Occupational justice in direct-funded attendant services: Possibilities and constraints

In direct-funded attendant services, public funds are transferred to service users to recruit, hire, train, and manage support staff. An outcome of activist efforts to deinstitutionalize support services, direct funding models are often said to increase the choice and control that disabled people have in their attendant services and in everyday life. Focusing on one direct funding program in Ontario, Canada, the overarching reflexive ethnographic study explored the work that physically disabled adults contribute to organize and manage their own attendant services. In this paper we present a secondary analysis of qualitative interview data, examining the impact of participation in direct funding on service users’ occupational engagement. The results of this analysis suggest that direct funding promotes occupational rights by providing supports needed to participate in a range of meaningful occupations. At the same time, occupational engagement was found to be constrained at individual and group levels. In this paper we apply occupational justice concepts to analyze systemic constraints on occupational engagement and occupational choice, including program eligibility criteria and societal factors that condition access to and use of public resources. The discussion highlights how direct funding can support occupational engagement and constrain occupational choice, illuminating the complexity of occupational justice as a dynamic concept that may be promoted and obstructed simultaneously within a given context. We situate direct funding within an ongoing history of institutionalized supports for disabled people and identify specific factors that may promote or inhibit the occupational rights of disabled people who use direct-funded attendant services.