Evidence Summary

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Consumer-directed care can empower older people and their caregivers by offering them greater flexibility and by increasing their involvement in care-related decisions.

Ottmann G, Allen J, Feldman P  A systematic narrative review of consumer-directed care for older people: Implications for model development

Review question

  • What are older people’s preferences for and levels of satisfaction with consumer-directed care?


  • Consumer-directed care models give control over home-based care to consumers, and usually involve transferring cash or vouchers to enable them to make their own care choices and purchase the care they need. 
  • Consumer-directed care is becoming increasingly common, although approaches differ across countries.
  • Studies have found high levels of satisfaction with consumer-directed care, and that this approach can also reduce carer burden, although older adults have been found to be less interested in this type of care when compared to younger adults.

How the review was done

  • The review identified all relevant studies published from January 1992 to August 2011.
  • A total of 17 studies that focused on describing the perspectives of clients and caregivers about consumer-directed care strategies were included. 
  • The study was co-funded by the Helen Macpherson Smith Trust, Percy Baxter Charitable Trust, B.B. Hutchings Bequest, John William Fleming Trust and the Australian Research Council.

What the researchers found

  • Many older people want greater involvement in care-related decision-making, demand greater flexibility in spending their care allowances, and want more control in employing personal-care workers.
  • A broad range of personalized options should be available to older adults, as preferences for consumer-directed care programs vary widely depending on personal preferences and support needs, as well as social situations and where they live.
  • Older people may not have support from families and friends, which requires that social and community supports be developed with consumer-directed care programs.
  • Decision-making support and assistance with the range of administrative and accounting tasks related to consumer-directed care programs can increase older people’s acceptance of and readiness to enroll.
  • Flexible care options ranging from full self-direction to full support from case managers are needed to meet the diverse needs of older people.


  • Consumer-directed care has the potential to empower older people and their caregivers by offering them choice and flexibility and engaging them in care decisions, but these programs need to be personalized to meet the varying needs and preferences of older people.

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