Hi Heidi –
We saw your email come through the NACDD listserv and were excited to see your questions about Virginia’s work developing and supporting a Shared Living approach to I/DD services. Our firm is currently working
on two projects – one for a multi-state provider and another for a Managed Care Organization – looking at how to grow and support Shared Living services. As you know, and reference in your email, Shared Living often takes on many definitions. For example,
in our project for the provider agency, shared living is classified as any non-brick and mortar residential supports – for example, host homes, independent living, companion living (not including family home) – whereas our work with the MCO focuses more narrowly
on the Shared Living model you describe below. We have drafted some of our findings to assist you in your research and hope you find it helpful – please feel free to reach out to us if we can assist further. Also, I would recommend reading Shared Living:
A New Take on an Old Idea (http://www.nasddds.org/uploads/documents/Shared_Living_Brief.pdf). The brief was developed by NASDDDS and looks at
states utilizing Shared Living and even discusses Medicaid-financing options.
An Overview of Findings in Provider-Based Project:
This project is currently still ongoing, but there are some interesting findings we can share. To complete our work, we are conducting a scan of state waivers and state plans to identify if there are: (a) service
categories that match the Shared Living model(s) and (b) what are the associated service definitions and provider requirements associated with the services. While our work it still in the early phases, I can note that California does have an Independent Living
model which is managed – primarily – by their 21 regions. The model is meant to support individuals to live independently in their own home or apartment with a focus on supporting and developing natural support networks. Under this model, I do believe a
paid live-in caregiver is an approved service. In Indiana, the “Live-in Caregiver” service is closely aligned to your description of Shared Services. Under this services, a roommate lives in a home owned or rented by the individual with an I/DD and has no
legal obligation to provide care, but serves in a companion capacity. Lastly, Ohio has a Shared Living model which encompasses personal care and supportive services provided by a paid live-in caregiver. In this model, the individual with an I/DD can either
live in the home of the caregiver or the caregiver can live in the home of the person with an I/DD. Here, at least 20% of the PC services must be provided by the live-in caregiver.
While there are other examples, we thought this would be a good start to our findings in this project. One of the biggest challenges, as you noted, is the recruitment of roommates. IN our work, we have seen that
Millennials are a good group to reach out to for these models because of the outcomes-based service approach, ability to “be their own boss” and an increased interest to social services.
In North Carolina, the DD Council has an active initiative about Supported Living going on now. The “Supported Living: Making The Difference” initiative aims to
a) expand and strengthen North Carolina’s capacity to support people with I/DD to participate in supported living;
b) launch a stakeholder group known as the Learning Community to support individuals with I/DD and their families, MCO and state staff to build
a clarified understanding of supported living concepts and improve their capacity to support individuals to utilize the service; and c) provide technical assistance to providers and direct support staff on practices that facilitate supported living. We are
working with the grantee to develop on Online Learning Community to help achieve these goals. You can find out more about the NCCDD grant at
https://nccdd.org/supported-living-making-the-difference.html
Again, there are more examples, but we hope this helps you in your research and efforts. Please feel free to reach out to us should you have questions or comments about what we have outlined above.
Hope this helps!
Kelly Friedlander & Drew Smith
Community Bridges Consulting Group
Main: (800) 214-1633
Direct: (919)330-0777
From: <xxxxxx@nacdd.simplelists.com> on behalf of "Lawyer, Heidi (VBPD)" <xxxxxx@VBPD.virginia.gov>
Reply-To: "xxxxxx@nacdd.simplelists.com" <xxxxxx@nacdd.simplelists.com>
Date: Tuesday, February 13, 2018 at 7:45 AM
To: "xxxxxx@nacdd.simplelists.com" <xxxxxx@nacdd.simplelists.com>
Subject: DD Councils Live in Caregiver provision in HCBS Wavier
INITIAL MESSAGE--Our newly designed DD waivers have shared living as a new service whereby a roommate’s rent is paid for if they are living in the individual
with a disability’s owned or lease home. They provide some ancillary services, companionship, etc. but not direct services like personal care, etc.
Although the service has been available since July, providers have been unwilling to enter into it. In part, because there are not yet regulations or a manual regarding how to implement and
they are afraid of being gigged on an audit but in larger part they don’t want the liability as they don’t control the roommate, the rent money goes directly to the individual with the disability who then pays the rent (and what if they don’t), the administrative
to the providers is extremely low vs. the time that they have to spend in set up, recruitment of roommates (if the person doesn’t have someone they want to live with ) training, and follow –up.
Do any of you have shared living in your waivers. If so, did you encounter barriers such as those noted above. Were they resolved and if so how? Is the service utilized heavily or poorly?
Thanks so much!
Heidi Lawyer
Executive Director
Virginia Board for People with Disabilities (VBPD)
1100 Bank Street, 7th Floor, Richmond, VA 23219
804-786-9369
800-846-4464