consumerdirected

Consumer-directed, also known as consumer-directed services or self-directed care, describes a policy approach in health, disability, and elder care in which individuals have a meaningful say in how paid care services are planned, delivered, and funded. In consumer-directed arrangements a portion of publicly funded long-term care resources is allocated to the individual, who may directly employ caregivers or authorize a fiscal intermediary to manage funds and compliance. The person typically develops a service plan, selects providers, sets service schedules, and supervises workers, subject to program rules and budget constraints.

Implementation varies by jurisdiction. Some programs provide direct cash payments or employer authority to hire family members as caregivers, while others use a managed budget via an agency or fiscal intermediary. Many programs require training, recordkeeping, and periodic reassessment to ensure needs are met and funds are used appropriately.

Common settings include home-based care for older adults, people with disabilities, and individuals with chronic health conditions. In the United States, consumer-directed options are frequently linked to Medicaid waivers and home- and community-based services, but similar approaches exist worldwide under different names.

Benefits often cited include increased autonomy, greater flexibility to tailor supports to personal goals, potential improvements in quality of life, and enhanced job satisfaction for caregivers. Critics point to administrative complexity, risk of mismanagement or underutilization of funds, and uneven availability of supports, with outcomes depending heavily on program design and participant supports.

Overall, consumer-directed models aim to shift decision-making power to the person receiving services, balancing independence with safeguards and accountability. They are part of broader debates about person-centered care and funding allocation in social services.