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Participant Direction During Difficult Budget Times: A Toolkit for State Policymakers and Advocates (2010)


Participant direction is a way to provide services that lets the participant (or the caregiver) control what services they receive, who provides them, and how and when those services are delivered. The National Resource Center for Participant-Directed Services (NRCPDS) developed this toolkit to serve as a resource for state policymakers and advocates when making key budget concerns that put participant direction at risk.

Key Points

The toolkit has three parts, including a budget myths chart, helpful tools, and important facts. It is emphasized throughout the document that older adults and people with disabilities want to live in their community for as long as possible. Additionally, it states that there are federal mandates to provide access to community-based options, eliminating community options will only increase costs, and participant direction can support people to work and volunteer, leading to additional benefits for the individual and the community.

Other toolkit highlights include:

  1. It is often assumed that those living in nursing homes have higher needs than those in the community, but it was estimated that people in nursing homes need assistance with an average of 3.9 activities of daily living compared to an average of 3.5 for those receiving home and community-based services.
  2. People who choose and direct their own services tend to report less unmet needs, higher satisfaction levels, and higher quality of services.
  3. Caregivers are the top providers of community-based services and support. These caregiversare a critical component in the control of health and long-term care costs because they provide complex support and help to delay or reduce nursing home admission and hospital care. Caregivers who are paid have less physical, emotional, and financial strain than those who are not paid.

How to Use

As noted, this toolkit informs the decision-making process for local officials, planners, and other advocates in need of making key budget decisions that might put participant directed services at risk. It provides valuable information on myths, counter-arguments, and facts that might alter the planning process.

View full report: Participant Direction During Difficult Budget Times: A Toolkit for State Policymakers and Advocates (2010) (PDF – 248 KB)

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