Supported Living

SUPPORTED LIVING

DON ANDERSON & MARK MCMANUS

Hello, I am Don Anderson, and welcome again to Social Work 644. The focus for today's class is on residential services/ supported living for people with disabilities. Joining me today is Mark McManus, who is a doctoral student in the School of Social Work here at the University of Wisconsin-Madison.The following is an outline of today's lecture.

WHERE SHOULD PEOPLE LIVE?

TYPES OF RESIDENTIAL SETTINGS

SUPPORTED LIVING & RESIDENTIAL SERVICES

PRIMARY FUNDING SUPPORT SOURCES

CURRENT BEST PRACTICES

EXAMPLE OF COMMUNITY LIVING

TYPICAL FAMILY LIVING

LIVING IN AN ADULT FAMILY HOME

LIVING IN THERE OWN APARTMENT

ROOMATES LIVING IN THE COMMUNITY

WISCONSIN STORIES VIDEO

PART ONE: WHERE SHOULD PEOPLE LIVE?

(Don) I would like to start today's class with a question for you, Mark. One question which frequently faces people with disabilities and their families is the issue of where people should live. I wonder if you could talk a little bit about this topic for us.

(Mark) The question about where I should live often confronts people with developmental disabilities, at a different time in their life than it would typically of people without disabilities. For example, I didn't think about where I should live until I graduated from high school. And then it was time to move on to college, and so did I want to live in an apartment or the dorms, starting college in a new city. I picked the dorms. This is sort of a natural transition that teenagers go through. For people with disabilities, that option of where I should live, that might come very early in life. The parents of a young child might decide, that due to our circumstances, we can't provide the care that is necessary for our child to live at home. We start to think about different options for the child. For others, people with disabilities might live at home their entire life and it is not until a parent dies that they're faced with A where shall I live? Am I going to live in a different place, or am I going to live with a brother or sister? So, it is different for people with disabilities.

Sometimes, people with disabilities might think about where am I going to live at the typical time, as they graduate from high school. At that time, it might be, as it was for me, a matter of making a choice about do I want to live in the northern part of the country or do I want to live in the southern part, the eastern part, the western part. Do I want to live with a roommate, or a group of people? Am I going to get married and live with a spouse? Am I going to live with my parents for the rest of my life, or am I going to live with a brother or sister, or maybe I just want to live alone. Do I want to live in an urban or rural area? What about living on a farm, or do I want to live in a high-rise apartment in a big city? Those are typical choices that all of us face.

Sometimes with people with disabilities we have a more limited focus about where it is people with disabilities should live. It might be that people with disabilities should live in institutions, large settings where they can be taken care of and provided for. Everything is under roof, all of the services, so they don't have to leave the building. The doctors and dentists and barbers and everything comes into the institution and provides care and support for people in the institution. It might be one model that people want to choose. For many people, they don't want that kind of residential placement. They think more about living in the community, having their own home in the community, or an apartment, or living in a small group home, the home is a place for them to live and a place for them to be, but all of the services are out in the community away from the home. The person goes out to the store to go shopping, and they go to the barber, the dentist, and the doctor in the community. They partake in recreation in the parks, go to playgrounds, go to school in the local neighborhood school. They are part of the community, and their house is just one segment or one aspect. It is not all under one roof. There are a little difference in the options of where I should live and how that is different for people with disabilities as they make that decision.

PART TWO: TYPES OF RESIDENTIAL SETTINGS

(Don Anderson)What are the types of residential settings available to people in the community?

(Mark McManus) Let me begin by talking about residential options, and going into a little more detail than I did in the first question. Let's start with living at home with parents or a family member. This is the primary residential type for people with mental retardation and other developmental disabilities. For example, we know that for all of the people with mental retardation, only about 12 - 15% ever live outside the family home. The family provides all of their residential needs throughout their lifetime. So we are only talking about 12 - 15% of the people with mental retardation that ever require or need some kind of outside residential placement outside the family home. This is very important. We don't think about that, because as social workers we are often not working with people in their own homes, living with their parents. Often times we are working with people who don't live at home with their parents. Keeping that in mind as the primary source, we need to look at some of the other options for people.

Another option is a supported apartment in the community. This means it might be an apartment with one other roommate with a disability, or it might be a roommate without a disability that is there to provide some support for them to be able to live in their own apartment.

Another option might be an adult family home. An adult family home is when a person with a disability moves in with a family and becomes a part of their family. It still means contact with their natural family, their brothers and sisters, but they don't live with them. Typically, the person might live with another roommate with a disability in an adult family home. But generally, it is one person, maybe two at the most. The next type of residential placement is typically called a group home. In Wisconsin, we refer to group homes as community based residential facilities (CBRFs). These are small homes, typically two to four people live together and generally a live-in staff person is there to provide the daily support for people.

The last type I would like to mention is the congregate care settings. That is what we think of as the large institutions. We typically refer to them as an intermediate care facility for the mentally retarded or developmentally disabled. ICF-MR is the acronym that is often used. In Wisconsin we have three state centers that are designated as ICF-MRs, Northern, Southern and Central Centers. In addition to the state institutions for people with mental retardation, we also have a number of people with disabilities living in nursing homes. Typically, a nursing home has set a portion of a wing or an area, and it is designated where people with mental retardation can live within the nursing home. Typically, we think of people with more medical needs or higher support needs as living in the institutions and nursing homes. There certainly are people living in both of those settings that possibly could move out into the community and have the desire to do so and are on a waiting list to get into the community options at this time.

PART THREE: SUPPORTED LIVING & RESIDENTIAL SERVICES

(Don Anderson) Mark, would you describe the difference between supported living and residential services?

(Mark McManus) Sure. Let me begin with the residential services portion. Residential services pertains to the housing piece. We are talking about the architect, the location of the home, the style of the home, the physical home. For the residential services, it is important for social workers to tap into the generic community services. So, if I was a person with a disability and wanting to purchase a home, I would go to a real estate agent, and to help them to understand my needs and have them find me a home. The real estate agent might talk to an architect about building a home if it is not in existence, or might go out and look in the neighborhood for a home that might meet my needs. I would go with the real estate agent and pick the home that best meets my needs. That is what I mean by tapping into the generic service system, instead of having a social worker or someone who is connected to me tell me what I need, and go out and find it and try to do everything. Relying on that community service, which is available to anybody in the community, to help locate a particular home that I might live in.

The second area is utilizing specialty services. Again, that could be an architect to help design a home that is fully accessible for me. Again, instead of relying on my social worker to help me design a home that would meet my needs, the social worker and the person with a disability can go and meet with an architect and talk about what it is that I need. I may need to be able to have a sink that is accessible, so I need an open counter so I can wheel up to the sink and do my dishes. Then the architect can design something like that in my home and help me to be able to utilize my home fully.

The third area is discovering the expertise that is available in the community. A lot of times we don't know who to go to find the different speciality areas or the expertise that is in the community. By utilizing some of the people that do know a lot about housing, they can help us locate people. For example, if I want to buy a house and I have a disability, where can I go? Is there a particular banker that is familiar with different funding sources for people with disabilities that can help me access the funding that I need to go out and purchase my home? Who is that person and how can I meet that person and get to know what services and expertise that person offers.

The fourth area is to reveal new opportunities to meet the support needs of individuals with developmental disabilities. Again, it is getting out there in the community and seeing what services are available. I am going to discover new things about my community that I didn't know. Maybe that is tapping into, as I am getting my hair cut, that my barber is telling me that there is a neat apartment down the street that is for rent. It is utilizing those natural connections with the community can help make the housing piece better for me, and match me to a house that is going to meet my unique needs. It is important for the case workers or social workers to be able to work with the members of the community, to tap into the existing resources, rather than trying to take on the whole housing piece all by him or herself.

The supported living piece is what it takes for me to live in my home or apartment or group home. What are the supports that are involved with my living as independently as possible? That might be having someone come in and assisting with cooking. That might be having somebody live with me that can insure that all the doors are locked at night, that I have help in cooking, that I have some help with banking, that can provide some transportation or help me get to the bus stop and utilize the public transportation system. Maybe I am a person with a disability that needs a little more support and maybe that person needs to be with me more than a few hours a day or a few hours a week. The supported living involves much more than just the housing. Although it utilizes the housing piece, the residential services piece, it goes out beyond the home. It connects them to the community with recreation, with work, school, transportation, practicing my religion or faith, getting to church or the synagogue, helping me to go to movies, go out to eat in restaurants, just being a part of the community and doing all of the things that anybody else would do in a community setting. What kind of supports does that take for me to be able to do that, given my unique abilities and disabilities.

PART FOUR: PRIMARY FUNDING SUPPORT SOURCES

(Don Anderson) Mark, what are the primary funding support sources for people living in Wisconsin?

(Mark McManus) The primary funding sources for community living involve a variety of funding sources. It involves personal contributions of a person, county dollars, local money, state money and federal monies. In the personal area, it might be wages that a person with a disability makes and contributes to the cost of living in the community. It might be their own financial resources or those resources of the family that enable the person with the disability to live in the community. It also might be their personal income that they receive from their social security income. There is a part of those funds that go directly to the person to use for their personal spending money. People might use some of that personal spending money to buy furniture or decorations for their walls, or kitchen appliances or TVS to make the home a more comfortable place. Those personal monies are also contributing to the costs of living in the community.

The next type is the community tax levy dollars. Those are funds that different counties provide to people with disabilities. Those are often coming in the way of supported employment monies and enabling them to have a day activity that they can go to that supports them to live in the community.

The third area is the state community aids. The state community aids is state funding that is available to supplement the federal money, Medicaid dollars and Medical Assistance waiver program, such as the Community Integration Programs, CIP-1A and CIP-1B. There is also a new program that started several years ago called Community Supported Living Arrangements money. That is CSLA money. Maybe some of you have heard about that. It enables the person with a disability to purchase their own home or to live in a small setting, one to two people generally, but it can be up to four people. People live in their own communities. There is a lot of interest right now in helping people to purchase their own homes with Community Supported Living Arrangements funds.