Planning for an Adult Life with Developmental Disabilities

September 6, 2018

Should I use provider-based services or self-direct my individual budget?

Utilizing self-directed services in lieu of provider-based programs is a relatively new option designed to offer more choice and control to individuals and their families. Individuals who opt for self-directed services may have more of an ability to determine how, where, and with whom they will live their life.  Individuals can organize their supports in a way that uniquely meets their needs.

Until the roll out of the fee-for-service system, almost all services were program-based through providers. Program-based funding is now ending and all individuals will have their own budgets. This means that, in essence, everyone receiving funding for services and support from the Division of Developmental Disabilities is self-directing because the individual is making the choices about how they will spend their budget. For most individuals residing in provider-based residences or attending day programs, and who wish to remain there, this won’t affect the services they receive, only how the provider is paid for the services that the individual receives.  If an individual wishes to self-direct all or part of their budget with limited or no provider participation, they need to consider the pros and cons of the opportunities and responsibilities involved.

An individual can “purchase” a wide range of services and supports with their budget. Besides provider supports they can utilize their funding for therapies, environmental modifications, assistive technology, etc. But the primary use of the budget that would be a departure from using provider supports would be if you decide to self-hire direct support professionals (DSPs). Under Individual Supports (Community Care Program) or Community Based Supports (Supports Program) you can hire a DSP to provide support while engaged in self-directed day or for home or independent living settings.

An individual not participating in a provider-based program or living in a provider-based residence can hire a DSP in two ways. They can contract with a qualified provider or agency to provide staff for the days and hours they need support in their own home or activity. Or, they can self-hire – meaning they hire someone they know or find themselves. If hired through a provider/agency, the provider/agency is required to complete all employment paperwork and train DSPs. They should also be able to provide substitutes as needed and deal with management and staff performance. If you self-hire, you will have employer authority, but you will need to work through a state Fiscal Intermediary to complete the hiring process and get your staff paid. The Fiscal Intermediary is a company subcontracted by the state to process employment applications and complete fingerprinting and background checks, provide access to required training modules, and process timesheets and payroll. They are also required to complete all tax filing requirements and provide a workman’s comp policy. You will be responsible for training staff to meet your unique needs and with communicating duties and responsibilities of their position. You will need to establish their schedule and prepare to meet coverage needs for vacations, sick days, etc.

There are pros and cons to the use of either provider-based services or self-directed services. Provider–based services may have more stability and convenience. Self-directed services may have more choice, flexibility, and control.  Here are a few more pros and cons for the two options:

Day Program/Supported Employment

Provider-based service

Pros: Day programs (day habilitation) are specifically designed for various levels of need.  Staff are trained to provide supports.  Activities are varied and accommodate interests and abilities of participants.  Transportation to community-based activities is provided and often to and from the program. Job coaches in supported employment can provide supports needed to maintain employment.

Cons: The choice of where and with whom you spend your day is limited by the location and other participants of the program. You cannot select who will provide your direct care.  The schedule of your day/week is fixed.

Self-directed day

Pros: You can do whatever you want with your day, whenever and wherever you need to. Each day can be different.   You can hire your own staff or contract with an agency/provider to provide that piece of needed support.

Cons: It may be difficult to find activities, volunteer, or employment opportunities yourself.  If you need direct care or support, you’ll need to hire, train, and supervise staff and deal with related paperwork.  Your opportunities to interact with peers and make friends may be limited. You will need to provide, or have your DSP provide, transportation.

 

Residential options

Provider-based service:

Pros: The costs of living – rent, utilities, insurance, maintenance, etc. are overseen by the provider (individual contributes a percentage of their income each month) Staffing is provided for direct care. The services of dieticians and nurses are available as needed (if available from your particular provider).  Transportation is provided.

Cons: Your residential choices about specifically where, and with whom you live is limited.  You can’t choose who provides your direct care and there are established rules and procedures guiding activities and management in the home.  Choices about spending time outside the home can be limited by the availability of staff to offer needed support and transportation availability.

Self-directed independent living

Pros: You can select where and with whom you live.  You can change residences more easily at your own discretion.  You can hire your own staff or contract with an agency/provider to provide that piece of needed support.  You control everything about your living situation.

Cons: You have to control everything about your living situation. You’ll need to find appropriate housing. You’ll need to apply for and maintain whatever assistance you may need – rental assistance, electric assistance, heating/cooling assistance, food stamps.  If you need direct care or support, you’ll need to hire, train, and supervise staff and deal with related paperwork. You may need to deal with repairs and maintenance. You will need to provide, or have your DSP provide, transportation.

No one option is perfect for everyone. Your choice may depend on how much current and ongoing support your family can provide to assist you with self-directed services, the availability of appropriate provider or community options, the ability of a provider or self-directed format to meet your unique support needs.  Your support coordinator should be able to assist you with thinking through your options and making an informed choice.  Whatever that choice may be today, you have the option of making adjustments or changes as your needs or situation changes.