Consumer Directed Care began in nation in 1998 and in Florida in the year 2000. Since the beginning of the program it has been the most effective program in improving the quality life of the elders and their caregivers. It is a program that makes sense not only because it allows the elder and/or the caregiver to direct his or her care by selecting the services and providers they like, but also because it saves money. The program has been in such demand that it makes me wonder why it has not been extended to the middle class families and why there are still areas in the country where it is totally unknown to the public.

In times when the financial resources are very limited we need to explore ways to serve as many elders as possible and do it in a way that will not compromise their well being. What better way to accomplish both goals than by allowing elders to choose the services and the programs they need to be kept at home. While Consumer Directed Care is an ideal program to help families manage their care, the program was designed not necessarily to help Medicaid recipients, but to contain costs. In government language the program was and is a budget neutral program. The hope was that the program will eventually become a cost avoidance program for the Medicaid budget. This means that the success of the program was going to be based solely on the amount of dollars it saves the Medicaid budget.

With more individuals becoming frail and living longer with frail conditions that require around the clock care, more resources are needed to keep them at home, therefore, the original cost savings anticipated by the program designers is not being realized, and this is making government officials think twice about continuing the program. It is very possible than even though thousands of elders and individuals with disabilities have improved their quality of life because of this program, Consumer Directed Care may be cancelled due to the fact that the financial bottom line, not the human bottom line has not been reached and the expected savings are no longer there. This is a sad commentary in the way our elected officials and bureaucrats do business because they continue to balance the federal and state budgets on the backs of frail and vulnerable people.

Before the ax falls on another good program we should become involved in the fight to save the Consumer Directed Care and all the other Medicaid waivers programs in existence today. We need to convey to our elected officials that Consumer Directed Care should be part of a legislative mandate in each of our states. We need a legislative mandate that allocates state funds under the framework of the consumers’ wishes and direction. Once that is accomplished we should also need to make sure that the federal Medicaid program makes Consumer Directed care a permanent Medicaid waiver program and not just a research project. Research projects have their own set of rules that are not necessarily the best rules for the caregivers or the frail person. The success or failure of programs for frail persons should not be based on how much money the government saved but in how much the program has increased the quality of life of participants. If money is saved, then it should be an added value to the equation, but not the only value.

Consider the following: Some families are not earning enough money to survive, some families cannot afford health care, some families have given up their jobs to take care of their loved ones at home and some families are not paying into the Social Security system. Under the present system, these families are in danger. They are mortgaging their future and the future of their children. Consumer Directed Care offers the option to pay family members a salary similar to the salary they pay now to private agencies for the work they do. If family members are able and willing to perform certain services they receive payment and a contribution to their Social Security. Paying family members at the lowest range of the payment scale saves money because family members provide more hours of services than an agency does for the same amount of money. In addition, sometimes the differences between the lowest cost and the next lower cost agencies charged to perform those services exceed $2.00 dollars per hour. And $2 dollars per hours times millions of hours of services represents a real savings. But this type of savings comes within the human aspect of the equation.

Some families are not able or willing to provide services themselves but they would like to choose the agency or individual worker who in turn will provide services to their loved ones. When families choose agencies and workers we discover they also pay attention to the unit cost, and in the majority of cases, select those individuals or agencies with the lowest cost, but the same quality of services. This is what having choices is all about, the ability to select the best providers for our situation or the most appropriate services for our condition. I have known of so many elders that are not happy with the services they receive but because they are not able to change agencies they have no choice but to accept those services. If an agency is not providing the services the way a frail person wants or desires, elders or caregivers should have the right to change providers, no questions asked. After all, the service delivery system exists not to protect agencies or to guarantee their existence but to protect and serve elders. Having the power of changing agencies should be the right of the consumer in any government funded program, not left to the discretion of an agency director, whose bottom line is to increase his or her budget, not the well being of the frail person.

Consumer Directed Care provides not only control and higher satisfaction, but actually avoids the following cost:1.195 million in case management services, 3.949 million in homemaker services, 3.917 million in personal care and 3.782 million in transportation costs. Add to the avoidance of the above costs another 3.251 in home delivered meals and the cumulative cost avoidance figures reach 16 million in one year. This is an impressive amount not to be easily discarded. These figures are based in the cost of services in Florida in 2000 with a total of 3,000 individuals in the program. The savings may vary in other areas of the country and with more or less individuals in the program.

This 16 million generated by avoiding a higher cost to be paid to agencies could be used to provide services to 2,500 to 3,000 more elders. It is a win-win situation for the elders, for the families and for the community at large.In a time when the federal government is considering eliminating the Medicaid program as it exists today and making Medicaid a Block grant to the states the warning has been given. It is up to us to fight for the preservation of those programs and services that make a real difference in people’s lives.

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.