Housing Project

A person with a disability may choose to live at home with his or her family for a variety of reasons. Sometimes it is family tradition for youth to live at home until they have a family of their own. Sometimes family members need one another for financial support. Some young adults choose to live at home to save money. Still others live with their families because it is the place where they can find the support they need to manage their lives. Young adults should learn to be as responsible and independent as possible, even if they live at home. All members of the family should contribute to the household. Families may need to talk about household rules and each member’s responsibilities. It is fair to expect a young person who is working and receiving an SSI (Supplemental Security Income) check to share in the cost of food and household expenses. SSI rules can be complicated. For instance, people who live at home with their family will have their SSI check reduced by approximately one-third. However, their check will not be reduced if they notify the Social Security Administration that they are paying a fair amount for room and board.

Greater opportunities now exist for people with disabilities to rent or own apartments, condos, townhomes, or homes and receive the services and supports they need in the location of their choice. Renting and owning have advantages and disadvantages. For some people, renting is a better choice. Some renters say they like to have the flexibility to be mobile and to be able to make important lifestyle changes more easily, such as taking a new job or being in a relationship. Others who rent apartments or townhomes like the fact that they are not fully responsible for maintenance. In addition, renters can save money on maintenance and general upkeep, including grounds, that are a landlord’s responsibility.

Subsidized rental housing is available to people with disabilities who may have low incomes. The option limits the amount one would pay for housing (including utilities) to 30 percent of income. For more information see, “What are the Funding Sources?” section.

Home ownership has several advantages over renting. First, being a home owner is a valued role in our society and one that can closely connect a person to his or her community. Having a home of one’s own can provide a sense of permanency for people with disabilities, something that might have been missing if their living situation was previously under the control of others. In addition, people who own their homes often have more living space and more freedom to change their property as they like. Housing payments are relatively stable. Owning a home also means that people are more likely to become involved in their community, because they are likely to live there long term.

However, there can be significant costs in securing a home loan and down payment. A person who owns a home is responsible for its maintenance and repairs. When looking for a home, a person with a disability must think about whether he or she wants to live in a city, a suburb, or in a rural area. He or she will have to determine if physical modifications are needed and available; whether it is better to live alone or with others; and if public transportation is needed that is available and nearby. The answers to these questions will help determine where that person lives.

People with disabilities should also be aware of community resources that may be helpful in finding a place to live. For example, many cities offer first time home-buyer money, and many agencies offer “Home Stretch” training. Financial assistance may be available from community land trusts such as “City of Lakes” in the Twin Cities Metro area. Check your city’s website for more information on land trusts and home ownership resources.

Co-housing is a relatively new movement in the United States; it has been functioning successfully in Europe, however, for more than 20 years. The philosophy is based on traditional community living where neighbors and residents can share some of the day-to-day responsibilities of family living. Co-housing creates cross-generational communities that invite a variety of families and single people to participate in the planning, design, and ongoing management of the development. A co-housing community typically includes individual units clustered around a common house that may contain a dining room, kitchen, workshop, laundry, or  library. Some communities may decide to share responsibilities, such as childcare, or they may plan their dinners together on certain days of the week. Because it is a new concept in the United States, financing can be a problem as co-housing does not receive government support.

Residential housing with services includes adult foster care and group homes. People who manage the homes are licensed and registered with the Minnesota Department of Health to provide specialized services to people with disabilities through varying levels of care. However, the Minnesota Adult Foster Care system is licensed with the Minnesota Department of Human Services (DHS).

A provider needs to be licensed (under Minnesota Statutes and Rules) in order to receive state and federal funding. In addition, the provider must adhere to standards adopted to protect the health, safety, rights, and well-being of vulnerable adults. For example, adult foster care has license requirements unique to that individual program, and routine site visits are currently required to be made at least once every two years. Another example is Rule 36, establishing standards for mental health programs providing residential treatment and rehabilitation services to adults with mental illness on a 24-hour per-day basis.

According to DHS, residential care services provide “supportive services” and “health-related services.” Supportive services mean the provision of up to 24-hour supervision and oversight. When a person is living in a residential-service housing option, a care plan must indicate what services the residential care provider will furnish. These services cannot be duplicated by other state plans or by waivered services. Care plans are developed by county public health, the person with a disability, and others (both county and parents or guardians) who may have decision-making capacity. Service direction should be provided by the person with a disability, with assistance from the residential care home staff, with oversight from the case manager. Supportive services include:

• Transportation, when provided by the residential care home
• Socialization, if socialization is part of the plan of care that has specific goals and outcomes established
• Assistance in setting up a person’s meetings and appointments, and assistance in arranging medical and social services
• Assistance with personal laundry, such as carrying the person’s laundry to the laundry room

Health-related services are limited to minimal assistance with:

• Dressing, grooming, and bathing
• Providing reminders to residents to take medications that are self-administered, or providing storage for medications if requested

It is important for parents to be informed and know the questions to ask a residential service provider. Some agencies may work more effectively to include individualized supports in the care plan, while others may try to fit needs into a prescribed set of offerings. Every family must realistically decide how much time and energy they are willing and able to commit. It is best if agencies have committed and caring leaders, have a clear set of principles that guide their work, be open to change, and have a clear understanding that services need to be individualized. Some questions families may want to ask about residential housing include:

• Who owns the residence?
• What are the abilities and disabilities of the people living here?
• How many people live here?
• How many people share a bedroom?
• Is the degree of supervision and freedom individually determined?
• What are the “house rules?”
• What are the qualifications and talents of the staff?
• What is the staff to resident ratio?
• Does the staff live here, rotate, or work shifts?
• What is the staff turnover rate?
• What kind of training does the staff receive?

For more information on questions to ask see "Questions to Ask Residential Providers" from rtc.umn.edu

Residential Openings List is an excellent resource that is supported by The Association for Residential Resources in Minnesota (ARRM) and the Metro Crisis Coordination Program (MCCP) lets families search for openings in current residential settings.

For example, one can do an Internet search for current residential openings in Minnesota by entering gender, disability type, and affect (mild to severe), special medical attention, housing option, and financial considerations. You can also call (612) 869-6811 for assistance.

GROUP HOMES

Types of settings included in the category of group homes include traditional adult foster care homes, board and lodging establishments, non-certified boarding care homes, and housing-with-services establishments. Licensing requirements and funding streams define the differences among these options.

ADULT FOSTER HOMES

Adult foster homes provide 24-hour continuous care as well as support, structure, nurturance, and control toward achieving individualized goals within a family home environment. Unlike group homes and ICF/DD, adult foster care is less formal and is licensed under the DHS, not the Department of Health. Professional foster parents serve people with disabilities who are at risk and need a long-term supportive environment in which to strengthen and internalize positive behaviors and skills. There can be two kinds of foster care homes: corporate foster care or family foster care.

A person with a disability may live in an adult or corporate foster care setting that is owned and operated by a service provider. This is what many of us know as the “group home model.” As discussed previously, Olmstead supports the concept that services and supports should be provided to the person with the disability in the most integrated setting possible. This has allowed people with disabilities to create individualized housing options. For example, the person with the disability and/or their parents or guardians may rent or purchase an apartment, condo, townhome, or home. They can then hire their own staff through various funding sources: Home and Community-Based Waivers, Homecare, Consumer Directed Services, Personal Care Attendants, paid or unpaid natural supports, or contract with a housing provider for services. The mixing and matching of services within service menus allows people with disabilities the ultimate freedom to hire or fire their staff or providers if they so choose.

New individualized housing options may include:

• Monitoring (“Smart Home”) technology to augment staff, which allows for increased privacy and monitors the safety of a person with a disability
• “Scattered” apartment or condo within a market property: housing that includes people with and without disabilities in an apartment or condo complex, where a provider has separate apartments or condos for on-site service staff as specified by a person’s Individual Service Plan
• Consumer or parent-owned housing where live-in staff or shift staff is hired by the person with a disability and/or their parent or guardian. Unique arrangements may be used to augment staffing using natural supports, which may involve parents, siblings, community members, or volunteers. The MSA Shelter Needy Supplement for room and board may be accessed for individuals relocating to the community from an institution or receiving State Plan Services, Home and Community-Based Waivers, or Self-Directed Supports.

CORPORATE FOSTER CARE HOMES

Corporate foster care homes provide sleeping accommodations and services for one to four adults—or five adults if the residents are elderly. The home is not the primary residence of the foster care license holder nor does the license holder need to be the primary caregiver. Individuals in this type of foster home may be eligible for Supported Living Services (SLS) paid for by the county.

FAMILY FOSTER CARE HOMES

Family foster care homes provide sleeping accommodations and services for one to four adults. The home is the primary residence of the foster care license holder who is also the primary caregiver.

An Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD) is a residential facility licensed to provide services to people who have developmental disabilities or a related condition that requires a 24-hour plan of care to assure their health, safety, and well-being. Residents are usually unable to apply learned skills without ongoing supervision and cannot take care of their personal needs by themselves. According to federal law, individuals with developmental disabilities “must have substantial limitations in their present level of functioning, manifested as significantly below average intellectual functioning and demonstrated deficits in adaptive behavior that appear before their 22nd birthday.” ICF/DD’s can serve from four to 64 people. Eligibility for ICF/DD services is determined through a screening process through the county.

An ICF/DD must:

• Provide a continuous active treatment program that is based on the needs, preferences, and goals of the person
• Be consistent with the principles of the least restrictive environment and self-determination
• Include opportunities to participate in the community
• Include functional skill development and opportunities for the development of decision-making skills

NURSING HOMES

Nursing homes are community-based settings that provide a 24-hour plan of care for individuals who need a nursing level of care. Nursing homes should be considered transitional facilities for adults and not permanent residences. By federal law, a residence of over 16 beds is considered an institution. Since laws have been passed to de-institutionalize settings, individuals with developmental disabilities and mental illness should not be in a nursing home with individuals over the age of 65. State and federal money pay for lodging expenses if counties place individuals in smaller settings like group homes of four or fewer.