Autonomy means the freedom to choose, whether it’s a cup of coffee or a career path. The act of making our own decisions allows us to enjoy our lives and, most importantly, to participate in society according to our will. This week, our Humans of EASPD story on autonomy focuses on personal budgets and their value for people with disabilities in terms of leading a life that they choose and want to live.

We spoke to Liesbeth Van Houdt, Spokesperson for VAPH, a government organisation based in Flanders, Belgium, which provides personal budgets to persons with disabilities to help them buy care and support, and make choices in their daily lives.

Liesbeth, in your words, how would you define personal budgets for persons with disabilities?

It’s quite simple: to make choices in life you need finances. With a personal budget, people with disabilities can buy the care and support they need, whether it’s choosing to pay for residential care, deciding to stay home with personal assistance, transportation, or psychosocial counselling. A personal budget, essentially, provides them with more choices, big or small. For example, you and I do not need to think much before we buy a coffee but ask someone who needs assistive technology to just hold a cup of coffee. This ‘small’ life decision for them is hard without assistance, and this is where personal budgets come in – it’s important for the autonomy of persons with disabilities to make choices as “simple” as getting a cup of coffee.

With personal budgets, they get the freedom to allocate their budgets and do what they want in their daily lives. Moreover, these budgets are essential to ensure quality of life. They are not only paying for care, but they are also paying to participate in society. It enables them to make choices to not just live life but to enjoy life. As a result, personal budgets are crucial for the autonomy of persons with disabilities.

Why did this personal budgets system come into existence?

It has a long history. In Belgium, more specifically in the Flemish region, we switched to this system in 2017. But, in the years before, we spoke to people with disabilities, politicians, and caregivers about their views. From this, we learnt that people with disabilities wanted more autonomy – that was noticeably clear from the beginning. The debate kept coming back to people with disabilities being able to decide for themselves. This strongly pushed us to adopt the personal budgets system in Flanders.

With this, came a power transition. Previously, we used to subsidise institutions, so that they could equip themselves to provide services to people with disabilities. Now, we give the money directly to people with disabilities. This empowers them to make their own choices, whether that means staying at an institution or staying in their own homes and receiving assistance or personal support.

What are the challenges you face within this system of personal budgets?

To understand the challenges, it’s important to understand the system at VAPH of allocating budgets to people with disabilities. First, we receive applications from people who request funds for the services they need. However, not everyone that applies can get the funds. The money comes from the government to us, and then we decide (after reviewing the application) who needs these funds the most.

It’s a hard decision to make. Our biggest challenge is dividing the funds given by the government to all those who apply. There are many who stay on a waiting list for a long time and we can’t do much about it. However, we always try our best to support these people on the waitlist with other tools or support that is already available, or reimbursing them for devices and tools that can make their lives safer, easier, and independent, such as an assistive chair. According to our statistics, each year we have more people with disabilities and, therefore, the funds need to increase exponentially every year.

A thorough application process has been put in place to make the selection process objective and fair, but it has a pitfall. There is huge amount of administrative work to be done. The paperwork can be discouraging for people applying. However, we’re trying to simplify the process as much as possible.

Ultimately, it’s an emotionally tough job to make these decisions, which is why we have a multidisciplinary team of psychologists, physicians, and the employees of VAPH who make a joint decision.

Can you share the proudest moment of your journey?

Seeing people live their lives. When we see how they can change their own life once they have the financial means to do so, I feel proud. Just a while back I was talking to a woman who couldn’t eat meals by herself. Recently, she received funds, and bought an eating device, so she no longer has to wait to eat until her support person is available. She can now eat whenever she wants to with the help of the device in her own apartment, which made her so proud! Outcomes like this make me see the impact of our work and want to keep building on it.