Nationwide people with disabilities are self-directing their long-term care supports through individual budgets. Because these individuals may rely on a “support broker” to assist them in making and executing decisions regarding their budgets, the interactions between the participant and the support broker can influence participant autonomy.
Massachusetts piloted a program for 14 participants to receive individual budgets for home and community-based services. Central to this pilot were the participant-designated support brokers, including home care case managers and peer advocates.
Analysis of data on participants and support brokers indicated that the support brokers struggled with when, how, and how much to assist participants to self-direct.
Case managers or other providers assuming the support broker's role will need proper training if they are to respond skillfully to challenging situations self-direction may bring.
Emma D. Quach, MPA, Project Director, currently works on long-term care policy issues at the University of Massachusetts Medical School, Shrewsbury, conducting policy analysis and program evaluations of Medicaid home and community-based long-term care supports for older Americans, including persons with disabilities.
Darlene (Dee) O'Connor, PhD, is Associate Professor of Family Medicine and Community Health, and Director of Long-Term Support Studies at the University of Massachusetts Medical School, N. Grafton. She has been the principal investigator for three CMS Real Choice grants and oversees policy research and analysis on long-term supports.
Erin McGaffigan, MSW, MS, is a consultant for the University of Massachusetts Medical School, Shrewsbury, conducting training for case managers to support increased self-direction in existing service delivery models.
Address correspondence to Emma D. Quach, MPA, University of Massachusetts Medical School, 3 Centennial Drive, N. Grafton, MA 01536 (firstname.lastname@example.org).
This work was supported by a Real Choice systems Change grant from the U.S. Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services (93.779). The views expressed are the authors' and do not represent the position of the DHHS.