Atlas.ti, coding and analysis procedures included deductive and inductive methods in an attempt to capture emergent themes and relationships in the data. The secondary analysis for the present study included a purposive sample of 15 care units from three states selected from all consumers aged 60 and older (total of 45 interviews). Due to the contemporary nature of the topic as well as the real-life context of the data and the multiple levels of analysis, an embedded multiple case study approach was utilized (Yin, 1994).;This study was an exploration of the factors that influence the degree to which older adults direct their own care in a consumer-directed model of services and supports. Findings revealed there are four key factors that play a role in the extent to which older adults direct their own care in consumer-directed models of long-term care. These include whether the consumer has a family or non-family care worker, attitudes about old age, perceptions of choice and control, and prior care experiences. The findings from this study provide insight into the planning and implementation of service models for the elderly and highlight the importance of an increased awareness of care work relationship dynamics, attitudes about old age, and personal control in later life. |
