Influence of a Consumer-Directed Personal Assistance Services Program on the lives of persons with mobility impairments

David B. Gray, Ph.D., Jessica L. Dashner, O.T.D., O.T.R./L., Kerri A. Morgan, M.S.O.T., O.T.R./L., Melissa Lyles, M.S.O.T., O.T.R./L., Michael D. Scheller, P.T.A., Carrie L. Morris, B.A., Holly H. Hollingsworth, Ph.D.

Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA

Disability and Health Journal,  October 2009 Volume 2, Issue 4, Pages 188–195


To examine the effects of a consumer-directed personal assistance services (CDPAS) program on the lives of persons with disabilities.


Thirteen individuals receiving paid agency-directed PAS services before enrollment in a CDPAS program (Agency Group) and 40 individuals receiving only unpaid PAS before enrollment (Informal Group) participated in this prospective study. In-home interviews were conducted just prior to CDPAS enrollment and again 6 months after CDPAS enrollment.


Overall choice and satisfaction with PAS improved significantly for both groups after CDPAS initiation (p < .05). Total PAS hours increased significantly for the Informal Group (p < .01) but not the Agency Group. The Informal Group used relatives to provide the majority of its CDPAS hours, while the Agency Group chose to use nonrelatives and nonfriends to provide the majority of its CDPAS hours. Few significant changes in health status were observed for either group after the CDPAS intervention, although most changes were in the positive direction. The CDPAS program did not appear to have a large effect on individuals’ personal and community participation, but participants reported a relatively high quality of participation at both time points.


This study supports other findings that consumers prefer CDPAS to agency-directed care and provides new evidence that this preference cannot be explained by an increase in PAS hours that often accompanies enrollment in a CPDAS program. Although CDPAS appear to have subtle positive effects on consumer health and participation, ways in which CDPAS can maximize health status and participation quality among consumers should be explored.