Self-directed care is no longer a niche alternative — it is emerging as a critical model for the future of long-term care. In this interview, Jennifer Truscott, chief operating officer of PPL, shares how her background leading complex health care operations shaped her belief in self-direction as a way to expand access, improve quality and support people living independently with dignity at home.
Truscott explains how self-directed care flips the traditional agency-based model by putting individuals in control of who provides their care and how it is delivered. By allowing people to choose trusted caregivers, the model strengthens continuity, deepens relationships and creates a better overall experience. Advances in technology, clearer program rules and stronger administrative support have also made it possible to deliver flexibility alongside accountability at scale.
As workforce shortages continue to challenge traditional home care, self-direction offers a more sustainable path forward. By supporting and compensating caregivers who are already providing care — family members, friends and trusted community members — the model expands the workforce and improves retention. Looking ahead, self-directed care is evolving into a central pillar of long-term care delivery in the U.S., driven by demographic shifts, consumer preference and growing proof that the model delivers better outcomes at scale.
Jessa Pacheco:
Welcome everyone. I'm Jessa Pacheco, content director with Fierce Life Sciences, and I'm really excited to be joined today by Jennifer Truscott, the chief operating officer of PPO. Jennifer, before we dive in, I'd love to start with a bit of your story. Can you share more about your background and your journey to becoming the chief operating officer at PPL?
Jennifer Truscott:
Sure, Jessa. Thanks for the opportunity. My career has been centered on leading large complex healthcare operations, particularly with a focus on access, quality, and sustainability. I've had the opportunity to work across health plans, clinical operations, and financial services. Most recently was at Aetna where I ever saw clinical strategy and operations across multiple lines of business. But when I reflect back on what drew me to PPL, it was clearly all about the mission. Self-directed care is one of the most powerful ways to help people live independently with dignity, supported by caregivers they know and trust. And that mission is extremely personable to me. My dad is the primary caregiver for my mom, and our top priority has always been to keep her at home where she feels the safest, most supported, most comfortable, because we really believe that will lead to better health outcomes for my mom.
And look, the belief that people should be able to live it with dignity in their own homes is what makes this work so meaningful to me. It's not just powerful, but it's at the core of what I truly believe. So to join PPL has just been actually amazing. Stepping into the COO role was really about scaling that impact and bringing operational rigor and technology, and strong support systems together to make this model work seamlessly for hundreds of thousands of people.
Jessa Pacheco:
That's really helpful context. And I think it sets the stage nicely for this conversation. Self-directed care has been around for years but still isn't widely understood. What would you like our readers to understand about the benefits of self-direction model?
Jennifer Truscott:
At the core, self-directed care flips that traditional model that we're all familiar with. Instead of caring, being dedicated by an agency or institutions, it puts the individual in control. That means that individuals can choose who provides their care, often someone they already know and trust, and decide how and when that care is delivered. And that level of choice leads, from my perspective, to better continuity, stronger relationships, and ultimately a better experience. Look, historically, one of the reasons the model hasn't been widely understood or adopted is that earlier versions didn't always have the infrastructure to support it at scale. That's changed though, and today, with clear program rules, better technology and strong administrative support, we're able to deliver both flexibility and accountability. And as a result, we're now seeing growing recognition that self-directed isn't just an alternative, it's an essential part of the future of care.
Jessa Pacheco:
I think that perspective is especially important right now as healthcare organizations look for more flexible and patient-centered approaches to care. So building on that, one of the biggest challenges we're hearing about across healthcare is workforce shortages. So with these shortages continuing to challenge traditional home care, how does the self-direction directed model change the dynamics of caregiver supply and retention?
Jennifer Truscott:
The traditional home care model is under real pressure right now because it relies on relatively fixed workforce. Self-directed care changes that dynamic in a meaningful way. It expands the workforce by bringing in caregivers who are already providing care. Think of family members, friends, trusted individuals in the community, and giving them structure, compensation and support. And that's the direct impact on retention. When caregivers have flexibility and feel connected to the person they're supporting, they're much more likely to stay engaged, and that consistently leads to better outcomes for the individuals receiving care. So instead of competing for a limited pool of workers, this model grows the workforce in a way that's more sustainable and more aligned with how care actually happens in people's lives.
Jessa Pacheco:
Those are great points. And as more states look to scale self-directed programs, what are the key operational or policy guardrails needed to balance consumer choice with program integrity?
Jennifer Truscott:
As more states look to scale self-directed care, the key is showing that flexibility and accountability can go hand in hand. As I see it first, you need clear and consistent program rules that reinforce the consumer's role in directing and approving care. Second, strong oversight, things like electronic timekeeping, real-time data visibility and standardized processes are critical to ensuring accuracy and preventing misuse. And just as importantly, you need to support people. That means accessible training, multilingual resources and responsive customer service so both the consumers and the caregivers can navigate the program confidently. When you get that balance right, you don't lose flexibility of self-direction. You actually strengthen it, and it makes it much more sustainable and at scale.
Jessa Pacheco:
I think that naturally leads into the bigger picture of where this model is heading overall. So looking ahead, do you see self-directed care remaining a complimentary model or evolving into a central pillar of long-term care delivery in the US, and what will drive that shift?
Jennifer Truscott:
I truly see self-directed care evolving into a center pillar of long-term care in the United States, not just a complimentary model. The drivers are clear. We have a rapidly aging population, a constrained traditional workforce, and a strong preference from individuals to receive care at home by someone they trust. Self-direction yields and delivers all three of those, but really accelerate that shift is proof at scale. As more states successfully implement these programs and demonstrate better outcomes, higher satisfaction, and more efficient use of resources, it becomes clear that this isn't just a different way to deliver care. It's actually the smarter one. So we're moving from proving that self-direction care works to showing that it can work at scale with the right structure, transparency, and support behind it.
Jessa Pacheco:
Thank you, Jennifer. This has been such a great conversation. And thank you again for taking the time to share your perspective and insights, and helping to bring more visibility to this important topic.
Jennifer Truscott:
My pleasure.