THE VBP Blog
The Power of Choice – Understanding Consumer-Directed Personal Care Programs
A Look at the Consumer-Directed Model and Its Benefits
January 23, 2025 – In recent years, there has been a growing shift in healthcare delivery toward providing care in the home. With that change, there is also a growing emphasis on allowing individuals to take charge of their own care. Consumer-directed personal care programs are key in this movement, providing individuals with disabilities, chronic conditions, or aging-related challenges the opportunity to manage their caregiving services.
In this blog, we will examine consumer-directed care programs, their benefits, and the states that have implemented them. As advocates, we support home care in all forms, including the agency model and structured family caregiving, but we are also excited to see the shift towards giving consumers more choice over their care, but we understand there is a right and a wrong way to implement these programs. For our full advocate perspective, check out the end of the blog!
What is the Consumer-Directed Model?
At its core, the self-direction model allows individuals to take control and make decisions about their care. This model contrasts with the traditional way services are delivered, where an assigned home care agency controls most aspects of service delivery, including who will provide the service. In a consumer-directed model, participants in these programs can hire, train, and manage their own caregivers. This allows them to decide how, when, and from whom their services and supports will be delivered and often includes hiring trusted family members or friends to provide services.
This unique model shifts the power dynamics traditionally seen in caregiving. It gives consumers more control over their schedules, care preferences, and relationships with caregivers. It’s not just about convenience. It is also about restoring dignity and independence to those receiving care. Consumers can set their expectations and communicate directly with caregivers. This personalized approach enhances the quality of care and aligns services with individual values and lifestyles.
It’s important to note that consumers are not alone when it comes to the administration of these programs. Fiscal intermediaries are crucial in streamlining the administrative tasks for consumer-directed programs. They handle payroll and compliance to ensure that those enrolled in the program—who might already be navigating complex health conditions—are not burdened by payroll management, tax compliance, or other documentation requirements. By bridging the gap between participants and the broader healthcare system, fiscal intermediaries make consumer-directed care more accessible and efficient.
Another important aspect of the consumer-directed model is its adaptability. Whether care is needed at home, in the community, or even during travel, the flexibility of consumer-directed programs allows participants to craft arrangements that suit their changing circumstances. This level of customization is rarely possible in traditional care settings, making the consumer-directed model a transformative solution for diverse needs.
Benefits of Consumer Direction: Why It Matters
Consumer-directed care programs have many benefits for participants, caregivers, and healthcare payers. From the perspective of participants, these programs provide autonomy and independence. They can choose caregivers they trust, including family members or close friends, which provides greater choice and control. It also allows them to create schedules that align with their unique needs and lifestyles, which can lead to improved quality of life. Consumers can also receive care in a personally and culturally sensitive way, which is especially important for diverse populations.
One of the most significant benefits of these programs is that consumers can also choose what services are provided. These programs typically offer a range of valuable services and support to eligible individuals, including personal care services like bathing, grooming, dressing, and more. In addition, they provide assistance with activities of daily living like nutrition, mobility, medication management, and more. We know these programs are working as studies have shown that care recipients in these types of programs reported higher satisfaction with their care and experienced fewer unmet needs compared to those receiving traditional agency-directed services.
For caregivers, especially family members, these programs offer the chance to provide meaningful support while being compensated fairly. The mutual trust and familiarity between the caregiver and care recipient often lead to better outcomes and higher satisfaction.
Healthcare payers also see advantages, including reduced hospitalizations and institutional care costs. Programs like these ensure that individuals are more satisfied with their care, which can translate into better compliance with care plans and improved health outcomes. These programs can also help mitigate caregiver shortages by enabling participants to tap into personal networks for support.
Consumer-Directed Programs Can Be Found Throughout the U.S.
The model is growing in popularity, and today, millions of Americans self-direct. However, consumer-directed personal care programs, while unified by their commitment to participant empowerment, vary widely across states.
Some of the biggest programs across the country include:
- New York’s Consumer Directed Personal Assistance Program (CDPAP)
- Colorado’s Consumer-Directed Attendant Support Services (CDASS)
- Pennsylvania’s Agency With Choice (AWC)
- Oregon’s Consumer-Employed Provider Program (CEP)
While similar in intent, these programs are structured differently based on state policies and healthcare needs. Perhaps the biggest difference between them, and what can make or break them, is how they handle fiscal intermediaries. In our next blog, we’ll examine these differences and how they influence care delivery and outcomes.
Advocates Perspective
Consumer-directed personal care programs prioritize autonomy, trust, and person-centered care. By shifting decision-making power to consumers, these programs not only enhance the quality of care but also uphold the dignity and preferences of those receiving it. Participants can choose caregivers they trust and decide how and when they will receive services. Consumer-directed care represents a lifeline to independence and dignity for individuals who rely on caregiving services in their homes. It also ensures that personal values and preferences are prioritized, paving the way for a future where healthcare provides whole-person care and truly meets the needs of every individual. As more states embrace consumer-directed care, we make strides towards a more inclusive, adaptable, and empowering healthcare system. However, policymakers and healthcare advocates, need to ensure that when expanding and refining these programs, we keep the consumer in mind, and develop programs that allow choice across the board.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.