Take Control of Your Services: Self-Direction

By: Cara Benson, Principal and Consultant, Self-Directed Services Consulting

Introducing Self-Direction

Self-direction, called Consumer Direction in Minnesota, affords options for a person who needs support, and empowers people to be in control of what happens in their home and community.

Self-direction became an option in Minnesota in 1997, through a demonstration project promoted and funded by the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation. Minnesota began offering self-direction statewide in 2004.

What is Self-Direction?

Self-direction is a long-term care service that provides the person needing support with more choice and control over when, who, what and how services and supports are provided in the home and community. Self-direction provides a shift from a “doing for” approach to an “empowerment” or “doing with” approach. It is an option regardless of age or ability.

All people who need support need to be able to have choice and control in their lives. Choice and control come in various forms. How that choice and control is structured will depend on the person and their support team.

When a person and/or their team chooses self-direction, they receive information and ongoing support to be sure they understand the program specifics, what to do and things to avoid. While it is the person’s responsibility to be in control, they may want help from family members or friends to make decisions.

Why Choose Self-Direction?

Self-direction needs to be a part of every person’s life, regardless of where they live or what kind of support they need. The person receiving services and/or their team knows their needs best, and that person needs to be at the center in making decisions about how care is provided. Self-direction gives different options for the person receiving services to be in control of their services and make the decisions they need to be successful at home and in the community.

What does this mean exactly? It means that the person receiving services designs their plan to get the support they need. The person-centered plan is based on the person’s assessed needs and goals they want to achieve. The person chooses their caregivers and decides what the caregiver will do or how care will be provided, among other things.

Minnesota provides a spectrum of self-direction, which is described below. It is important to know that the options a person has available to self-direct depend on their eligibility for the service or program.

Self-Direction in Minnesota

Minnesota has three options for a person to self-direct their services. Before they can start their self-direction journey in one of these three options, a person must have an MnCHOICES assessment and be determined eligible.

Each option offers a different level of choice, control and responsibility:

  1. Personal Care Assistance (PCA): With two choices (Traditional PCA or PCA Choice), PCA provides support with activities of daily living, instrumental activities of daily living and complex health needs.
  2. Consumer Support Grant (CSG): CSG is a state-funded alternative to PCA. CSG gives people more flexibility and responsibility to choose the supports they need.
  3. Consumer-Directed Community Supports (CDCS): This service is provided under the Alternative Care program or one of five waivers: Brain Injury, Community Alternative Care, Community Access for Disability Inclusion, Developmental Disabilities or Elderly.

Looking to the Future

Minnesota continues to look at different ways the person receiving services can be in control of their services. One such endeavor is Community First Services and Supports, or CFSS. This program is designed with the principles of self-determination in mind: freedom, authority, support and responsibility. CFSS is under development and will replace PCA and the Consumer Support Grant when it becomes available.

Here for You

LBSA is here to help you find resources and information on disability services choice, control and support. A FREE consultation from Family Navigation Services is available for your loved ones with intellectual or developmental disabilities (IDD).

About the Author

Cara Benson is the principal and consultant at Self-Directed Services Consulting in Shakopee, Minnesota. She has over 20 years of experience working in Medicaid home- and community-based waiver services and personal care services. Her passion for self-direction and developing relationships with people using these services, various stakeholders and industry leaders has led her to understand the importance of the self-directed service delivery model on many levels.

Ms. Benson is the former Minnesota Department of Human Services Policy Lead for the Community First Services and Supports program. In this role, she created policy and operational components. More about Cara »