Beginning more than 30 years ago, many states began experimenting with a new form of home and community-based care for individuals who were directing in-home services. This alternative form of service delivery empowers individuals to direct their own care with the option of choosing some or all of their own care attendants and essentially serving as the direct employers of their caregivers. The movement gradually gained in popularity because individuals were ready and willing to take charge of their own care and experienced greater satisfaction with their lives once they had done so. In other states where the program has already been implemented, the level of satisfaction is reportedly very high.