The one predictor that is counter-intuitive and difficult to interpret is that not having anyone to turn to for advice is associated with fewer reported incidents of provider abuse. Several of these relationships suggest that ease of communication with the worker and trust in the worker based on a prior relationship positively influence clients' sense of safety. That those who live alone should feel more secure seems more surprising because other findings generally point to the importance of informal supports in making it less likely that clients will actually experience threats to their safety. In other words, clients who live alone may feel more secure because they are more comfortable taking risks and are more confident in their own abilities to take care of themselves. Alternatively, those who live alone may perceive themselves to be more dependent on their workers, choose their workers more carefully, and, for that reason, feel safer with workers whom they trust.
More research is necessary to understand the dynamics at work here.
The issue is of interest because the disability rights movement has tended to equate independence and autonomy with being able to live alone and not relying on informal supports. Clients in the CDM as compared to the PMM and, within the CDM clients with family as compared to non-family providers, reported significantly more satisfaction with respect to amount of choice as well as more actual choice and greater preference for taking charge of training and supervision. It is particularly striking, for example, that, in this study, the professional management model was not found to have better outcomes with respect to client safety. Indeed, in the bivariate analyses, with respect to reported instances of neglect and suspected theft by providers, consumers in the consumer-directed model reported significantly fewer negative experiences. . . . Stratifying in this way increases the precision of the estimates.