A/HRC/28/37 work, as well as those who formerly worked, in residential institutions to ensure that they actively contribute to the transformation and complement the deinstitutionalization process. 38. Persons with disabilities must have control over the support provided and be the ones who hire, employ, supervise, evaluate and dismiss their assistants. The possibility to choose between different service providers is a way to make the services more accountable, increase control by the user and provide protection against the risk of abuse. There may be a variety of providers, including the State, as well as providers from the private and nonprofit sector, although in practice the choice may be limited by the type of impairment or the available service alternatives. Payment to users rather than providers contributes to ensuring that the support is person-centred and respects the preferences of the person with disabilities. In several countries, direct payments rather than services in kind have been introduced, often in the form of a personal budget payable to the eligible person. In Germany, by 2009 about 10,000 recipients, 31 per cent of whom were persons with intellectual disabilities, had opted to receive vouchers. Independent planning support and facilitation services may be required to assist the person in deciding how to use personal budgets. The National Disability Insurance Scheme currently being piloted in Australia will provide persons with disabilities with individualized planning support to identify suitable and necessary services based on their functional needs rather than on diagnosis. 39. Lack of adequate human resources, poor service coordination, disparities in access between urban and rural settings, and the conditions attached to the provision of support (for example, when dependent on a specific living arrangement) are some of the common barriers to adequate community support services. Lack of information and awareness is often another reason for the exclusion of persons with disabilities. Inappropriate policy and institutional frameworks, as well as the lack of knowledge of policymakers and service providers, often result in low quality support, routinely geared towards medical or charity approaches. There have been instances in which personal assistance has been misused. At the policy level, regulations have failed to establish guarantees for user control over budget and services. At the practical level, service providers have absorbed budgets to cover general expenses, instead of providing individualized services, or personal assistants have imposed decisions or actions on the user. In order to avoid such abuse and ensure that the user has control over the budget and supervision of the personal assistant, a correct understanding of the concept of personal assistance is essential. 31 This is also needed to enable users to enjoy access to effective redress and remedy. 40. Eligibility criteria for access to support services need to be defined in a nondiscriminatory way. In particular, the assessment should shift from a medical to a human rights-based approach to disability, focus on the needs of the person rather than the impairment32 and respect individual choice and preferences by ensuring the participation of persons with disabilities in the decision-making process. In defining criteria, it is also important to ensure that persons with disabilities have equal access to support. Here, adopting an open concept on disability compliant with the Convention on the Rights of Persons with Disabilities (art. 1, second paragraph) is an essential step. 41. There are different options for covering the costs of support services. Some States cover the entire budget for service delivery and provision, while others share costs with beneficiaries. Sometimes services are provided directly by organizations of persons with disabilities, which can receive co-financing by State or local government, or can raise their 31 32 12 The European Network on Independent Living, for instance, has proposed a definition of personal assistance, available from www.enil.eu/policy/. The Committee on the Rights of Persons with Disability has expressed concern about linking the eligibility of social services to a specific grade of disability. See, for instance, CRPD/C/ESP/CO/1.