Virginia’s Medicaid Intellectual Disability Waiver provides
two forms of residential placement options. These options include group home
placement and sponsored residential services.
We will explore each of these options and discuss their
benefits and limitations. Group homes have been the primary form of
community-based residential services. However, sponsored residential services
are rapidly becoming an alternative for families who wish to keep their loved
ones at home.
Group Homes
When people think of outside residential placements, they
usually think of a group home setting. A group home is a residence that serves
individuals with intellectual disabilities and is staffed 24 hours a day. These
homes are licensed and regulated by the state. Providers are reimbursed through
Medicaid funding.
Group homes are the primary form of outside residential
placement in VA. Staff are usually trained to give medication, CPR, first aid,
and behavioral management. Group home staff provide all of the direct care
services and provide all transportation to appointments and community outings.
Group homes play a vital role in providing services to
individuals in the community who might otherwise be placed in a state
institution or more confined facility. Group homes are even more important now
that Virginia is moving to downsize institutions and implement more
community-based housing options.
Limitations of Group Homes
However, there are some limitations to group home
placements. Any time you live in close quarters with others, there is an
increase in the chances of illness. Staffing may also impact the level of
community integration. If there are not enough staff on duty, opportunities for
community outings will be limited.
The group home setting also provides limited one-on-one
attention due to the needs of the other residents. Unfortunately, group homes
also tend to have a high turnover rate. This could negatively impact the
overall quality and consistency of care. As with just about any service, there
are some good group homes and some that only do the bare minimum to keep their
license. I encourage families to tour as many homes as possible, research, and
ask questions before deciding on placement.
Costs of Group Homes
Group home placements are not inexpensive, but they do cost
less than state institutions. Based on current reimbursement rates in Virginia,
the average group home placement costs the state around $130,000 a year. This
figure is what Medicaid reimburses the provider for staffing the home. This
does not account for room and board, which can range from $600 to $800 per
month.
Sponsored Residential Services
Sponsored residential services are an interesting
alternative to the group home setting. Sponsored residential services are often
compared to adult foster care in that it provides an opportunity for an
individual to live with a private family or single caregiver instead of a home
with other residents.
Caregivers are hired and trained through agencies that are
licensed by the state. These caregivers or "sponsors" provide all of
the direct care just as the staff in the group home. Sponsors also have the
flexibility of providing more one-on-one attention and more opportunities for
community integration.
Another unique aspect of sponsored residential services is
that parents and family members can be certified sponsors and get paid for
caring for their disabled family member. Some are opposed to family members
getting paid to be caregivers, but I think it's a great idea. The program was
originally established for rural areas of Virginia where there were limited
service providers. It was actually less expensive to train family members and
caregivers than to put people in facilities.
In addition, the money that the family makes balances out
because many parents of special needs children (or adults) have a difficult
time maintaining a regular job. This is due to the constant doctor
appointments, therapy sessions, and meetings centered around services. Best of
all, family members often have a better knowledge of the individual's needs
than staff in a group home.
This option would be most appropriate for individuals with
specialized medical needs that can be best managed by a family member.
Costs of Sponsored Residential Services
The average cost of sponsored residential is around $90,000
per year. Room and board costs are usually cheaper than that of a group home.
Another advantage of sponsored residential services is that the caregiver's
income is TAX-FREE. Caregivers do not have to file taxes for any income earned
for providing these services.
Potential Benefits
I work with several clients and families that use this
service, and they give nothing but positive feedback. Clients reported that
they have more freedom than they did in the group home setting. One family told
me that this program has allowed their family to have the ability to go on
vacations and enjoy life just like any other family.
Families also point out that this program allows their loved
ones to receive care from people who have a personal connection with them
instead of someone they don't know. Group homes also have a high turnover rate,
and they could have different care staff each day. High staff turnover
diminishes the overall quality of care.
Limitations of Sponsored Residential Programs
The sponsored residential program does have its limitations.
Sponsor homes face the same regulations as group homes. They have to be
approved by the fire marshal and the state licensure department. Personal homes
may not be approved if they are not up to code.
The sponsor must be able to complete documentation as if
they were staff in a group home. A case manager with the sponsoring agency can
assist with this documentation. This can be a difficult transition for families
not used to documenting everything they do throughout the course of a day.
The sponsored residential program is not appropriate for
everyone. Some family members start the program but later realize it's just too
much work. Keep in mind that this is a 24-hour-a-day job. Some situations
require a more structured environment due to certain behavioral and medical
needs.
Final Thoughts
In summary, group homes and sponsored residential services
provide a vital service for people with intellectual and developmental
disabilities. These services allow people with special needs to enjoy the same
freedom to live in a normal neighborhood and community just like the rest of
society. Unfortunately, institutions are the only option in some situations.
However, more people are enjoying life in the community because of these
community-based programs.
