AARP Hearing Center
Self-direction is a model of long-term services and supports delivery in which the individual receiving support chooses how, when, and from whom services are delivered. As of 2026, more than 2 million older adults and people with disabilities self-direct their long-term services and supports.
This report shares findings from the 2026 Self-Direction National Inventory, conducted by Applied Self-Direction. It provides state-level enrollment data as well as policy and operational insights gathered from across state agencies. The report highlights the significance of self-direction in meeting demand driven by the growing shortage of the direct care workforce, with some of the highest uptake in rural areas where participants hire family and friends. Strong program integrity in self-direction programs, meanwhile, results from the contribution of a range of stakeholders, from the federal government and states to program participants.
Key Takeaways:
- Self-direction is a model of long-term services and supports (LTSS) delivery in which the individual receiving support chooses how, when, and from whom services are delivered.
- Self-directed LTSS enrollment trends vary across states. From 2019 to 2026, they ranged from an increase of more than 1,100 percent in Florida to a decrease of almost 50 percent in Pennsylvania and Arkansas.
- Self-directed LTSS is now available in every Veterans Affairs Medical Center, and more than 12,000 Veterans participate in the model, known as Veteran-directed care.
- State agencies generally indicate that self-directed LTSS is cost-effective relative to traditional agency models, with some showing that self-direction costs 20 percent to 30 percent less per person.
