As the number of older people in need of long-term care increases, efforts to support older people remaining in their home are intensified in most OECD countries. In this context, there is a movement towards allowing more individual choice for older people receiving publicly funded long-term care at home. Having more flexibility in terms of how to receive care can increase the older person's self-determination and that of his/her informal caregivers. Having a choice among alternative care providers can empower older people as consumers and may help strengthen the role of households in the care-management process. The main aims of this article are (i) to categorise and analyse different types of arrangements allowing home care users more choice and map the prevalence of such arrangements in OECD countries, (ii) to give an overview of some country-specific outcomes in terms of care quality for care recipients, and (iii) to discuss some implications for employment and fiscal sustainability.