Self-Directed Care

Washington State’s Self-Directed Care Act of 1999, ensures that persons who can and want to be in charge of their own healthcare, but are physically challenged to do so, can still receive care in their own homes. Self-directed care is the process in which an adult person, who is prevented by a functional disability from performing a manual function, related to health care that an individual would otherwise perform for himself or herself, chooses to direct and supervise a paid personal aide to perform those tasks. The Act set the following guidelines for the provision of self-directed care:

• Health care tasks are those medical, nursing, or home health services that enable the person to maintain independence, personal hygiene, and safety in his or her own home, and that are services that a person without a functional disability would customarily and personally perform without the assistance of a licensed health care provider.
• The individual who chooses to self-direct a health care task is responsible for initiating self-direction by informing the health care professional who has ordered the treatment which involves that task of the individual's intent to perform that task through self-direction.
• When a licensed health care provider orders treatment involving a health care task to be performed through self-directed care, the responsibility to ascertain that the patient understands the treatment and will be able to follow through on the self-directed care task is the same as it would be for a patient who performs the health care task for himself or herself, and the licensed health care provider incurs no additional liability when ordering a health care task which is to be performed through self-directed care.
• The role of the personal aide in self-directed care is limited to performing the physical aspect of health care tasks under the direction of the person for whom the tasks are being done. This shall not affect the ability of a personal aide to provide other home care services, such as personal care or homemaker services, which enable the client to remain at home.
• The responsibility to initiate self-directed health care tasks, to possess the necessary knowledge and training for those tasks, and to exercise judgment regarding the manner of their performance rests and remains with the person who has chosen to self-direct those tasks, including the decision to employ and dismiss a personal aide.

Note: If an individual is compensated to serve as a personal side provider under contract and agreement with the State of Washington, the individual must register with the state to perform self-directed tasks. Also, when state funds are used to pay for self-directed tasks, a description of those tasks will be included in the individual's comprehensive assessment, and subject to review with each annual reassessment.