Self-Direction in Long Term Services and Supports

Ten years after the results of the Cash and Counseling Demonstration and Evaluation were released, this book assesses the impact of this study, which developed individualized plans for helping people with disabilities to stay independent in the community. The study was the first wide-scale test of people with disabilities managing their own budgets and results from the random-controlled trial demonstrated significant positive outcomes, encouraging the US federal and state governments to provide this option as part of their community-based care programs. This volume looks at what people with disabilities and their caregivers are saying about this option ten years removed from the study, and what the latest research shows in terms of what it will take to improve this approach, making the option available for all people with disabilities. The contributions also discuss what needs remain unmet even when people can manage their own budgets, and present participants' and their family caregivers' views on what support broker activities really help (or hurt). Finally, the book summarizes the results of a project involving the Council of Social Work Education and nine schools of social work to develop modules to train future social workers on person-centred planning and participant direction. Of interest to those researchers studying social care with a focus on disabilities, this book would also be of use to those training social workers and support staff. The chapters in this book were originally published in the Journal of Gerontological Social Work and Home Health Care Services Quarterly.

Kevin J. Mahoney is Professor Emeritus in the Boston College School of Social Work, USA; Founding Director of the National Resource Center for Participant-Directed Services; and was National Program Director of the Cash and Counseling Demonstration Evaluation and Replication (1996-2008). Ellen K. Mahoney is Associate Professor and Department Chair in the Connell School of Nursing at Boston College, Massachusetts, USA. Michelle Putnam is Professor and Director of the Doctoral Program in Social Work at Simmons College, Boston, Massachusetts, USA. In addition, she is the Editor-in-Chief of the Journal of Gerontological Social Work.

Introduction 1. "It's Changed Everything": Voices of Veterans in the Veteran-Directed Home and Community Based Services Program 2. "It just took the pressure off": The voices of Veterans' family caregivers in a participant-directed program 3. "I'm just trying to cope for both of us": Challenges and supports of family caregivers in participant-directed programs 4. Preparedness of representatives for people with dementia in a self-directed program 5. Unmet needs in self-directed HCBS programs 6. The Tasks and Characteristics of Supportive Support Brokers 7. The times they are a-changing: Self-directed long-term services and supports and gerontological social work