Caregivers are the backbone of this society and as such, the country must begin to honor and support their needs and desires. Without caregivers willing to give up their personal lives to keep their loved ones at home, the economic crisis we are presently facing as a country will be much worse and the Medicaid deficit may reach a trillion dollar amount within the year. It makes economic sense to allow caregivers to direct the care of their family members, especially if the family member is not longer able or willing to care for himself or herself and the caregiver is willing and able to take this responsibility. After all, without the caregiver there is nothing that will keep a frail person at home.

It also makes human sense to provide financial assistance to the caregivers. Some of them will need to give up their jobs because employers may not be sensitive to the caregivers’ needs or would be willing to allow for the missing days and missing focus. Caregivers should be financially helped if they are willing to provide the services; this way the entire family can financially afford to take care of a frail child or a sick elder at home. However, even though it makes economic and human sense to change the existing policy and to begin to invest in the caregiver and in the family, no government official has taken the lead of faith to change the system. On the contrary, we continue to invest hundred of millions of dollars in supporting and expanding Nursing Home placement while family members watch in horror how their physical, emotional and financial strength begins to disappear.

Why, we may ask, if it makes sense to help families direct the care for their loved ones and even receive payment for what they are willing to do, is our government maintaining a system of care driven not by the consumers, but by the agencies. It is a system of care that gives control and decision making authority to the agencies and businesses and not the person or the family. This system is very expensive, very impersonal and inflexible at a time that we need the opposite. It is my belief that unless we the caregivers of the nation come together to demand with one voice that our loved ones be given the option of direct control of their care, the system will not change and the resources we need to make our family situation more manageable will continue to go elsewhere. It is important to realize that the only power we have is the power of our voices, and if our combined voices are synchronized demanding that our state provides a consumer directed care option this will never happen. It will never happen because we are not part of the dialogue, and negotiations take place at the time of budget allocations where we have no representation.

I am a firm believer in Consumer Directed Care. It is the only mechanism that exists that allows the consumers, this could be the frail person or the caregiver, to choose the providers and to select the best combination of services to meet their unique needs. This is particularly important in the rural areas where consumers may be waiting to receive services, not because the money is not available to pay for services, but because there are not enough workers to provide services to the person. There are not enough workers or agencies willing to transport the individual, to deliver daily meals or to bathe the patient. In situations like this, it makes sense to hire a family member, and I say, hire, because in some cases the family doesn’t have the financial resources to survive without a job. The investment of keeping a family member or a neighbor well will generate a bigger return that any other investment I know. It is a cost effective way to deal with the aging of the population and in meeting the demand for quality care. What we have found is that the family member or neighbor hired to perform the homemaking or transportation or personal care job will be given more than the one, two or three hours of services the worker from an agency will be able to give for the same compensation.

Consumer Directed Care is one of the solutions to the budget crisis we are presently facing. It eliminates some of the administrative costs that are now consuming more and more of our tax dollars. It also caps the cost of providing services because family members are more willing than providers to accept the existing payment system and do much, much more with the same and not ask for a higher reimbursement rate or for increased benefits. Let’s face it, now as caregivers we have no benefits, no salary, and no options. We will be happy with just a little support and more control of the lives and dignity of our family.

Maybe the way to go about this is to make sure Consumer Directed Care is not forgotten is to add a Consumer Directed Care option to each of the existing states’ laws and to incorporate the Consumer Directed Care program as an integral part of the Administration on Aging’s new Caregivers Initiative program. This is our window of opportunity to incorporate in the implementation of the Caregivers’ Initiative program at the local level this option. It really meets the expectations and dreams we have as caregivers when we hear of the initiative. The Caregivers’ Initiative at the federal level was designed to support new ideas and new efforts to make the life of the caregivers easier. So far the funding for the local programs has not met the expectations. What I have seen is that the programs that are getting the financial support are not really introducing new ideas but just expanding some of the already tested concepts like additional Respite hours to cover weekends and nights, more regional conferences, or adding multilingual support groups. All these are good expansions, but they are not truly focusing in the intent and purpose of the Caregivers’ Initiative. Consumer Directed Care can do what it can to meet the goals and objectives of the Caregivers’ Initiative program while introducing a more humane way, a more dignified way for our caregivers and their family members to age in place, age with the security and purpose in the home and community they love.

Whether Consumer Directed Care makes it to the general public and it becomes a household idea is up to all of us. If we don’t ask for the program we will never get it and it may go away because of lack of demand. We need to take a more active role to assure that our generation of caregivers is given the option to stay at home without more sacrifices than what is needed. We need to allow the caregivers to do what they do best without worrying about their own futures. The time is now to request the establishment of Consumer Directed Care as a service option. If we remain silent, we will never be able to achieve the control we desire in the care of our elders, our children and our most frail citizens. This is your wake up call a call to action now.

Dr. Gema Hernández


  • Dr. Gema G. Hernández, the founder of Aging & Cultural Consultants, Inc. and Access Ready: Communities for Life program is the former Secretary of the Department of Elder Affairs in the State of Florida, a professor and management consultant to many organizations nationwide and a caregiver for her parents for 18>
    Dr. Hernandez established Aging & Cultural Consultants, Inc. consulting firm to provide alternatives to nursing homes and to facilitate the creation of an elder friendly environment nationwide in which the private corporation understands the unique needs of its mature customers and uses that knowledge for entrepreneurial ideas to expand their businesses and to carve a niche for their companies in the mature adult market.