This report, based on interviews with government officials, advocates, home care agency association staff, and union officials in CA, CO, KS, ME, MI, OR, WA, and WI, reaches four conclusions. Older people are less likely to want consumer direction than younger persons, but a significant minority of older people prefer consumer direction. Most stakeholders express concern about the capacity of persons with cognitive impairment to manage their care. The most contentious issue surrounding consumer-directed programs is quality and monitoring of care. Independent workers, many of whom are family members, appear to fare better than agency workers in their work environment, but do less well financially.