self-directed care

The Canadian province Ontario has empowered patients and their caregivers to control the types of services they receive at home, The Canadian Press reports. The self-directed care program will start with pilot projects first with the goal "to give patients and their caregivers more flexibility and control over the care they receive by involving them more in the planning and coordination at the start." Additional funding will provide 80,000 additional nursing hours for patients with more complex needs so they can stay at home instead of being cared for at a hospital or nursing home.

People with disabilities are fighting Wisconsin Governor Scott Walker's proposed changes to long-term managed care in the state's budget, The Marshfield News-Herald's Liz Welter reports. They are concerned that changes to managed care would trade a community-centered system with a state-wide approach run by out-of-state insurance companies. They also are concerned that the autonomy the current system gives them to direct how some of their care is carried out would be eliminated.

Disability rights advocates in Wisconsin are dismayed about a plan that would eliminate the autonomy that people with disabilities have to self-direct some of the money expended by the state government for their care. Wisconsin Governor Scott Walker has put forth a plan for long-term care for people with disabilities that would lead "the Department of Health Services to cease operation of other long-term care programs or waivers, including IRIS — a program for self-directed long-term care. IRIS currently has more than 11,000 participants, who choose the program because of their ability to self-direct their supports, including hiring their own caregiver," The Capital Times' Jessie Opoien reports.

During law school I did research about various efforts to put patients in charge of their own care, whether their issue is addiction, a disability or mental health. So I was very interested to read a piece that Newsworks' Laura Benshoff published about a pilot program in a Philadelphia suburb to put Medicaid patients with mental health issues in charge of decisions about their care: "It gives patients the option to redirect that money towards a 'freedom fund,' saving for something that improves quality of life. In addition, participants make decisions about care with a certified peer specialist as a recovery coach."

However, putting people in charge of their health care did not reduce costs. The first two years of the program showed that costs went up from $6,800 to $7,500 because "participants who had gotten used managing their symptoms tended to opt for more, off-plan services through the program – such as gym memberships – rather than cut back," Benshoff reports.

Self-directed care has become a big trend for people with mental illness, disabilities and other issues. The idea is that consumers know what will help them live healthier lives better than "experts," and many Medicaid programs have built in flexible funds to allow consumers to spend their money as they set fit (subject to some conditions). Consumers often are directing their care to hiring home-care workers.

So the latest development for self-directed care is that home-care workers are going to have to be paid minimum wage and overtime if they work more than 40 hours a week. The U.S. Department of Labor won't be enforcing the rule for the first six months after it goes into effect January 1, 2015, the Kansas Health Institute's news service reports.

Increasing wages for home-care workers won't be without cost. Kansas Gov. Sam Brownback "had expressed concern that the rule boosting the pay of personal care attendants hired by elderly and disabled Kansans to help them stay in their own homes would add $33 million to $40 million to the overall Medicaid budget in Kansas, including $15 million from state funds not in the current budget," KHI reports.