Throughout home care, consumers have traditionally had little choice in the manner in which care is provided to themselves or their loved ones. In recent years, the model of Consumer Directed Care has become the most widely accepted and effective way to promote choice and flexibility.

On several fronts, the Consumer Directed model of care has shown to be preferred over Agency Directed Care:

  • Cost to the Consumer – Consumer Directed Care typically costs approximately 20-30% less than Agency Directed Care
  • Consumer Participation in Decision Making – Consumers can choose their own caregivers, and communicate directly with the caregiver regarding how their care is provided.
  • Greater Caregiver Continuity – With this model of care, the only parties with a right to change the arrangement are the consumer and caregiver.  Often with Agency Directed Care, the agency can change caregivers based on business needs. (See, Benjamin, Mathias and Franke, Comparing Consumer-directed and Agency Models for Providing Supportive Services at Home, Vol. 35 Part II, Health Services Research No. 1 Selected Papers From the Association for Health Services Research Annual Meeting (April, 2000) at 351, et seq.)
  • Caregiver Compensation – Caregivers generally receive higher hourly rates than their counterparts in the Agency Directed Care model.



Within the Consumer Directed Care Model, consumers have two options: Utilize the services of a Nursing Referral Services Agency, or locate a caregiver "on their own."

Licensed by the state of Maryland Department of Health and Mental Hygiene, Office of Health Care Quality, Nursing Referral Services Agencies (NRSAs) are companies that match self-employed, independent contractor caregivers with consumers. NRSAs perform a rigorous screening process that most consumers are not equipped to do on their own, with requirements such as:

  • Appropriate licensing or certification
  • Driver’s license or state identification card
  • Proof of work authorization (i.e. Social Security card, birth certificate, driver’s license, passport, work permit, etc.)
  • TB Screening
  • Hepatitis B screening
  • Criminal background check
  • Employment and character references
  • Employment background verification
  • Current CPR, if applicable