Your Guide to Self-Direction

What happens if your loved one gets hungry after the home-care agency staff has already left? What if your loved one doesn’t feel comfortable with the person the agency keeps sending over? How does your loved one manage going to the bathroom when the home help staff have left for the day?

As a family caregiver, you always want to make the best choices about your loved one’s care. While you should always trust healthcare professionals, you should also trust yourself and your loved one to know what may be best for your family. 

Learning about self-direction and how it is different from other in-home care models — like agency-provided care — can help you and your care recipient make choices you both feel good about that put your loved one’s needs first. 

Self-direction means the individual who receives services decides how, when, and from whom those services will be delivered. This is different from getting services from a worker employed by a home care agency. People who choose self-directed programs can hire family, close friends, or neighbors as paid caregivers. This way, they can be cared for by someone they already know and trust. This can make a big difference when it comes to helping with tasks like going to the restroom, bathing and dressing.

Can I Use Medicaid Waivers For Self-Directed Services?

Yes! In many states, Medicaid waivers can be used for self-directed services. Since each state has its own guidelines, it’s important to check what’s available in your state. The rules for who can qualify will vary depending on your state but if your loved one has a disability, chronic illness, or requires elder care, they may be able to receive self-directed services.

What Is Self-Direction?

Self-direction allows care recipients to have more control over when, where and which services are delivered. 

Self-directed care allows care recipients, and their caregivers, to work with their Medicaid case manager to:

• Take charge of their care plan, by managing which services their loved one receives and when.
• Manage certain parts of their Medicaid budgets, which allows for more personalized care.
• Hire, train, and even pay trusted family members or friends to provide care to your loved one, which can ensure your loved one receives a more intimate level of care.

Policies for self-directed services differ from state to state. This means that the rules for who can qualify and what services they can receive may also vary. 

When to Choose Self-Directed Care

While traditional, agency-provided care might be right for many, it doesn’t work for everyone. 

Self-directed programs allow caregivers and their loved ones to be more independent when it comes to handling Home and Community-Based Services, but this can also mean more responsibility. Resources are available to provide care recipients enrolled in a self-directed program with support. If your loved one has cognitive decline, for example, the case manager can help manage the paperwork. Still, the levels of responsibility required can be overwhelming for some caregivers. If that sounds like you, a more traditional agency-based care plan might be the better choice. 

As a caregiver, you may need to help your loved one:

• Handle paperwork and budgeting.
• Train, hire, and —if necessary — dismiss care providers.
• Oversee daily care routines to ensure everything runs smoothly for your loved one.

Remember, there’s no right or wrong answer—just what works best for your family.

Finding the Right Path Forward

Home and Community Based Services and Medicaid waivers won’t be exactly alike in every state. Take time to explore your options, check your state’s policies, and lean on available resources to support you. Your loved one deserves care that’s tailored to their needs—and you deserve the support needed to make a decision about what approach works best in your situation.