Self-directed long-term care programs can improve
participant well-being, care quality, and cost containment. Long-term care in the United States was
once a predominantly institutionally based system of care.
The provision of long-term care in the U.S. has shifted to one in
which recipients can increasingly receive a range of both medical and
supportive services at home and in the community, highlights the latest edition of The Gerontological Society of America's Public Policy & Aging Report
). Further, individuals have gained the increased ability to choose how, where, and from whom they receive these services.
‘The provision of long-term care in the United States has shifted to one in which recipients can increasingly receive a range of both medical and supportive services at home and in the community.’
Today, almost 850,000 Americans direct their own care through 270
long-term services and support (LTSS) programs that are generally
heralded by those on both sides of the political spectrum.
Self-direction is the umbrella term applied to an approach to the
delivery of LTSS in which those eligible receive cash payments in place
of traditionally delivered services. With these payments, they can
decide how best to meet their support needs.
"Self- or participant-directed care has been a model of successful
public policy development and implementation - a movement coming from
the grass roots and developed through the combined efforts of federal
and state governments, philanthropic organizations, professional and
advocacy organizations, and committed social and health care
researchers," states PP&AR
Editor-in-Chief Robert B. Hudson, in the issue's introduction.
The new publication explores the evolution of the self-directed care
movement in LTSS, as told by many of the principals who helped to shape
and grow it. It examines many of the implementation challenges as
self-direction moved from a controlled experiment to a national option,
as well as the major changes in the environment that have shaped its
Among the expert authors is Kevin Mahoney, who is currently the
director of the National Resource Center for Participant-Directed
"It has been nearly ten years since a major journal devoted a full
issue to participant self-direction in long-term supports and services. A
lot has happened in that time. It is appropriate that this attention
comes as a new administration and Congress debate future directions and
A total of seven articles are included, starting with a look at the
evolution of participant-directed care in home and community-based
services in the U.S. and a review of recent trends in demand and
availability. The issue also documents changes in federal legislation,
regulation, and practice that have encouraged the growth of
Another piece makes international comparisons
between programs in Australia, England, Germany, the Netherlands, and
the U.S. - and highlights significant differences in terms of
eligibility, policy, and process between the approaches taken in each of
the countries. The final article focuses on where the field of
participant- directed care is likely to go next from its current status
in the American health care system.