Individuals interested in home ownership, for personal and economic benefits and also for the social benefits a community can offer, may organize to form a kind of corporation called a cooperative or co-op. Members don’t own their individual units; rather, they own one share in the cooperative and have one vote at general membership meetings. Members sell their share back when they move out. After co-op members elect a board of directors, the board may hire a property manager, contract for needed services, or decide that members will manage the services on a volunteer basis. The co-op is eligible for financial assistance or low-cost loans from the government. Shared leadership and responsibilities, including rules and regulations of the co-op, are important factors to consider before choosing to participate in a housing co-op. Your son or daughter may want to also look at the activities and interests of the other members for compatibility.

Community Residential Settings

“Community Residential Settings” is the new terminology that includes Adult Foster Care commonly known as group homes. The informal term “group home” does not refer to a specific state license or registered setting. Community Residential Settings are licensed and registered with the Minnesota Department of Human Services (DHS) to provide specialized services to people with disabilities through varying levels of care. Community Residential Settings provide sleeping accommodations and services for one to four adults (five adults, if the residents are elderly). They provide 24-hour continuous care plus support, structure, nurturance, and control toward achieving individualized goals within a family home environment. Some caregivers own and live in the homes they provide care in, while others are employees paid to live on site. When the caregiver owns the home, it is called Family Adult Foster Care. When the caregivers are employees, it is called Corporate Adult Foster Care. Unlike group homes and Intermediate Care Facility for Developmental Disabilities (ICF/DD), a community residential setting is less formal and is licensed under the Department of Human Services.

As discussed previously Olmstead supports the concept that services and supports should be provided to people with disabilities in the most integrated setting possible. States have been directed to comply with the new Home and Community-Based Services and Settings rule. Minnesota received final approval of its Statewide Transition Plan (STP) by the Centers for Medicare and Medicaid Services (CMS) on February 8, 2019.

All providers had to go through an attestation process for all settings that group people who receive Home and Community Based Settings.

• The “attestation process” includes a framework consisting of three phases: assessment, validation and remediation.
• Guidance provided by the Minnesota Department of Human Services (MN DHS) to assist providers with the necessary steps to reach compliance include helpful tips tools and resources, as well as “assessment” and “validation” (proof) of documentation from the provider, audits, on-site visits and a review of a persons with a disabilities experiences of the settings and services.
• “Remediation” or steps the provider still needs to complete for specific sites, will be completed to bring their settings into compliance.
• If providers cannot complete these requirements, and settings are not “presumed to be Home and Community-Based” they will need to go through “heightened scrutiny”, meaning settings must be submitted to Centers for Medicaid (CMS) for approval.

The final approval was granted to Minnesota after they worked collaboratively with Centers for Medicare & Medicaid Services (CMS) on the above attestation process with the understanding that they have additional processes. Those are to continue to review the progress of the proposed milestones, address challenges during the remediation process, and address the sites that are under heightened scrutiny, with the expectation they reach compliance by March 2023.

Housing and services providers that are lease holders must now work with your son or daughter with a disability, their legal guardian(s) where appropriate, and the case manager, to develop a plan to transition the lease from the provider to the person. This process cannot take longer than two years unless the Minnesota Department of Human Services approves an extension. Your son or daughter may choose to include others in the planning process, such as the housing service provider and landlord.

According to the Minnesota Department of Human Services (DHS), community residential care services provide “supportive services” and “health-related services.” Supportive services mean providing up to 24-hour supervision and oversight. When a person is living in a Community Residential Setting, the Coordinated Service and Support Plan (CSSP) must indicate what services the residential care provider will furnish. These services cannot be duplicated by other state plans or by waivered services.

Supportive services include:

• Transportation, when provided by the residential care home
• Socialization, which is part of the plan of care that establishes specific goals and outcomes
• Assistance in setting up a person’s meetings, appointments, and 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 self-administered medications or providing storage for medications, if requested

It is important for parents to be informed and know which 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?
• Is the degree of supervision and freedom person-centered?
• 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?

Institutions

Other Group Home Settings

Housing settings that include services where seniors or people with disabilities live in the same building are also sometimes called “group homes.” Group homes may include boarding and lodging establishments, non-certified boarding care homes, and housing- with-services establishments, sometimes called “assisted living.”

Licensing requirements and funding streams define the differences among these options and are overseen by the Department of Health (MDH). Housing under these categories may include five or more people who may have individual or shared bedrooms, depending on the facility. Living rooms, dining rooms, or cafeterias, are shared spaces.

Intermediate Care Facilities

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 Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD) must:

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

Since Minnesota’s Olmstead Plan identifies increasing the number of people with disabilities to live in the most integrated housing of their choice, the state has seen a shift from those living ICF/DD’s into housing of their choice.

Nursing Homes

Nursing homes are community-based settings that provide a 24- hour plan of care for individuals who need nursing 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 or mental illness should not be in nursing homes with individuals over the age of 65. State and federal money pays for lodging expenses if counties place individuals in smaller settings, such as group homes of four or fewer people.

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