Personal assistance services: The
Hub of the Policy Wheel for Community Integration of People with Severe Physical Disabilities
Nosek MA, Howland CA. Personal assistance services: The
hub of the policy wheel for community integration of people with severe
physical disabilities. Policy Studies Journal 1993;21(4):789-800.
ABSTRACT
The success of persons with severe physical disabilities in living independently
in the community, engaging in self-directed productive activities, and
staying healthy depends, in part, on getting and maintaining adequate personal
assistance with basic tasks such as getting out of bed and tending to personal
hygiene. Although few policymakers would disagree with the contention that
many people with disabilities need assistance with daily tasks, there is
considerable debate about who should provide assistance, what services
should be included, who should pay, who should be entitled to publicly
provided and paid services, how much assistance should be provided, and
who should control its administration. The prevailing model for delivery
of personal assistance services has been primarily medical, with control
of services by health care professionals, rather than independent living,
with control by consumers receiving services. Traditionally there has been
an institutional bias of funding for disability-related service, despite
its much higher expense than community-based personal assistance services
and its violation of basic human rights. Proponents of various solutions
to health care reform have given little consideration to the provision
of support services for people with disabilities. The advantages of implementing
a uniform national system for the delivery of personal assistance services
based on consumer control are discussed.
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