The shift toward self-directed care is transforming the U.S. healthcare landscape by moving away from agency-managed services to a model where individuals take a central role in managing their own care, including selecting caregivers and setting schedules. This transition is driven by a growing demand for personalized, home-based services and a critical shortage of professional healthcare workers. By formalizing and compensating family members and friends as caregivers, self-direction expands the workforce while utilizing modern technologies like electronic visit verification to maintain oversight and program integrity. Ultimately, the model is evolving from a niche alternative into an essential component of long-term care that aligns system efficiency with the personal and cultural preferences of patients.

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