The highly anticipated fifth Self-Direction National Inventory for the 2023 AARP Long Term Services and Supports (LTSS) State Scorecard has arrived! Applied Self-Direction conducted an extensive national survey of self-direction programs in the United States. The research revealed eight key findings on the growth of self-direction, along with data on program expansion and ideas for future policy development.
According to the 2023 Inventory, there are more than 1.5 million people who self-direct their long-term services and supports. This represents a 23 percent increase since 2019. By comparison, enrollment grew by 17 percent from 2016 to 2019. Most states (44) reported an overall increase in self-direction enrollment and six of those states have more than doubled self-direction enrollment since 2019.
Inventory data confirms the pandemic accelerated the expansion of self-direction nationwide. States reported that self-direction uptake rates spiked during the early days of the pandemic due to a combination of factors, such as emergency Medicaid waiver amendments. Self-direction became critical to filling the void left by the widespread closure of day services and other supports across the country, and in many states helped family caregivers receive payment for the care they provide. It has also helped mitigate, but alone cannot entirely make up for, pervasive workforce shortages. New to this edition of the Inventory - a comprehensive list of state strategies to address workforce shortages.
