Summary
In recent years, the provision of long-term care in the United States has continued its movement from what was once a predominantly institutionally based system of care to one in which recipients can increasingly receive a range of both medical and supportive services at home and in the community. As the availability of home and community-based services (HCBS) grows, so does interest in consumer- or participant-directed models of service delivery.
In this article, authors trace the evolution of participant-directed care in HCBS in the United States and review recent trends in demand and availability. We then discuss current debates about the value of participant direction and the impact of two significant economic and policy events of the past decade: the Great Recession of 2007–2009 and the Affordable Care Act (ACA) of 2010.
Publication Authors:
- Kathryn G. Kietzman, PhD, MSW