Topics on Aging

By Juan Gallo

What is self-directed care?

May 31, 2022

As we close Older Americans Month, I wanted to take one last look at the theme of “Age My Way.” Specifically, I want to take some time to explore the history and current impact of self-directed care.

Simply put, self-directed care, or self-directed services, is the God-given right and ability for a person to continue to make everyday decisions as they always have, regardless of their mental or physical ability.

Historically, this wasn’t always the case. There was a time, even in our own country, when those who were aging or struggling with mental health could not direct their own care.

In short, the Supreme Court ruled that people with disabilities were entitled to receive state-funded services in the community, rather than through institutions like psychiatric hospitals or nursing homes.

That began to change in 1990 with the passage of the Americans with Disabilities Act, or ACA. The ACA was part of the civil rights movement, requiring equal opportunities to those with disabilities. In fact, the ACA mirrors the Civil Rights Act in 1964, which prohibited discrimination on the basis of race, color, religion, sex, or national origin.

The implementation of the ACA wasn’t perfect. As people with disabilities continued to struggle, in 1999, the U.S. Supreme Court made what would be called the Olmstead decision. In short, the Court ruled that people with disabilities were entitled to receive state-funded services in the community, rather than through institutions like psychiatric hospitals or nursing homes.

Of course, we could dive down the rabbit hole to explore the historic problems with brick-and-mortar, state-funded facilities and large-scale asylums, explaining why it’s necessary to offer an alternative. Suffice to say: many people prefer to receive care from the comfort of their own home.

The final piece of the self-directed care puzzle I want to explore today is the Medicaid Long-term Care Waiver. The waiver is designed to financially empower older individuals and those needing long-term care to stay out of institutions for as long as possible. The waiver allows Medicare to reimburse individuals for care within their home or within the community.

Along with the waiver came the availability for companies like GT Independence, my former employer, to become fiscal intermediaries and tap into Long-term Care Wavier funds on behalf of an individual. This allows that person to become their own employer of record and hire and fire whoever they decide to take care of them.

That really changes the way a person is treated, giving them authority to self-determine their care. For people at their wit’s end, trying to figure out how to keep their loved one at home, access to the Long-term Care Waiver could be the answer.

To learn more about the waiver and determine if you or a loved one is eligible, call your Area Agency on Aging. If you live in Florida, use this map to determine your local Area Agency on Aging.

To help a senior stay in their home, volunteer through Heart2Heart’s Home-Based Community Visits.

Read more about:
Juan Gallo
Juan Gallo is the CEO of Heart2Heart Outreach, where he oversees the mobilization of volunteers to provide hope, share love and restore purpose to the lives of the aging population across South Florida.

He also serves as a local pastor and as an adjunct professor at Trinity International University, where he is teaching a course on diversity and aging. Juan has a master’s degree in counseling and psychology and is a licensed mental health counselor intern.

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