Updated on July 2, 2023
Residential placement is often a decision that parents start to plan when their child is graduating from high school and is starting that transition into adult services. These services should be discussed with a case manager long before graduation. I would suggest discussing the transition at least 2-3 years prior to graduation. For this particular post I will discuss the primary residential options according to client type, disability type, and funding source. In general, residential placements tend to be categorized along these lines. There may be a few acceptations but these are the basic categories, with funding source as the key component.
Intermediate Care Facilities for the Mentally Retarded or ICFMR are designed to care for the medically fragile. Actually, they are now referred to Intermediate Care Facilities for the Individuals with Intellectually Disabilities (ICF/IID) due to changes and upgrades to terminology.
Client Type- Children and adults can qualify for ICFMR placement. However, ICFMR placements for children tend to be more difficult to find than adult facilities.
Disability Type- This type of facility serves individuals diagnosed with an intellectual disability . In addition to the intellectual disability, residents are often diagnosed with significant medical disorders such as Cerebral Palsy or other serious conditions that require nursing care on a daily basis. The medical care required is usually more than a group home can provide.
Funding Source- ICFMR placement is funded through Medicaid.
Also See: Detailed description of ICFMR Facilities
Group homes provide 24 hour care to consumers in family style homes. Group homes are integrated into the community and they allow residents to live in regular neighborhoods. Most group homes provide services to 4-5 residents.
Client Type- Children and adults are eligible for group home placements. However, group homes for children with intellectual disabilities tend to be rare. Most parents don’t seek group home placement until after high school unless there are severe behavioral issues that the parents can no longer manage.
Disability Type- Group homes provide services to individuals diagnosed with mild to severe intellectual disability. In addition, some group homes are equipped to assist residents who need wheelchair assistance. Some group homes also assist with g-tube feedings and have nurses available to provide assistance. However, this level of care is usually handled in an ICFMR facility.
Funding Source- Group homes usually funded through Medicaid Waiver
Adult Foster Care
Adult foster care is a program that allows an adult with disabilities to live in a licensed home with another family. The program is operated just like foster care for children. The homes are licensed and monitored by local social services agencies.
Client Type- Adults age 18 and over with a diagnosed with an intellectual disability.
Disability Type- Individuals diagnosed with mild to severe intellectual disability may qualify for adult foster care. This primarily depends on if the foster parent is able to provide the most appropriate care. Some foster parents would prefer to have individuals that are more independent while some embrace the challenge of an individual who needs more support with everyday activities.
Funding Source- Although programs vary by state, local social services agencies usually provide a monthly stipend to compensate foster parent. Social Security benefits also assist with monthly expenses.
Sponsored Residential Services
Sponsored residential services are similar to adult foster care in that the individual moves into another family home. In some cases, parents and family members can also provide these services and are compensated by the state. All caregivers (or sponsors) are hired and trained by licensed agencies to provide the service.
Client Type- This service is primarily used for adults diagnosed with an intellectual disability. Children can also be served but there are only a few agencies that are licensed to work with children. Children also tend to have other programs available including child foster care, in-home support, etc. Parents usually don’t seek residential placement outside of the home until the child is coming close to high school graduation. In this case, the “child” is more than likely an adult anyway.
Disability Type- Children and adults diagnosed with an intellectual disability.
Funding Source- Sponsored residential services are funded from Medicaid Waiver. People can also use their Social Security benefits to cover monthly rent.
Supported living programs provide assistance to people who live in their own but still need some help with managing daily tasks such as maintaining a clean residence, taking medication, and cooking. Staff might also assist with paying bills and shopping. Supported living programs often consist of an apartment or home that is shared by two or more residents. The difference between this arrangement and a group home is that support staff is not there 24 hours a day. Residents receive support as needed and the rest of the time they are on their own.
Client Type- This program is for adults diagnosed with and intellectual disability. Supported living programs also provide services for individuals with a mental health diagnosis.
Disability Type- Supported living programs are most successful with individuals who have a mild to moderate level of intellectual disability. They must be able live on their own with minimal supervision.Funding Source- Medicaid can cover the cost of staff support. However, the resident is responsible for paying his/her rent and utilities. Many people in this program also work to help cover their expenses. Section 8 Funding may also be an option in some situations.