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5 Good Reasons Why You Should Consider Self-Direction

Post by: Marc Fenton

Self-direction, also referred to as participant-direction or consumer-direction, is an approach that helps aging adults and people with disabilities maintain their independence and stay in their homes and communities. With this approach, Medicaid recipients have more control over their approved services and supports. They hire service providers they want to work with and pay them using individual budgets that are available through a Medicaid waiver program.

Self-direction is based on the belief that people know their needs best and are in the best position to manage their services and service providers. Some people manage self-direction on their own. But many people have someone (usually a family member) who helps them make decisions and manage their service providers.

More than one million people in the United States are currently using self-direction, and new people are choosing this approach every day. Here’s why:


1. Self-direction is flexible

With self-direction, people work with their case managers to qualify for a set of services. Then they decide when and how they want their services delivered.

Instead of having a home care agency send a worker to your house for a 9:00 am to 5:00 pm shift, you can make your own schedule. You could hire someone to come in the morning for a few hours. You could hire someone else to come back after 5:00 at night. And you could have them tailor their services to your individual needs and preferences.

You can get even more creative than that. I know a young woman in Massachusetts whose family uses self-direction to get the support she needs to volunteer in the community, attend exercise classes, and receive training on new skills. That’s something she and her family wouldn’t be able to do with traditional home care agency services or a facility-based day program.


2. Self-direction lets you choose your service providers

Self-direction allows people to hire service providers to deliver their services and supports. You can hire workers you’re compatible with or workers who share your culture or interests.

For example, there’s a man in his 20s in Kansas who is autistic and passionate about music. His mother uses self-direction to hire other young people who love music to provide his services. He now gets his services delivered by people his age who also listen to and play music with him. This level of personalization is not available through a home care agency or a facility-based day program.

In some states, people can also hire family members to deliver services. Family members of aging and disabled individuals often have to quit their jobs because they simply can’t work full time and support a loved one. Self-direction can turn a challenging situation into a win-win situation. People get their services provided by a family member who knows and loves them. And family members earn income for the important services they’re already providing. Being able to hire family members is also very important in rural areas where there are not enough home care workers or professional home care agencies.


3. Self-direction is cost effective

People who use self-direction are given a budget and are in charge of their money and what they spend it on (with restrictions). People manage their budget to pay their service providers. Studies show that people who use self-direction spend their money wisely—paying for the services that give them the most benefit. People use their budgets to get what they need, not simply to spend their money.

Self-direction can also help individuals get more value for their money. For example, if you hire a home care worker through an agency, you may pay the agency $25 per hour, while the worker only receives $15 per hour. With self-direction, you could pay your workers $15 per hour directly (or more) and use the money you “saved” to pay for additional services.


4. Self-direction improves quality of life

Several surveys have been done in which people who use self-direction are asked, “Are you happy with self-direction and would you recommend the approach to a friend who has similar needs?” In nearly all of these surveys, more than 90% of people say yes. Individuals, their families, and their service providers all report high levels of customer satisfaction. Studies also show that, with self-direction, there are fewer hospital stays and lower rates of nursing home use.


5. Self-direction gives more power to the people

Self-direction puts control back in the hands of individuals, instead of home care agencies or government agencies. It’s a fundamental change in the way people on Medicaid are directing their services. People from all walks of life self-direct their services and supports. Children, adults, veterans, and the elderly use self-direction. People with physical or intellectual disabilities and people with mental health issues use self-direction. And people who live in cities, suburbs, and rural communities in all 50 states use self-direction.

Because self-direction is a Medicaid program, each state makes its own rules for how it works. To learn more about self-direction, ask your case manager. Better yet, ask your case manager if you can speak with someone who is already self-directing his or her services. As with most things, there’s nothing like talking to someone who has first-hand experience.

Of course, self-direction isn’t for everyone. There are risks involved. Individuals and their families may not want to take on the extra effort, management, and decision-making that self-direction requires. But self-direction is working well for a lot of people. And maybe it can work for you too.


Marc Fention is the founding director of Public Partnerships LLC, a PCG Company. A leading expert on self-direction, Marc has more than 40 years of experience serving health, human services, and Medicaid agencies in 30 states.

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