When it comes to managing your services, everyone has different needs and preferences. In recent years, there has been a growing movement within the aging and disability communities that is known variously as independent living, self-determination or consumer-direction. While there are some differences in each of these, they have basically this philosophy in common: that people are the best judges of what assistance they may need and of how that assistance should be delivered.
The Texas Health and Human Services System (HHS) has long been a leader in promoting best practices in home and community services. Some of the earliest and best examples of consumer-directed services were developed and implemented in Texas.
HHS gives you a choice about how your services are managed:
- Agency option (agency-managed)
- Service responsibility option (co-managed)
- Consumer Directed Services employer (self-managed)
Remember that the choice is yours.
What's Right for Me?
There are five factors you may consider:
- Personal preference. Do you like to make most of your own decisions, or do you want an agency to make most decisions about your services?
- Time and effort. Are you willing to do more work in exchange for more control over your services?
- Capabilities. Are you (or someone you trust) physically and mentally able to handle the responsibilities that come with more control over your services?
- Control. Do you like to control your own day-to-day routines, or do you prefer to let someone else take charge?
- Support. What support consultation services may be available in your CDS and SRO options to help you meet employer responsibilities?
Services That Can Be Self-directed
The CDS option is available for the following services in the programs listed below.
- Community Living Assistance and Support Services (CLASS) — Habilitation services, respite services, nursing, physical therapy, occupational therapy, speech, hearing and language services, cognitive rehabilitation therapy, employment assistance, supported employment and support consultation
- Consumer Managed Personal Attendant Services (CMPAS) — Personal assistance services
- Deaf Blind with Multiple Disabilities (DBMD) — Residential habilitation (less than 24 hours), intervener, respite services, supported employment, employment assistance and support consultation
- Home and Community-based Services (HCS) — Supported home living, respite services, nursing, cognitive rehabilitation therapy, supported employment, employment assistance and support consultation
- Medically Dependent Children Program (MDCP) — Respite services and flexible family support services delivered by an attendant or a nurse, employment assistance and supported employment
- Primary Home Care (PHC), Family Care (FC), Personal Care Services (PCS), Community Attendant Services (CAS) — Personal assistance services
- Texas Home Living (TxHmL) — All services and support consultation
- Roles and responsibilities (PDF) outlines the duties of the service planning/IDT team, case manager, employer, Consumer Directed Services agency (CDSA), support advisor and program provider.
Hiring a Nurse Resources
- Employer Guide to the CDS Option for Nursing and Professional Therapists — Community Living Assistance and Support Services
This content was developed under grant CFDA 93.791 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.