Returning to Self-Direction: How Sophia Transitioned Out of an Institution

Sophia had once lived a self-directed life—hiring caregivers of her choosing and making decisions about her daily support. But when uncontrollable family circumstances left her without a backup plan, there was no one available to step in.

Most self-direction programs require families to have a backup plan in place. For Sophia, there simply wasn’t one. With no other options, she was admitted to an institution—the only place that could accommodate her quickly.

She remained there until her home situation stabilized. But when it was time to consider returning to self-direction, her family was overwhelmed by what came next.

What Is Self-Direction (PDS)?

Self-direction, also known as Participant-Directed Services (PDS) in Kentucky, is a Medicaid waiver option that allows individuals and families to:

• Hire and manage their own support staff
• Create schedules that fit their unique needs
• Choose who provides their care
• Use Medicaid funds in flexible, person-centered ways

It’s one of the only models that puts control directly in the hands of the person receiving support.

A Complicated Path Back Home

Sophia’s family knew she didn’t belong in an institution—but they had no idea how to get her out.

❌ They weren’t sure what the rules were for transitioning back to self-direction

❌ They didn’t know where to start with the mountain of paperwork

❌ They had no one in their circle who could guide them through the process

They were emotionally drained and drowning in frustration. They had already recruited caregivers on their own—but the biggest hurdle was still ahead: navigating the administrative process of onboarding staff.

The Right Support at the Right Time

To move forward, they needed someone who understood the system and could walk them through it step by step.

Within one month, the entire team was onboarded:

✔️ Three employees and their representatives were approved and ready to start

✔️ All paperwork was completed correctly and on time, avoiding costly delays

✔️ The transition out of the institution was finally in motion

Many families get stuck at this stage—not because they lack motivation, but because the process is so hard to navigate without help.

Now, Sophia Is Living Life on Her Terms

With the administrative barriers removed, Sophia returned to a home of her choosing, surrounded by a team she selected.

Today, she is:

🏡 Living where she wants to be

💡 Making her own choices

😊 Enjoying life with the support she needs

For Sophia, this wasn’t just about leaving an institution. It was about reclaiming her independence.

If you support individuals transitioning out of institutional settings:

➡️ Don’t assume the family knows how to return to self-direction

➡️ Ask whether they understand the onboarding process for staff

➡️ Make sure they’re connected with someone who can walk them through it

✅ Connect them with someone who can help them use their waiver—not just have one.

Meet Samantha

Samantha Harrison is a disability consultant with over 13 years of experience helping Kentucky families navigate Medicaid waivers, hire caregivers through Participant-Directed Services (PDS), and build care teams that actually work.

She partners with professionals who want more than checklists—offering practical support to help families move forward with clarity, confidence, and the right team in place.

When families are overwhelmed, and professionals are stretched thin, Samantha steps in with hands-on solutions that actually make a difference.

📩 Connect with Samantha to learn how she can support the families you serve.

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