What is self-directed care?
Self-directed care is an emerging trend in the world of health care in which certain patients are permitted to plan and receive personal and medical services from the comfort of their own homes.
Also referred to as “self-managed care,” such programs are often available to seniors, adults with cognitive or physical disabilities, adults with chronic illnesses, and families who have children with medical conditions that require continuous care. In other words, eligible patients are generally people who need both regular medical and personal assistance that does not necessitate continuous hospitalization.
“In contrast to conventional home care programs in which care is managed and delivered by professionals or agencies on behalf of the client, in self managed programs the client takes a more active and central role both in defining needs and in determining how those needs should be met,” a 2006 report prepared for Health Canada explained. “A key characteristic of many self managed programs is that instead of funding professionals or agencies who deliver services to clients, governments directly fund clients who then purchase services from providers of their choice.”
Needs met by self-directed care programs often include personal support services such as help bathing and cooking, one-on-one nursing care, therapy services such as physiotherapy, and respite services for existing caregivers, so people such as family members can schedule breaks from tending to loved ones.
Such programs are already widespread in European countries like Germany and France, as well as in Australia. Self-directed care programs, however, are less prevalent in Canada -- and they differ widely in terms of patient eligibility and structure.
Ontario, for example, currently offers self-directed care programs for some families with autistic children as well as for some seniors and persons with disabilities. The province, moreover, recently completed a pilot project that became a full program in late 2017 that is set to start operating this spring. The agency responsible for this program, which has been dubbed Self-Directed Personal Support Services Ontario (SDPSSO), has a mandate to help Ontarians with high-need conditions requiring at least 14 hours of support per week select and schedule their own personal support workers. Once launched, it promises to be the largest self-directed care program in Canada.
The Ontario Ministry of Health and Long-Term Care and Local Health Integration Networks (LHINs) are also launching a new self-directed care program - Family-Managed Home Care - under which clients or their decision-makers will receive funding to purchase home care or employ care providers.
Researchers have said that self-directed care programs are cheaper, of a higher quality and create greater patient satisfaction than more traditional home care programs. Other studies have shown that nurses also report higher job satisfaction in self-directed care settings.
“Despite significant differences in programs across countries, evaluations reveal a consistently positive picture,” a 2010 report from The Commonwealth Fund, a private U.S. foundation that focuses on improving health care, stated.
That conclusion was echoed by the C.D. Howe Institute -- a non-profit Canadian policy research organization -- in a 2016 report that advocated for more autonomy for seniors in their continuing care.
In that report, it was estimated that 15 per cent of all “acute-care hospital beds” in Canada are occupied by patients waiting to receive care outside of a hospital. That, the report stated, costs provincial governments just less than $3 billion a year.
“Canadian provinces’ one-size-fits-all approach to helping seniors continues to steer individuals toward institution-based care even when they would prefer to receive it elsewhere,” the report concluded. “Going forward, Canada must encourage a greater role for patients in choosing their care paths, and doing so means expanding access to a more self-directed system.”