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How disability is compensated for is mainly a function of the human care that people with disabilities receive. When they decide to pay their carers directly, they become individual employers. 70,000 disabled people have made this choice in France. Among them, the majority pay for a relatively low degree of help by direct employment. But only 2%, little more than 200 people, that is about a quarter of those with serious and multiple disabilities, use 12 daily hours or more. For these people, the organization of their human help as direct employment is a deliberate choice. The more the person concerned needs help, the more is at stake when becoming a direct employer. To choose and manage the people who care for them enables them to increase their autonomy, by deciding for themselves, with the idea that participation in the organization of one’s own existence is the first step towards a wider form of social participation.