Most people, when they imagine receiving support services, picture someone else making the decisions.
A caseworker assigns a caregiver. An agency sets the schedule. A plan gets written by professionals in a room the individual may never have entered. And the person whose life is being planned around? They are often the last one asked.
This is not how it has to work.
Self-direction is a model of support that flips that picture entirely. And at the heart of it is something called person centered care, an approach that starts with the individual, their preferences, their goals, and their definition of a good life, and builds everything else around that.
For adults with autism or an intellectual or developmental disability (I/DD), self-direction and person centered care are not just policy concepts. They are practical tools for living with more agency, more dignity, and more control over what each day looks like.
At Elevate Spectrum, we believe that every adult with I/DD deserves to be the author of their own life. Understanding what self-direction really means, and what person centered care actually looks like in practice, is where that authorship begins.
What Is Person Centered Care?
Person centered care is an approach to support that places the individual at the center of every decision about their life.
It sounds simple. In practice, it represents a significant departure from how services have historically been delivered to people with disabilities. Traditional models often start with a diagnosis, a category, a funding level, and work backward to the person. Person centered care starts with the person and works outward from there.
That means asking different questions. Not “what does this person’s diagnosis require?” but “what does this person want their life to look like?” Not “what services are available?” but “what kind of support would actually help this person reach their own goals?”
Person centered care recognizes that adults with I/DD are not passive recipients of services. They are individuals with preferences, opinions, relationships, and ambitions. Some want to live independently. Some want to work. Some want to build friendships, pursue hobbies, or simply have more say in their daily routine. All of those goals are valid. All of them deserve to be heard.
In Maryland’s DDA waiver system, person centered care is built into the planning process. Person-Centered Plans (PCP) are supposed to reflect what the person actually wants, not just what is easiest to provide. The degree to which that happens in practice varies, which is why understanding your rights within the process matters.
What Does “Staying in Control” Mean?
When families and individuals first hear about self-direction, the phrase “staying in control” can feel abstract. Control over what, exactly?
In the context of person centered care and self-directed services, staying in control means several concrete things.
It means choosing who supports you. Rather than accepting whoever an agency assigns, a self-directing individual can hire someone they already know and trust, or recruit someone who is a genuine fit for their personality and communication style. That choice belongs to the individual and their family, not to a staffing coordinator.
It means deciding how your day is structured. Person centered care supports the idea that schedules should reflect real life, not institutional convenience. If someone does better with support in the mornings, the schedule should reflect that. If someone wants help with a specific goal like cooking or community access, services should be built around that goal.
It means having input into your budget. In fully self-directed models, individuals have visibility into the funding available for their services and can make decisions about how that funding is allocated. This requires support, but it is a meaningful form of financial agency that traditional service models rarely offer.
Staying in control does not mean doing everything alone. It means that when support is needed, the individual gets to shape what that support looks like, who provides it, and when it shows up. That distinction is the foundation of person centered care.
How Do I Make My Own Care Decisions?
Making your own care decisions within a self-directed model is a skill, and like any skill, it develops over time with the right support.
The starting point is knowing what you want. This sounds straightforward, but for many adults with I/DD who have spent years having decisions made for them, articulating preferences can take practice. Person centered planning tools, coordinators of community services, and services that build that build real-world decision-making skills can all help with this.
From there, the person centered plan becomes the document that reflects those decisions. This is where the goals matter. A plan that says “individual will attend a day program” is not the same as a plan that says “ individual wants to build cooking skills and increase community connections.” The second version reflects person centered care. The first reflects a service slot.
Advocating for your own plan is something families and individuals can and should do. You have the right to bring people you trust to planning meetings. You have the right to request changes to your plan when your goals or needs shift. You have the right to disagree with recommendations and ask for alternatives.
For adults with I/DD who need support making decisions, authorized representatives and supported decision-making agreements are tools that allow trusted people to help without removing the individual’s voice entirely. Supported decision-making is one of the clearest expressions of person centered care in action. It says that needing help with a decision is not the same as losing the right to make it.
If you are not sure how to start shaping your own care decisions, coordinator of community services, self-advocacy group, or organization like Elevate Spectrum can help you find your footing.
What Support Is Available in Self-Direction?
One of the most common concerns families raise about self-direction is whether they will be left to figure everything out on their own. The answer is no, and understanding the support structure available makes the whole model feel much more approachable.
Coordinator of community services are a central resource. Their role is to help individuals navigate the waiver system, develop their Individual Plan, connect with services, and advocate for their needs within the system. A good coordinator of community services understands person centered care and sees their job as helping the individual get what they actually want, not just what is easiest to arrange.
Fiscal Management and Counseling Services agency handle the administrative side of self-direction. When an individual is hiring their own caregiver or managing a self-directed budget, the fiscal intermediary takes on payroll processing, tax withholding, background checks, and compliance. This is what makes it possible for a family to manage care relationships without becoming an employer in the full administrative sense of the word.
Life skills programs like Elevate Spectrum’s DayVentures provide structured support for building the real-world capabilities that self-direction requires. Budgeting, communication, decision-making, community navigation, and relationship skills all develop over time with the right environment. Person centered care is not just a planning philosophy. It is also something that shows up every day in how programs are designed and delivered.
Benefits counselors are an underused but important resource, particularly for individuals and families concerned about how self-direction might interact with SSI, Medicaid, or other supports. Changes in services, income, or savings can have ripple effects, and a benefits counselor helps families understand those dynamics before they become problems.
Finally, peer support and self-advocacy communities offer something that professionals cannot: the perspective of people who have navigated this system themselves. Connecting with other adults with I/DD who are living self-directed lives is one of the most affirming and practical steps anyone can take.
Control Is Not Something You Have to Earn
For too long, the message delivered to adults with I/DD and their families has been that control over daily life is something granted by the system, when the paperwork is right, when the funding aligns, when the professionals agree.
Person centered supports says something different. It says that control belongs to the individual from the start. The system exists to support that, not to manage it.
Self-direction is the structure. Person centered care is the philosophy. Together, they create something that looks less like a service delivery model and more like a life.
At Elevate Spectrum, everything we do is built around this idea. Our programs are designed to help adults with autism and I/DD build the skills, confidence, and connections that make self-direction real, not just on paper, but in daily life.
✨ Book an intro call ✨ Explore DayVentures
Because a good life is not something that gets assigned. It is something you build, on your own terms, with the right support beside you.
