Roadmap to Residential Services: Adults with Developmental Disabilities © 2014

A self-guided, self paced decision tree intended to assist families and individuals on what housing and residential placement options are available for adults receiving services through regional center.

Click on individual squares in the decision tree to learn more of the service.

• Click on the title of each page to return to the decision tree.• Click on the arrow to return to the particular branch of services. • Click on words in blue or red to get detailed definition of service.• Click here to go to the decision tree.

Note: •For residential placement in the community the guiding principle directing the services to be arranged is the need to maintain the health and safety of the individual.•This roadmap is not to replace the importance of a discussing residential service options with the regional center service coordinator.•The roadmap does not address housing trends or describe services or availability.•The definitions for the services described in this roadmap are from the Department of Developmental Services, http://www.dds.ca.gov/

Vendor DirectoriesSanta Clara, Santa Cruz, San Benito, Monterrey Cnties

Questions to Consider

Where will my adult child live?

• At home with family

• Somewhere outside the home.

At home with family

• In home support service• Independent living services• Respite Services• Natural supports• Other supports

In Home Support Service (IHSS)In-Home Supportive Services (IHSS) provides personal care and domestic services to persons who are aged, blind or disabled and who live in their own homes. IHSS is provided to those who otherwise might be placed in an out-of-home care facility but who can safely remain in their own home if IHSS services are received.Regional centers have a mandate not only to serve persons with developmental disabilities, but to provide services in the most cost-effective manner possible. They are required by the Lanterman Act to use all other sources of funding and services before using regional center funds to provide services. Persons who receive services from a regional center and are eligible for IHSS are expected to use IHSS services available to them.The In-Home Supportive Services (IHSS) program is administered by each county with oversight by the California Department of Social Services (CDSS). For application and eligibility information contact your local county welfare department, adult services section. Look for them in the county government section of your local telephone directory

In home Outside the home

Independent Living ServicesIndependent Living is a service provided to adults with developmental disabilities that offers functional skills training necessary to secure a self-sustaining, independent living situation in the community and/or may provide the support necessary to maintain those skills. Individuals typically live alone or with roommates in their own homes or apartments. These homes are not licensed.Independent living programs, which are vendored and monitored by regional centers, provide or coordinate support services for individuals in independent living settings. They focus on functional skills training for adults who generally have acquired basic self-help skills or who, because of their physical disabilities, do not possess basic self-help skills, but who employ and supervise aides to assist them in meeting their personal needs. Generally the level of support is not as extensive as what is available through supported living services. Often services can be provided at a less than daily level. For more information about Independent Living Services, contact your local regional center.

In home Outside the home

Respite ServicesRespite (In-Home) Services means intermittent or regularly scheduled temporary non-medical care and/or supervision provided in the person's home. In-Home Respite services are support services which typically include:•Assisting the family members to enable a person with developmental disabilities to continue living in the family home. •Providing appropriate care and supervision to protect that person's safety in the absence of a family member(s);•Relieving family members from the constantly demanding responsibility of providing care; and•Attending to basic self-help needs and other activities that would ordinarily be performed by the family member.•Respite (Out-of-Home) Services are provided in licensed residential facilities.•Respite services typically are obtained from a respite vendor, by use of vouchers and/or alternative respite options. Vouchers are a means by which a family may choose their own service provider directly through a payment, coupon or other type of authorization. For more information about respite services contact your regional center representative.

Somewhere outside the home.

• Nursing: Residential arrangements to meet involved nursing and health needs.

• Non-nursing: residential arrangements that do not require more involved nursing or health care needs.

Nursing: Residential arrangements to meet involved nursing and health needs.

Skilled Nursing

Intermediate Care Facility

Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN) aka 962’s

Supportive Living Services

Intermediate Care Facility: General Definition

Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/IID) are health facilities licensed by the Licensing and Certification Division of theCalifornia Department of Public Health (CDPH) to provide 24-hour-per-day residential services. There are four types of ICF/IID's, which primarily provide services to regional center clients with developmental disabilities

Four Types

Intermediate Care Facility

The four types of homes are:ICF/DD (Developmentally Disabled)ICF/DD-H (Habilitative)ICF/DD-N (Nursing)Developmentally Disabled-Continuous

Nursing Care (DD-CNC)

Intermediate Care Facility:ICF/DD (Developmentally Disabled)

ICF/DD (Developmentally Disabled)"Intermediate care facility/developmentally disabled" is a facility that provides 24-hour personal care, habilitation, developmental, and supportive health services to developmentally disabled clients whose primary need is for developmental services and who have a recurring but intermittent need for skilled nursing services.

Intermediate Care FacilityICF/DD-H

(Habilitative)

ICF/DD-H (Habilitative)"Intermediate care facility/developmentally disabled-habilitative" is a facility with a capacity of 4 to 15 beds that provides 24-hour personal care, habilitation, developmental, and supportive health services to 15 or fewer developmentally disabled persons who have intermittent recurring needs for nursing services, but have been certified by a physician and surgeon as not requiring availability of continuous skilled nursing care.

Intermediate Care FacilityICF/DD-N

(Nursing)

ICF/DD-N (Nursing)"Intermediate care facility/developmentally disabled-nursing" is a facility with a capacity of 4 to 15 beds that provides 24-hour personal care, developmental services, and nursing supervision for developmentally disabled persons who have intermittent recurring needs for skilled nursing care but have been certified by a physician and surgeon as not requiring continuous skilled nursing care. The facility shall serve medically fragile persons who have developmental disabilities or demonstrate significant developmental delay that may lead to a developmental disability if not treated.

Developmentally Disabled-Continuous Nursing Care (DD-CNC)There is an additional facility type, the Developmentally Disabled – Continuous Nursing Care (DD-CNC). The DD-CNC Waiver program provides 24-hour continuous skilled nursing care in home and community-based residential settings to persons with developmental disabilities who are medically fragile. Eligibility criteria requires that DD-CNC Waiver participants be Medi-Cal eligible, enrolled in, and certified by a Regional Center as having a developmental disability, exhibit medical necessity for 24-hour continuous skilled nursing care and free of any clinically active communicable disease. Participants must also meet specific minimum medical criteria as described in the waiver. The program provides home and community-based services that assist Medi-Cal beneficiaries to live in the community and avoid institutionalization. The DD-CNC program is initially licensed as an ICF/DD-N type facility. However, the license is suspended while the facility operates under a Waiver program. DD-CNC development is currently limited by a regional center’s assessed need for this program

Intermediate Care FacilityDevelopmentally Disabled-Continuous Nursing Care

(DD-CNC)

Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN) aka 962’s

• “Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN)” means any adult residential facility that provides 24-hour health care and intensive support services in a homelike setting that is licensed to serve up to five adults

with developmental disabilities.

Supportive Living ServicesSupported Living Services (SLS) consist of a broad range of services to adults with developmental disabilities who, through the Individual Program Plan (IPP) process, choose to live in homes they themselves own or lease in the community. SLS arrangements assures up to 24 hours of daily support. SLS may include:

• Assistance with selecting and moving into a home;• Choosing personal attendants and housemates;• Acquiring household furnishings;• Common daily living activities and emergencies;• Becoming a participating member in community life; and,• Managing personal financial affairs, as well as other supports.

These services help individuals exercise meaningful choice and control in their daily lives, including where and with whom to live. SLS is designed to foster individuals' nurturing relationships, full membership in the community, and work toward their long-range personal goals. Because these may be life-long concerns, Supported Living Services are offered for as long and as often as needed, with the flexibility required to meet a persons' changing needs over time, and without regard solely to the level of disability. Typically, a supported living service agency works with the individual to establish and maintain a safe, stable, and independent life in his or her own home. But it is also possible for some individuals to supervise their services themselves, to secure the maximum possible level of personal independence.The guiding principles of SLS are set down in Section 4689(a) of the Lanterman Act. The Department's regulations for SLS are found in Title 17, Division 2, Chapter 3, Subchapter 19 (Sections 58600 et seq) of the California Code of Regulations (CCR).Individuals who choose to live in their own homes, and their agencies or other people who support them, often will need information about affordable housing options, sources of financial support such as Supplementary Security Income (SSI), and how to stretch a limited budget to meet living expenses. These are the ordinary challenges that are inseparable from a truly self-directed life in the community. For the many adults for whom SLS makes great sense, such challenges are often also road signs on the path to a satisfying life.

Nursing Outside the home

Non-Nursing:No, or limited medical needs

• In their own apartment or home.

• In someone else’s home.

• Intentional Community

In their own apartment or home.

• Market rate rents.

• Subsidized Housing.

• Owned or rented by self or family.

• Shared financial responsibilities with roommates.

Services and supports provided to keep secure these housing arrangements.

Services and supports provided to keep secure these housing arrangements.

• Supported Living Services

• Independent Living Services

• IHSS

In someone else’s home.

• Department of Social Services Licensed Homes Community Care Facilities.

• Family Home Agencies.

Department of Social Services Licensed Homes, Adult Residential Facilities

• Community Care Facilities (CCFs) are licensed by the Community Care Licensing Division of the State Department of Social Services to provide 24-hour non-medical residential care to children and adults with developmental disabilities who are in need of personal services, supervision, and/or assistance essential for self-protection or sustaining the activities of daily living. Based upon the types of services provided and the persons served, each CCF vendored by a regional center is designated one of the following service levels:

• SERVICE LEVEL 1: Limited care and supervision for persons with self-care skills and no behavior problems.

• SERVICE LEVEL 2: Care, supervision, and incidental training for persons with some self-care skills and no major behavior problems

• SERVICE LEVEL 3: Care, supervision, and ongoing training for persons with significant deficits in self-help skills, and/or some limitations in physical coordination and mobility, and/or disruptive or self-injurious behavior.

• SERVICE LEVEL 4: Care, supervision, and professionally supervised training for persons with deficits in self-help skills, and/or severe impairment in physical coordination and mobility, and/or severely disruptive or self-injurious behavior. Service Level 4 is subdivided into Levels 4A through 4I, in which staffing levels are increased to correspond to the escalating severity of disability levels.

Family Home Agencies

• A Family Home Agency (FHA) approves family homes which offer the opportunity for up to three adult individuals with developmental disabilities per home to reside with a family and share in the interaction and responsibilities of being part of a family. The individual with developmental disabilities receives the necessary service and supports from the family, agencies and the community to enable the individual to be a participating member of the family and the community where the family resides. The family home arrangement allows the sharing of food, shelter, experience, responsibilities and love.

• The FHA is a private, nonprofit organization under contract to, and vendored by a regional center. FHAs are responsible for recruiting, training, approving and monitoring family homes, as well as providing ongoing support to family homes. Social service staff employed by the FHA make regular visits to the family home to ensure that necessary services and supports are in place, and that the match between the family and the new family member is viable, and continues to be viable.

• FHA and family home services and supports are a new option which enables adults with developmental disabilities to enter into partnerships with families that promote self-determination and interdependence.

Intentional Community

• Family Investment Model

• Co-Op Housing

Modeled loosely on retirement villages or farmsteads that offer not just housing but a community and programming aspect not available in individual apartments or group homes.

Family Investment Model

• An intentional community is privately owned by investors (private or non-profit), who may or may not be parents and family members. In this model, the investors pool their funds as an LLC to acquire or build a multifamily property with the specific intention of renting at least a portion of the units to adults with developmental disabilities. The investors earn income through rental payments which cover mortgage, operations, and maintenance. The LLC does not provide services or supports, which would need to funded separately through the Regional Centers.

Co-Op Housing

• Co-ops are typically single-family homes owned by a landlord, parents, or nonprofit where 2 to 4 tenants with developmental disabilities live in separate bedrooms but share the living space. Co-ops are unlicensed. Tenants typically rely on SLS or ILS support funded by regional center and provided by a vendor. Along with the safety and security of the individual, the services are delivered to assure the stability of this housing arrangement.

Vendor Directories

• http://sarc.org/– Click: Service Providers– Click: Service Provider Directory

– Click: http://www.php.com/resources

San Andreas Regional Center

Parents Helping Parents

Further Questions to Consider

• The first and most important place to start when arranging housing is the service coordinator at regional center. Having an open conversation with the coordinator is vital. Share needs and wants. It is through creative planning and open give-and-take dialogs that housing arranged for individuals with developmental disabilities becomes a home for our family members. If difficulties are encountered it may be a good idea to include the coordinator’s managers. Keep in mind, for residential placement in the community the guiding principle directing the services to be arranged is the need to maintain the health and safety of the individual.

• Arranging housing is not easy, and decisions made today may often change over time. Hopefully the definitions about residential services found in this roadmap will help build the understanding and awareness needed to ask the right questions and search for the best housing. It may be helpful to get advice from other parents and providers, and organizations like Parents Helping Parents, Area Board 7, the Office of Client’s Rights, Housing Choices Coalition, and other members of the Disability Collaborative.

Questions to Consider

Further Questions to Consider