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Hoarding: How Case Managers Can Help

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August 15, 2015

Group Home or Boarding Home?


Finding safe and affordable housing for clients can be a challenge for a service coordinator or case manager. Case managers often are tasked with finding housing for individuals with a variety of mental health, physical and developmental challenges. In most cases, group homes are a suitable solution. 
However, there are also clients who don’t have medical insurance and have criminal backgrounds that prevent them from obtaining an apartment or any form of subsidized housing.  In many cases, they don’t meet the criteria for many waiver programs that tend to cater to lower functioning clientele.
Boarding homes are sometimes a viable option for clients who are difficult to place. Boarding homes are similar to group homes in that the home is shared with others. However, there are some significant differences between the two. Case managers should examine these differences before assisting with placement.

Group Homes
Group homes are basically houses that are shared with other residents with disabilities and are staffed 24 hours a day with trained residential staff. In most cases, group homes must be licensed by the state in order to receive Medicaid funds. Group homes also must develop a treatment plan and provide ongoing training and skill building.  In addition, group homes require a significant amount of background information to meet state compliance standards.  Psychological reports, TB Tests, and a physical are required before admission in to most group homes.

Group homes provide more a structured environment which is often needed with clients who may require the extra support to remain safe. Group homes are most suitable for those with significant development disabilities and require 24 hour supervision.  Group homes also tend to serve individuals with the same or similar diagnosis (i.e. Intellectual Disability). Group homes must be licensed to house a very specific population.  For example, you would rarely find a group home that was licensed for the intellectually disabled and a transition home for people coming out of prison.  
Group home have a few restrictions. In some cases, residents are limited in their activities if the home is understaffed.  Residents that need more one on one may not get enough support when staff is not available. Turnover is also a big problem with group homes. Most support staff earn very little and they often leave for better paying jobs. Medicaid Waiver funding is also distributed differently in each state and funds may not be available when a group home placement is needed.

Advantages
1. Licensed by the state
2. Trained staff
3. Regulated by state and local agencies
4. Structured Environment
5. Higher level of care

Disadvantages
1. Usually require Medicaid or Medicaid Waiver Funding (which can be limited)
2. More restrictive environment
3. Staff Turnover

Boarding Homes
Boarding homes are also houses  that allow people to rent a room. Like any other rental process, a lease or contract may be required. Boarding homes are pretty much unregulated and anyone who owns a house can rent out bedrooms and make it a “boarding home”.  The residents  usually have access to most of the common areas of the home such as the kitchen, laundry room, and the dining areas.  

Boarding homes are ideal for difficult to place residents who do not have Medicaid and do not met the criteria for Medicaid Waiver funding. These individuals are usually higher functioning and are independent enough to care for themselves.  In these situations, a boarding home can be a good option.

The downside to boarding homes is there is no regulation. Well, depending on your feelings about regulations this can be considered a downside. Boarding homes have no specific criteria for who lives in the home. There could be residents with different levels of disability to people with no disability living in the home. This could pose a safety issue for more vulnerable residents. Of course, the home owner can determine the type of resident they want to have in their house.  

Advantages
1. Ideal for difficult to place residents
2. No Medicaid requirement
3. More freedom and independence

Disadvantages
1. Unlicensed and unregulated by the state
2. Unpredictable clientele
3. Little to no support staff


Both group homes and boarding homes can provide critical residential services needed for people with disabilities. However, as a case manager, I would consider a boarding home as a last resort for most of my clients.  Case managers have to examine the situation to determine the best placement. 

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