case management, long-term care, self-direction



  1. Quach, Emma D. MPA
  2. O'Connor, Darlene (Dee) PhD
  3. McGaffigan, Erin MSW, MS


Purpose: Nationwide people with disabilities are self-directing their long-term care supports through individual budgets. Because these individuals may rely on a "support broker" to assist them in making and executing decisions regarding their budgets, the interactions between the participant and the support broker can influence participant autonomy.


Primary practice setting: Massachusetts piloted a program for 14 participants to receive individual budgets for home and community-based services. Central to this pilot were the participant-designated support brokers, including home care case managers and peer advocates.


Findings/conclusions: Analysis of data on participants and support brokers indicated that the support brokers struggled with when, how, and how much to assist participants to self-direct.


Implications for case management practice: Case managers or other providers assuming the support broker's role will need proper training if they are to respond skillfully to challenging situations self-direction may bring.