%0 Journal Article
%T Self-Directed Home- and Community-Based Services Improve Outcomes for Family Caregivers: A Systematic Review.
%A Kueakomoldej S
%A Dinelli E
%A Beestrum M
%A Sadler T
%A Caldwell J
%A McHugh M
%A Heinemann AW
%J Gerontologist
%V 64
%N 8
%D 2024 08 1
%M 38853407
%F 5.422
%R 10.1093/geront/gnae068
%X Self-direction is an approach that allows older adults and people with disabilities to determine the home- and community-based services they receive, including the ability to hire caregivers of their choice. Self-direction has been shown to improve outcomes for the service recipients. The promotion of choice and control in self-direction may also affect family caregivers. We conducted a systematic review examining the impact of self-direction on a broad range of caregiver outcomes.<BR>We conducted a systematic review guided by PRISMA guidelines. Literature search was conducted in 8 databases. We appraised risk of bias using the Joanna Briggs Institute critical appraisal checklists and assessed certainty of evidence using the GRADE framework.<BR>Sixteen studies meeting inclusion criteria were included. We found, with moderate certainty, that self-direction is associated with improved caregivers' personal and social well-being. Caregivers also reported reduced unmet needs and increased access to care for the care recipients under self-direction. Self-direction did not appear to reduce caregiving hours. With less certainty, self-direction was also positively associated with increased respite care use, perception of choice, and intention to continue caregiving by caregivers.<BR>Beyond delivering person-centered services that improve recipient outcomes, self-direction may also improve the outcomes of family caregivers.