Self-Directed Home- and Community-Based Services Improve Outcomes for Family Caregivers: A Systematic Review

Area of Science:

• Gerontology
• Disability Studies
• Caregiver Support

Background:

• Self-direction enables older adults and individuals with disabilities to control their home and community-based services.
• This model includes the autonomy to select personal caregivers, enhancing recipient outcomes.
• The influence of self-direction on family caregivers warrants thorough investigation.

Purpose of the Study:

• To systematically review the effects of self-direction on various family caregiver outcomes.
• To synthesize evidence on how increased choice and control impact caregiver well-being.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted.
• Literature searches encompassed 8 databases, with critical appraisal using Joanna Briggs Institute checklists.
• The GRADE framework assessed the certainty of evidence.

Main Results:

• Sixteen studies indicated that self-direction moderately improves caregiver personal and social well-being.
• Caregivers reported fewer unmet needs and better access to care for recipients.
• Evidence suggests increased respite care use and intention to continue caregiving, though with less certainty.

Conclusions:

• Self-direction benefits not only service recipients but also enhances the well-being and support systems of family caregivers.
• Promoting autonomy in service delivery positively influences the caregiver experience.