Supporting Choice in an Increasingly Complex World: What a Great Time for Self-Direction! 

2018 Self-Direction Workshop Open Plenary: Supporting Choice in an Increasingly Complex World: What a Great Time for Self-Direction! 

Here in the U.S., our fragmented patchwork of long-term services and supports will continue to be strained for decades to come -- by growing demand, an aging population, a shrinking direct support workforce, continuous budget pressures on public services, a lack of affordable private long-term care insurance, and a federal political environment unable to find compromise on policy related to health and human services.

So where’s the good news? The discourse in local communities and within many state systems continues to be vibrant and innovative – and self-direction continues to grow across multiple populations, regardless of morphing financial structures, implementation of managed care, changing authorities and differing regulatory interpretations.

The importance of self-direction as a component of sustainable systems – and the opportunity to support people to exercise choice, control and self-determination – are core tenets that resonate with people of differing political and cultural perspectives, and align with current healthcare priorities including social determinants of health, patient-centered care, person-centered systems and the need for flexibility. The presentation starts with some thoughts on why it is a great time for self-direction, and the ways that states, programs and people are relying upon self-directed supports to achieve good lives and good policy.