Attendant care as a prototype independent living service

Of all the services and programs associated with the movement for independent living, attendant care has particular symbolic significance for the movement's adherents. Because it is a self-directed service, attendant care can be contrasted with home health services which are directed by professionals and agencies. This article demonstrates how attendant care mirrors key independent living values and concepts, partially by evaluating the provisions of attendant care services under titles XIX and XX of the Social Security Act. An analysis is made of how selected states have used titles XIX and XX authority to make self-directed attendant care services available. Consideration is also given to how selected eligibility criteria for titles XIX and XX create serious work disincentives that compromise the independent living goals implicit in self-directed attendant care services. Funding prospects and their effect are on the future of attendant care also are discussed.