Consumer Direction, Consumer Choice, and the Future of Long-Term Care

Traditionally, our long-term care system has had a strong institutional bias, with care directed by health care professionals and few options for consumers. There is now a growing trend toward consumer direction and consumer choice in long-term care. Some degree of consumer direction can be achieved under different models of long-term care, but many consumers prefer the independent living model in which they hire, train, and manage their own personal assistants. The Supreme Court's Olmstead decision supported the consumer-direction trend, finding that unjustified institutionalization is discriminatory and that Medicaid recipients with disabilities must receive their care in the most integrated setting appropriate. Initiatives by disability rights advocates, states, and the federal government to ensure the option of consumer-directed home- and community-based care, as well as innovative home-based programs in other countries, have further fueled the trend. The policy challenge will be to offer consumer-dir...