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Consumer Directed Care In Danger of Extinction

Consumer Directed Care began in the US in 1998. Since the beginning of the program, it has been most effective in improving the quality of life for elders and their caregivers. It’s a program that makes sense, not only because it allows the elder and/or caregiver to direct his or her care by selecting the services and providers they like, but also because it saves money. The program has been in such demand that it makes me wonder why it has not been extended to middle class families and why there are still areas in the country where it is totally unknown to the public.

In times when the financial resources are very limited, we need to explore ways to serve as many elders as possible, and do it in a way that will not compromise their well-being. What better way to accomplish both goals than by allowing seniors to choose the services and the programs they want. While Consumer Directed Care is an ideal program to help families manage their care, the program was designed to contain costs, not necessarily to help Medicaid recipients. In government language, the program is a budget-neutral program. The hope was that the program will eventually become a cost-avoidance program for the Medicaid budget. This means that the success of the program was going to be based solely on the amount of dollars it saves the Medicaid budget.

With more individuals becoming frail and living longer with conditions that require around the clock care, more resources are needed to keep them at home, therefore, the original cost-savings anticipated by the program designers is not being realized, and this is making government officials think twice about continuing the program. It is very possible that even though thousands of elders and individuals with disabilities have improved their quality-of-life because of this program, Consumer Directed Care may be cancelled due to the fact that the financial bottom line, not the human bottom line has not been reached and the expected savings are no longer there.

Before the ax falls on another good program we should become involved in the fight to save the Consumer Directed Care and all the other Medicaid waiver programs in existence today. We need to convey to our elected officials that Consumer Directed Care should be part of a legislative mandate in each of our states. We need a legislative mandate that allocates state funds under the framework of the consumers’ wishes and direction. Once that is accomplished, we should also make sure that the Federal Medicaid program makes Consumer Directed Care a permanent Medicaid waiver program and not just a research project. Research projects have their own set of rules that are not necessarily the best rules for the caregivers or the frail person. The success or failure of programs for frail persons should not be based on how much money the government saved but in how much the program has increased the quality-of-life of participants. If money is saved, then it should be an added value to the equation, but not the only value.

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