Affordable, attainable, high-quality personal assistance services could enable millions of people with severe physical disabilities to lead productive and independent lives. Indeed, the degree to which these services are available and adequate in large part determines the potential of such persons to be employed and to be active participants in community life, regardless of the individual's inherent capability to achieve these goals. This article defines and estimates the need for such services and reviews literature that addresses issues of funding and service delivery mechanisms. The article analyses implications of a public policy focus on redirecting existing funding channels, the possibility of incorporating consumer control and other independent living concepts and techniques into existing service structures, the impact of reliance on family, and methods for making services available to a larger segment of the population in need.
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