Personal Assistants : Ideals of social Care-Work and Consequences for the Norwegian Personal Assistance Scheme 1 By

Ideal models of care change over time. In the case of personal assistance services, the major actors are influenced by different ideals of social care work. This article is based on a survey among personal assistants in Norway, with a central finding that assistants emphasise, to various degrees, the ideal of caring rationality or a service orientation model The personal assistance scheme has many inbuilt dilemmas, such as user-control in contrast to co-determination of assistants, as well as continuity of help in contrast to continuity of relations. This article discusses whether matching assistants and users with mutual interests and similar expectations can help to reduce the inbuilt systemic dilemmas.


Introduction
Personal assistants are a new occupational category in Norway. This new group has emerged from the development of the Personal Assistance (PA) scheme. This scheme was inspired by the Independent Living (IL) movement that flourished in the United States during the later 1960s (cf. DeJong 1983). The Norwegian Government's plan of action for disabled people for the period 1994-97 launched PA as one of the Government's new priorities. At the end of 2002, about 800 persons were granted personal assistance with financial aid from the state. Nearly 2,500 persons worked as personal assistants at that time.
In Norwegian public documents, PA is described as "an alternative way of organising practical and personal assistance for people with severe functional disabilities who need support in normal everyday life, both in and outside the home" (Inst O nr 22 (1999(Inst O nr 22 ( -2000). Although the service is referred to as "an alternative way of organising assistance", "the user-as-manager" role is something qualitatively new in relation to traditional social services (Askheim & Guldvik 1999). I view personal assistants as a new occupational category, similar to the Norwegian worker groups known as home-helpers, personal support contacts, etc. This does not mean to say that personal assistants differ from other types of care-workers with regard to occupational or educational background or that their tasks are essentially different (Guldvik 2001). They are, however, distinguished from other careworkers by four main factors: • Personal assistants work for one individual user only; • the user participates in the recruitment process; • the user is the manager of the work, and • personal assistants are expected to carry out services both in and outside the home.
A key-concept of PA is user-control. In Norway, the idea of user-control is contained in the very name of the service: 'user controlled personal assistance' (brukerstyrt personlig assistanse), in contrast to for example the Swedish term which does not emphasise user control (personlig assistans) (Askheim 2001a). User control and user influence are terms with highly positive connotations (Rønning & Solheim 1998). In the PA scheme, the concept of user-control has been formalised through designating the user as the work manager for his/her assistants. Work management means that the user decides both the form and the content of the service, (what tasks should be performed, when and how they should be performed, the assistant's working hours, etc), while the local public authorities determine the scope of PA. To prepare the users for managing these tasks, the majority of them follow courses arranged by public authorities. These courses are developed and carried out in cooperation with representatives of both user and personal assistant organisations. The extent to which users actually exercise control over social care services will nevertheless tend to vary according to their capacity and motivation for doing so.
Working as a personal assistant is challenging. The assistants experience their personal relations with the user as multi-faceted and complex. A frequent comment is that the most positive aspect of the work is the relationship with the user, and the sense of fellowship. This relationship is described as unique, as well as socially and emotionally inspiring. However, many assistants also stress the need to set limits, explaining that the relationship may tend to become too intimate, and that it is important to separate working relations from friendship (Gough 1994;Askheim & Guldvikl999). The challenge lies in maintaining a balance between intimacy and distance in situations where the assistant works alone with only one user.
Assistants have varying approaches towards their work, emphasising usercontrol, caring relations, service orientation, co-determination, etc. to various degrees. These varying approaches or ideologies will, in the next instance, have an effect on both usercontrol and on the ways PA services are organised. The assistants' various approaches and the users' different expectations towards the service and their capacity for user-control may create dilemmas between the two parties. This article focuses on the two following questions: 1) What social care work ideals are characteristic for the personal assistants? 2) How do ideals of social care work influence the relations towards users and user-control?
Possible consequences of different assistant approaches/ideologies for the future development of PA will then be discussed.

Methods
This article is based on material from a survey conducted among personal assistants in Norway (Guldvik 2001). The aim of this study was to examine job experience of personal assistants. The questionnaire was fairly comprehensive and contained questions about the background of assistants, their motivation/wishes for seeking such work, the recruitment process, their working conditions, tasks and worksettings, as well as their satisfaction with different aspects of the work. Most of the questions had fixed response categories, but some questions were open-ended. Because of the extensive task of procuring an overview of names and addresses of all PAs in Norway, it was decided to concentrate efforts on only half of them. The questionnaire was sent to approximately half of the known population of PAs in 1999, a total of 680 assistants. Completed questionnaires were received from about 70%, a response rate which can be considered reliable for drawing conclusions about the personal assistant group as a whole.

Social care work ideals and job motivation
Notions about ideal models of care change over time. Traditionally, the home-helper in Norway has had her/his fixed list of service recipients/ users with whom she/he established fairly stable, personal care relations, and also, there were previously no requirements concerning formal qualifications. During the 1980s and '90s, home care-work in Norway showed an increasing trend towards professionalisation. Instead of working with one person, the homehelper had increasingly several clients/users. As a result of more education and a growing sense of professional identity, there was a clearer demarcation between home-helpers, as well as care-workers in general, on the one hand, and users on the other, where care workers' loyalty to managers and colleagues competed with loyalty to the individual user. In terms of form and content, the job has moved away from the focus on care and "others" to a taskbased, nursing orientation (Thorsen  2000).
Schematically, one can describe three different ideal-types of social care-work: the care ideal, the rehabilitation ideal, and the service ideal (Hugemark & Wahlstrom 1999). These approaches imply different perceptions of both user and helper, as well as of their differing understanding of the aims of the help provided. In the care ideal, the user and helper together, through dialogue, arrive at "the good life" for the user. This means that the helper is involved in decisions concerning both form and content of the service offered. The rationality of caring is integral to the care ideal. The caring rationality emphasises that rationality must not exclude feelings; on the contrary, feelings must be included if actions are to be considered rational (Christensen & Syltevik 1999:13). The care ideal lies close to the traditional home-helper's way of thinking and acting.
The rehabilitation perspective is a likely result of care-workers becoming more professionalised. If the objective is medical rehabilitation, the helper becomes the expert who knows best how "the patient" should be treated. The expert has "the last say" when it comes to defining the patient's problems. The Independent Living movement has raised strong objections to what they call the "the rehabilitation paradigm", where disabled people are expected to act like clients, including taking instructions from professional actors within the health and social care sector (cf. Oliver 1993). In other words, this is a traditional, medical rehabilitation approach. Nevertheless, the rehabilitation ideal today stresses that the user should have influence on the services offered (Norwegian Ministry of Health and Social Affairs 2001).
The service ideal emphasises user management of a service-oriented helper. This ideal gives the user the explicit right to decide which tasks should be carried out, when and how. From this point of view, the user is the expert, and the goal is the user as a satisfied customer. The IL ideology prescribes de-professionalism as a means toward gaining freedom and independence for disabled people (Oliver 1993). These are ideal types and theoretical constructions. Even if there is a historical line in the development of these various models, they have not replaced each other but rather co-exist within present-day social care services (Hugemark & Wahlstrom 1999).
Personal assistance was established to comply with the critique of certain aspects of social care services. One of the reasons for introducing PA into the repertoire of social care services in Norway was that users should have greater continuity in relation to helpers, i.e. fewer individual helpers per user. People struggling with disabilities should be spared from having to relate to many different helpers (Askheim & Guldvik 1999). From this point of view, the establishment of PA may open for a return to a traditional type of organisation, i.e. the care ideal, with personal, stable social care relations.
Nevertheless, this conclusion should not be taken too far. Personal assistance is established in another historical context than the early home-care services. Most current social care work practice is marked by professionalisation and an end-means rationality which emphasise effective task-solving (Waerness 1999). These experiences will also mark the interpretation and implementation of the PA scheme (Hugemark & Wahlstrom 2002). In addition the IL-ideology expresses a view of the user as an actor who should decide and control how the help is to be designed. This role is quite different from the role of the user in traditional social services (Williams 2001). According to the Independent Living ideal, the provider of social care services should first and foremost be service-oriented, try to fulfil the customer's requirements, and not be "dazzled" by care ideals. These are values closely connected with the service ideal.
I will apply the care and the service ideal for my analysis. The reasons for choosing those two, and not the rehabilitation ideal, are both substantial and also pragmatic. My aim is to highlight the assistant's relationship with the user, including the assistants' codetermination on the one hand, and usercontrol on the other, as they appear from the more "traditional" care worker approach, i.e. the care ideal, and the more "modern" approach of the service ideal respectively. The care ideal and the service ideal emphasise relations towards the users and user-control to various degrees. If we, from a pragmatic view, are searching for the "traditional" medical rehabilitation perspective, the empirical material does not encompass suitable data. In addition, the empirical material makes it difficult to separate the rehabilitation ideal from the care ideal if we look at the "modified" rehabilitation perspective, consisting of co-operation between the "expert" and the user.
As previously noted, the PA scheme builds on ideas from both the care and the service ideal. With such a background, the services offered by the assistants will, more or less, be marked by values from the two ideals. My presupposition is that assistants have different motives for the job, and hence they will form the job in different ways. However, the question of job motivation is complex. Several studies have tried to connect job motivation and satisfaction with what people appreciate about their work situation. One way is to characterise motivation as forced by internal versus external factors. Herzberg's model distinguishes between "internal factors", i.e. those related to the interplay between the employee and the job, and "external factors" as salary, benefit, work conditions, etc. (Kaufmann &Kaufmann 1996).
The assistant's motivation for the job may, on the one hand, come from "internal factors" such as the relations between the employee and the work manager, possibility of involvement, and responsibility. This assistant will expect close relations towards the user and dialogue concerning how to form the service. Co-determination is central in such a relationship. These factors are closely connected with the care ideal.
On the other hand, the motivation may also be tied to Herzberg's "external factors", such as salary and working conditions. The assistant will expect that he/she should do an "ordinary" job and fulfil the user's wishes and orders. The assistant will not involve her/himself in a dialogue about "the good life" for the user. The user should decide which tasks will be carried out. Assistants, whose motives are external, may not consciously enter into a service-oriented ideal, but the practical consequences of this approach will fit into the service ideal. In addition, the job must be seen in a broader perspective. The job may be instrumental in relation to fulfil other goals (Bj0rvik 1987). Personal assistance is mainly a part-time job. Most assistants combine personal assistance jobs with other activities. When students, for example, work as personal assistants, they do so partly to finance their studies.
of the assistants as a group is presented. Second, the data material is used to create two assistant profiles or ideal types, which give the care and service orientations different weight. Selected characteristics of the assistant profiles and their working conditions are illustrated. Further, the profiles are used to describe and analyse the assistants' relations towards the user and degrees of user-control.

Empirical findings
This section builds on empirical data from the survey. First, a brief overview

Assistants as a group
The personal assistants were mainly women, aged 30 -40 years and educated to upper secondary school level. Most of the assistants worked part-time, in many cases quite a limited number of hours, and two out of three combined the job with paid or unpaid work or studies. Almost two out of three assistants had flexible working arrangements, i.e. an agreement about varying working hours or no fixed working hours. Even if the job was part-time, the social engagement among assistants was strong. Many of them had a genuine wish to work with people. Nevertheless, many assistants also mentioned the need for paid work as a job motive.
The recruitment process was highly informal. Two out of three assistants heard about the job through personal contact with the user, through acquaintances, or through the local municipalities.
Therefore, many assistants knew the user before they became assistants. The remainder of the assistants were recruited through advertisement.
The results from previous studies indicate that personal assistants' experiences mainly have been positive (Gough 1994, Gough & Modig 1996, Holth 1996. This is also confirmed by this study. Four out of five assistants stated that they were generally 'satisfied' or 'very satisfied'. The picture varies more when the assistants assessed concrete aspects of their job. With regard to the relationship with the user, the assistants viewed the relationship more as a working relationship than a friendship. Communication, respect and tolerance between assistants and users were positively valued.
This picture is mainly a positive one, but the assistants also described problematic aspects connected with their job. The users' requirements for flexibility were in contrast with many assistants' wishes for stable working tasks and fixed working hours. Some assistants also experienced that the user involved them too much in their private life. This complex picture of how the assistants experience the job is probably one of the reasons why many assistants are uncertain regarding the future. Two out of five said they did not know if they would continue working as an assistant. An equal proportion stated they would certainly continue, and one out of five planned to quit their job.

Two assistant profiles -Huma and Pragma
Drawing on the assistants' stated motives for wanting to work as a personal assistant in our questionnaire I have cultivated two assistant profiles, the Huma and the Pragma profile. The first comprises assistants who answered that "the desire to work with people" and "interest in working in the social care sector" are "very important", that is to say "internal factors". These are the "humanists" among the assistants. The second profile characterises assistants who express "external factors" and can therefore be called the "pragmatists". This group comprises assistants who stated that "the need for paid employment" and "the possibility of combining work with other activities" is "very important".
The groups are mutually exclusive in the sense that the assistants have answered "very important" to both variables belonging to either the humanist or pragmatist profile, while none have answered "very important" to the variables in the other profile. The groups are small and it is only a minority of assistants who represent such "pure" profiles. All together the pragmatist profile consists of 24 assistants and the humanist of 36 assistants. This classification serves to illustrate assistants' varying motives for undertaking this kind of work. On this basis, we can imagine these groups as ideal types at the respective ends of a continuum, where the one type of assistant stands for the care ideal and the rationality of caring and is called Huma, while at the opposite end we find the type characterised by the service ideal and the end-means rationality whom we can call Pragma. Since the numbers are small, we should be cautious in interpreting differences between the groups, but such differences can reveal certain trends in the material. Between these two theoretical extremes, assistants have elements of both rationalities, some leaning more toward the care ideal and some more toward the service ideal.
If we look at the characteristics of assistants representing these two "pure" profiles, the following picture emerges.

Figure 1 Characteristics of the two assistant profiles
Pragma is just under 30 years old and has education up to the college/ university level. She was a student before taking the personal assistant job and still combines the job with study. She is either unsure of the future in regard to her job as assistant, or she is planning to leave. Pragma heard about the job through an advertisement and had no previous acquaintance with the user.
Huma is almost 40 years old and is educated to upper secondary school level. She was already in employment before starting work as an assistant. Huma combines her job with work in the municipal social care services. In regard to the future, she has no plans other than remaining in the job. Huma knew the user before she started. She came to hear of the job through an advertisement or through personal contact with the user.
Pragma tends rather more frequently than Huma to work part-time and for a limited number of hours (less than 14 hours a week). With regard to flexibility, Pragma has more flexible arrangements than Huma, i.e. to a greater extent she has no fixed working hours and more week-end working hours.
When it comes to satisfaction with basic working conditions, Pragma is generally more satisfied than Huma. This seems to suggest that shorter periods of part-time work and flexible working arrangements harmonise with Pragma's wishes for the job. Her job expectations are probably moderate because she has a relatively short time perspective in relation to her assistant job. The job acts more as an "instrument" for continuing her main activity, continuing her education. She is therefore not so concerned about the basic working conditions provided, as long as the daily routine works smoothly enough. For Huma on the other hand, the job of personal assistant is one she has aspired to and about which she has certain expectations. She also plans to stay in the job, and good working conditions are therefore important for her job satisfaction.

Relations towards the users
According to the data material, representatives of these two "assistant profiles" approach the job in different ways, in regard to how they experience their relationship with the user. In Huma's experience, the assistant/user association is equally a working relationship and one of friendship. The positive relations towards the user and the caring ideal create an involvement, which tends to be an intimate relation between the two parties. Pragma is much more inclined to experience it as a working relationship. She has a more distanced relationship towards the user and a more "professional" approach to the job.
The end-means rationality of the Pragma profile leads to the service ideal with the satisfied customer as the overall goal. The work manager is viewed as an independent person capable of making decisions about his/her own life, and the relationship between user and assistant is an ordinary working one. Pragma represents the "ideal" assistant from an Independent Living point of view, where the user has the position of an actor who is an expert on her/his own life. Pragma represents a "waiter ideology", executing the user's "orders" first of all because it is practical and functional in relation to the main activity she is pursuing, but also because the "customer is always right".
The Huma profile, who has been motivated to take up this type of work from a caring rationale, lies close to the traditional Norwegian home-helper role, in which user and assistant in fellowship will arrive at what they see as "the good life" for the user (Hugemark & Wahlstrom 1999). The working relationship and friendship between user and assistant are the essential aspects. This collaboration can in turn lead to limitations on usercontrol because Huma is anxious to exert some influence for "the good of the user" (Skar & Tamm 2001).
Huma and Pragma view their collaboration with the user in much the same positive ways, with regard to communication, reliability and respect. Personal chemistry and common interests work better according to Huma than from that we can find in Pragma's answers. Huma's positive experience of her relations with the user can be an effect of the fact that she learned about thejob through personal contact with the user and/or that she knew the user before she started thejob.

Degrees of user-control
If we look at the idea of PA, the main intention is that the users themselves should determine what tasks should be performed. Work management, however, is not an absolute requirement that can be imposed on the user. Generally users vary in their capacity for user-control and for undertaking the responsibility of managing the work. Factors such as age, type of disability, personality, user experiences, the extent to which assistants "take charge" etc, also affect the degree of user control (Askheim & Guldvik 1999, Hugemark & Wahlstom 1999, Askheim 2001b. In certain situations, both minors and intellectually disabled individuals may be offered PA (Rundskriv 1-20/2000), in which case parents or other persons close to the user may exercise work management.
From the point of view of both Huma and Pragma, user-control is real but not absolute, in regard to who decides what to do. To a great extent, users have either main responsibility or co-responsibility for deciding which tasks assistants should perform. Many more "pragmatists" than "humanists" stated that the user decides which tasks should be performed (92% and 69% respectively). Such user decision would be in accordance with the Independent Living Ingrid Gulch ik ideology. According to the data in this study, "humanists" use more of a codeterminative way of making decisions, either in collaboration with the user, the employer, or other persons exercising work management. There would therefore appear to be varying degrees of user-control or user influence in PA, since the determination of tasks is a responsibility the user either has her/himself or shares with several of the people who are involved.
User-control or influence in practice, however, is not without its problems for the assistants. The "pragmatists " seem to have problems with the user being "bossy". Why do the "pragmatists", influenced by the "waiter ideology", experience it as "bossy" when the users do what they are expected to? Most employees anticipate, or they have become used to, some degree of codetermination in the job situation. If it is largely the user who decides what tasks are to be performed, the assistant may experience the user as being "bossy". That is to say, that the users are expected to be managers, but not "bossy" managers. For the assistants, this may be the cost of "strong" user-control. The "pragmatists" also feel that users involve them too much in their private lives. The two types of assistants probably view the degree of involvement in the user's private life differently. What the "pragmatists" regard as inappropriate involvement may be seen as natural participation by the "humanists". Neither is Pragma used to be involved in an intimate dialogue with the user in the same way that Huma is used to.
Almost every sixth assistant, "humanists" and "pragmatists" to the same extent, experienced that usercontrol is exercised at the expense of the assistant's right to co-determination. In other words, assistant "profile" seems to have little influence on how the assistants experience user-control versus assistant co-determination. The experiences will partly depend on the practice of user-control and partly on the assistant's expectations. User-control seems to be established to a larger extent among "Pragma-users" than among "Huma-users". On the basis of various degrees of user-control, an equal number of assistants experienced that it is hard to balance on the edge between assistant co-determination and user-control.
Equally interesting is the fact that an equal number of Huma and Pragma assistants, a total of one out of five, experienced the user as being too passive in managing the work. Here too, the degree of passivity will probably vary between the users. The point is, however, that perceived passivity in task-planning is just as great a problem as user-control exercised at the expense of co-determination. This challenges the very ideology underlying the system of user controlled personal assistance.
The observation that the assistants experience the users both as passive and "bossy" appears to be a contradiction.
Nevertheless, it is possible to understand this complexity. Traditionally, people who need help to handle their daily lives have been characterised and treated as clients or patients by the helpers (Askheim 1998). The role as a client requires passivity because the professional helper knows best what to be done. To transform the client role into the role of work-manager presupposes conscious raising, empowerment, knowledge and training. So what about the "bossy" user? The assistance takes place in private homes. Users often experience that the helpers to a great extent bring with them an institutionalised practice into their private home. The users often feel they have to "fight" to keep control over their private territory (Lillest0 1998). This strong need for control may result in a role which the assistant interprets as a "bossy" user.
This study confirms that the experiences of assistants are complex and diverse. Experiences of the Huma and Pragma profiles appear both similar and yet different.
Experiences related to relationships with users and user-control differ between the profiles. The differences show that it is fruitful to analyse the material along the two dimensions of the care and the service ideal. At the same time, an equal number of assistants from the two profiles have the same experiences on user-control exercised at the expense of codetermination and passivity among users. These experiences probably depend on the fact that the assistants are employees within a specific social care work context. Within the working life context they expect a certain degree of co-determination, and within the PA context they expect a certain degree of activity from the users.

Various directions of personal assistance in the future?
PA users are a heterogeneous group regarding user-control. Many of them have been inspired by the Independent Living tradition. They are relatively young, they are well educated compared to disabled people in general, and they are active in the interest organisations of disabled people. Some of them have been pioneers in the personal assistance movement and initiators of the PA scheme in Norway. Other users are less aware of the ideology of personal assistance, and did not know the arrangement before the local municipality offered them the service. Many of those users had been "trained" into a client role, and they prefer a dialogue with the assistant on which tasks and activities to be carried out when and how (Askheim &Guldvikl999).
Here too one can describe a continuum with two extremes, with the "ideologists" who are aware of their rights to execute user-control at one end, and the "traditionalists" who are not so engaged in user-control, but would like to involve the assistants to a greater degree at the other (Askheim & Guldvik 1999:36). According to the IL ideology, the "ideologist" would be the "up-todate" user who prefers flexibility of services rather than stable relations towards the assistants. The "traditionalist" is a more "out-of-date" user who emphasises safe and stable relations towards the assistants at the expense of flexible solutions and user-control.
What are the consequences of the different assistant ideologies for the future development of personal assistance? If we put together the user and the assistant profiles there is reason to assume that the "ideologists" among users and the "pragmatists" among assistants will have areas of mutual interest, the same being true of the "traditionalists" among users and the "humanists" among assistants. I intend here to highlight such areas of mutual interest in user-control versus assistant's co-determination and continuity of help (flexibility of service) versus continuity of relations (fewer helpers) (Naess 1999). This coincidence of interests can be described in terms of harmony, (see figure 2).
The "ideologist" prefers an assistant who can be "taken down off the shelf when needed. This means that the user can get the desired tasks done, but that the assistant is present for shorter periods of time because it is tiring for the user to relate to assistants over a longer period (Lillest0 1998). Pragma therefore does the work the "ideologist" decides. This way of organising the work is generally in line with Pragma's interests. There are no "ties" between user and assistant beyond ordinary working relations. Both the "ideologist" and Pragma will be satisfied with the way they cooperate (see figure 2, box 1). The "traditionalist" on the other hand is not primarily interested in user control but is more concerned that the assistant should practice co-determination and provide care. Huma's rationality of caring perspective fits into this setting. The user/assistant relationship is based on reciprocity and friendship (see figure 2, box 4).
An analysis of continuity of help (flexibility) versus continuity of relations (fewer helpers) produces a similar picture of common interest. The "ideologists" among users and the "pragmatists" among assistants both prefer continuity of help/flexibility of service. The user gives priority to a higher number of assistants and shorter periods of help. Pragma also prefers short working hours and flexible solutions (see figure 2, box 1). The "traditionalists" and the "humanists" give priority to continuity of care relations. These users and assistants value the stable relationship as one of the most important aspects of the working situation (see figure 2, box 4).
If we pair assistants and users with dissimilar approaches to collaboration, this may lead to a clash of interests between the two, because assistants and users see relations and task-solving in different ways. This opposition of interests can be described in terms of conflict (see figure 2). On the one hand, the "ideologist" wants to control the situation, while Huma may seek to influence it because of her rationality-ofcaring approach. The "humanists" will seek continuity of relations, while the "ideologist" prioritises continuity of help (see figure 2, box 2). On the other hand, Pragma expects the "traditionalist" to be the active party in the relationship, while the user in this case needs someone who is willing to collaborate in determining what form the services will take. The "pragmatist" focuses on continuity of help, while the "traditionalist" emphasises continuity of relations vis-avis the assistant (see figure 2, box 3).
Harmony and conflict can be illustrated in the following manner by putting together the different types of users and assistants: Explaining differences regarding social care work on the basis of some single factors is undoubtedly too simple. However, single variables can constitute a reasonable basis for discussions about how to interpret the material. One can also object to ideal models, in that they are dependent on a context, such that when external conditions change, so will both the content and the relative importance of the models change. Of course there will be a development in the roles of assistants over time. However, other studies also underline the dilemmas in the user-assistant relationship (Gough & Modig 1996, Noren 2000. Therefore it is useful to concretise how the actors experience the dilemmas and how it is possible to handle them for all of the actors involved. These user and assistant profiles have been naturally presented here in a schematic form. Nevertheless, they show that ideal types of users and assistants may "find" each other in coinciding interests, or on the other hand, suggest that one can try to avoid a mismatch of users and assistants. Moreover, it is possible that "well-matched" pairs of users and assistants can contribute in different ways to the development of the PA system. The service-oriented relations will contribute to improving certain aspects of these services, while the care-oriented relations will help to develop other aspects. In the longer term, this could lead to a two-pronged scheme in which "ideological" and more "traditional" solutions are found side by side. On the one side, we could imagine a type of PA system in which the principle of user-control is paramount and the assistant is a service person or "waiter" ready to carry out the user's orders. Simultaneously, there could be a PA system in which there is a more moderate degree of user-control, and the assistant's role is closer to that of the home-helper in the traditional home care services. The development of different PA schemes also includes tensions. Usercontrol is a term with highly positive connotations. In spite of this, absolute user-control is not necessarily desirable for all groups of users. Some users need to be protected against risks they are not aware of because their limited experiences in life (cf. Caruso 1999).
The care system is in any case responsible for the user's welfare, even if user-control is a strongly held value. The consequence of great emphasis on user-control may be that public authorities neglect to take responsibility for disabled people's welfare and life quality. The reverse would be that a strong "waiter ideology" could lead to a low quality service in which users for example lose functional skills in the name of user-control.
On the other hand, some assistants enter into a caring role towards users who leave the control in the hands of the assistants. In such a situation, the PAscheme will lose its most distinctive feature. The difference between traditional services and personal assistance will be vague. The question remains if one can then continue to conceptualise such a service as "user controlled personal assistance".
In earlier studies, we have discussed a possible bipartite division of the PA system on the basis of target groups eligible to receive PA (Askheim & Guldvik 1999). In making the Norwegian PA system statutory, eligibility for the service has been linked to the user's capacity for work management, but no absolute requirements have been made as to who can participate in the scheme (Rundskriv 1-20/2000). Development of the service will largely depend on what practices local authorities choose to establish with respect to the target group,