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Viewing: Community Integration in Residential Service Options and Supervised Apartment Living Arrangements for Individuals with Developmental Disabilities, 02-601

Current Status: Active PolicyStat ID: 437530

Community Integration in Residential Service Options and Supervised Apartment Living Arrangements for Individuals with Developmental Disabilities, 02-601

Full Implementation Date 11/1/2013

Applicability

This policy is applicable to all forms of housing, whether in Host Homes, Group Homes, Community Living Arrangements, Personal Care Homes, apartments, campus cottages or other forms of congregate living. This policy is not, however applicable to the Target Population of the Settlement Agreement, as defined in this policy.

POLICY

DBHDD ensures that residential services provided pursuant to the State of Georgia plan for home and community based services administered through the HCBS Waiver Program and Comprehensive Support Waivers shall reflect the values of informed choice, autonomy, and community integration.

These values are consistent with federal and state law, including the Social Security Act, Americans with Disability Act, the Olmstead v. L.C. decision (527 U.S. 581, 1999 ), and the Settlement Agreement entered into between The State of Georgia and the Department of Justice. See CMS 2249-P2 proposed rule for HCBS housing, 10385 Fed. Reg. May 3, 2012

DEFINITIONS

Community Integration means that the individual shall have full access to the greater community including opportunities to seek employment, engage in community life, control personal resources, and receive services in the community in the same manner as people without disabilities.

Informed Choice means a voluntary, well-considered decision that an individual, or where legally required, the individual’s legal guardian, makes on the basis of appropriate available options, information, and understanding.

Settlement Agreement means the resolution of litigation between the Department of Justice (DOJ) and the State of Georgia addressing the population of Developmentally Disabled persons in State Hospitals (Civil Action No. 1:10-cv-249-CAP, Oct.19, 2010).

Target Population of the Settlement Agreement for the purposes of this policy includes individuals with a primary diagnosis of a developmental disability who are currently hospitalized in the State Hospitals, were hospitalized and transitioned to the community under the Settlement Agreement and those who are at risk of hospitalization in the State Hospitals.

Residential Service Options includes Personal Care Homes (PCH), Community Living Arrangements (CLA), Apartments and Host Homes.

Most Integrated Setting is a setting that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.

Personal Care Home is a licensed residence that provides or arranges for the provision of housing, food service, and one or more personal services for two or more adults with developmental disabilities, who are not related to the owner or administrator by blood or marriage. (Personal services include but are not limited to individual assistance with and supervision of self-administered medications and essential activities or daily living such as eating, bathing, grooming, dressing, and toileting.)

Community Living Arrangement is a licensed residence, whether operated for profit or not, that undertakes through its ownership or management to provide or arrange for the provision of daily personal services, supports, care, or treatment for two or more adults with developmental disabilities, who are not related to the owner or administrator by blood or marriage and whose residential services are financially supported, in whole or in part, by funds designated through the DBHDD.

Host Home is the (unlicensed) private home of an individual or a family, whether owned or leased, in which residential supports are provided to one or two adults with developmental disabilities.  The home owner or lessee must not be an employee of the same DBHDD approved provider agency which provides the host/life sharing home services.  Individuals should not be related to the occupant owner or lessee by blood or marriage.  The occupant owner or lessee must not be the guardian of any person served on their property nor the agent in such person's advance directive for health care.

Supervised Living Arrangement provides community living support services to individuals with developmental disabilities in which the individual can experience living in community with supervision.  It is a living arrangement where individuals live in an apartment unit.  Individuals are involved in activities that will lead them to greater independence and more control of their lives.

Standards for Integrated Settings

For the purposes of this policy, the following standards are set by DBHDD for integrated settings.  So long as the individual is not exposed to undue risk to his or her safety, the provider shall insure that the residential service options possess the following attributes:

  1. Setting
    1. The setting is integrated in the greater community, and facilitates the individual’s full access to Community Integration as defined above.
    2. The setting is selected by the individual from among all available alternatives.
    3. An individual’s essential personal rights of privacy, dignity and respect, and freedom from coercion and restraint are protected.
    4. Individuals have choices in community engagement, such as employment, volunteer activities, church and civic membership and participation;
    5. The living arrangement provider demonstrates input and involvement by:
      • Advocates; and
      • The person served;
      • Families;
      • Business and community representatives
    6. The provider coordinates with community organizations to develop and expand its array of services, support, care and treatment as a basis for:
      • Continuity in cooperative service delivery
      • Provider Networking
      • Natural Supports
      • Joint planning efforts
  2. Choice
    1. Individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact are optimized and not regimented.
    2. Individual choice regarding services and supports, and who provides them, is facilitated.

CAPACITY

The Comprehensive Supports Waiver (COMP), by existing policy, does not allow residential facilities, such as Personal Care Homes and Community Living Arrangements to serve more than four (4) individuals in this residential setting.  Exceptions require the approval of the DBHDD Regional Coordinator and are reviewed by the Division of Developmental Disabilities.  All exceptions prior to October 2010 require approval to the existing policy and are based on justifications, such as assuring safety, privacy, community integration and participation. No exceptions are made for residential settings that began to provide waiver services October 2010 or later.

There is no exception to the capacity limit of two (2) for Host Homes.

Supervised apartment living arrangements include:

  • Scattered arrangements - Individuals and others with disabilities reside in apartments scattered/geographically dispersed throughout the community.  
  • Cluster arrangements - Individuals and others with disabilities reside in apartments located in one building. 

The following standards are followed regarding supervised apartment living:

  • Individuals renting/leasing in private residences must meet all standards for integrated settings.
  • All homes/apartments must comply with all state and local zoning regulations.
  • The Standards for Integrated Settings as specified in this policy pertain to supervised apartment living.
Attachments:
Approver Date
Joetta Prost, Ph.D.: DBHDD Policy Office 2/23/2012
Joetta Prost, Ph.D.: DBHDD Policy Office 4/25/2013
Amy Howell: General Counsel 9/5/2013
Charles Li, M.D.: Assistant Commissioner for DD Services 9/5/2013
Joetta Prost, Ph.D.: DBHDD Policy Office 9/6/2013