Self-direction is a long-term care services and supports (LTSS) delivery model that prioritizes personal choice and control. In a self-directed model, a person decides how, when, and from whom they will receive LTSS.
Federal Resources
- Self-Direction Briefing Paper Series— Compendium for policymakers and stakeholders to inform conversation and policy on home and community-based services self-direction (Centers for Medicare & Medicaid Services)
- Recruiting, Selecting, and Retaining Direct Service Workers To Provide Self-Directed Home and Community-Based Services (HCBS)— Online training provides information to people who self-direct or wish to self-direct their HCBS and others interested in finding, hiring, and retaining workers (Centers for Medicare & Medicaid Services)
- Self-Direction Options— State options under the Medicaid state plan and waivers for providing enrollees with services, and with the option to self-direct (Centers for Medicare & Medicaid Services)
- The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and Policy Opportunities— History of self-directed services in the U.S. and ramifications of the growing use of Medicaid-managed care arrangements for the future of these services and supports (National Council on Disability, 2013)
Other Resources
- Advancing Self-Direction in LTSS: Empowering Individuals and Mitigating the Direct Care Workforce Crisis Slide Deck— Webinar on self-direction and a member discussion on ARPA implementation plans (Long-Term Quality Alliance, 2024)
- What is Self-Direction?— Article describes self-direction in long-term care service delivery, emphasizing participant choice, control, and flexibility, and includes real-life stories and videos (Applied Self-Direction, 2021)
- Taking It to the Next Level: Using Innovative Strategies to Expand Options for Self-Direction— How four states used innovative strategies to develop and expand options for self-direction and a toolkit for training, collaboration, and replication (AARP Public Policy Institute, 2018)
- “It’s Changed Everything:” Voices of Veterans in the Veteran-Directed Home and Community Based Services (HCBS) Program— Study explores the value and impact of a Veterans Affairs self-directed HCBS program on veterans’ lives in their voices (Journal of Gerontological Social Work, 2018)
- 2020 Evaluation of Experiences With Self Direction in New York State: A Focus on Sustainability— Survey results of people participating in New York State’s self-direction plan (Institute on Community Integration, 2021)
- How Can Matching Service Registries Increase Their Impact?— Article highlights an online matching service registry in Minnesota (PHI, 2019)
- Empowering Choices: Suzanne Crisp on the History of Self-Direction (YouTube)— Video podcast discusses the history of self-direction (Public Partnership, LLC, 2023)
- National Inventory of Self-Directed Long-Term Services and Supports Programs— Findings from the 2023 inventory conducted by Applied Self-Direction. Part two of the report describes the impact of national workforce shortages on self-direction and family (AARP Public Policy Institute, 2024)