Available Service Models and Technologies for Independent Living

The purpose of Live-in Caregiver Services is to pay the additional cost of rent and food that can be reasonably attributed to an unrelated live-in personal caregiver who is residing in the same household with an individual.

SERVICE REQUIREMENTS:

1. A caregiver is defined as someone that is providing supports and services in the individual’s home.
2. Live-in Caregiver Support must be approved by DDA.
3. Explicit agreements, including detailed service expectations, arrangement termination procedures, recourse for unfulfilled obligations and monetary considerations must be executed and signed by both the individual receiving services (or his/her legal representative) and the caregiver. This agreement is developed by the provider and will be forwarded to Coordinator of Community Services (CCS) for submission to the DDA as part of the service request authorizations.
4. The individual in services has the rights of tenancy but the live-in caregiver does not, although they are listed on a lease.
5. Live-in caregiver support for live-in caregivers is not available in situations in which the participant lives in his/her family’s home, the caregiver’s home or a residence owned or leased by a DDA-licensed provider.

Personal supports are individualized, delivered in a personalized manner to support independence in a participant’s own home and community in which the participant wishes to be involved, based on their personal resources. Personal Supports services assist participants who live in their own or family homes with acquiring, building or maintaining the skills necessary to maximize their personal independence. These services include:

1. In-home skills development including budgeting and money management; completing homework; maintaining a bedroom for a child or home for an adult; being a good tenant; meal preparation; personal care; house cleaning/chores; and laundry.
2. Community integration and engagement skills development needed to be part of a family event or community at large. Community integration services facilitate the process by which participants integrate, engage and navigate their lives at home and in the community. They may include the development of skills or providing supports that make it possible for participants and families to lead full, integrated lives (e.g. grocery shopping; banking; getting a haircut; using public transportation; attending school or social events; joining community organizations or clubs; any form of recreation or leisure activity; volunteering; and participating in organized worship or spiritual activities) and health management assistance for adults (e.g. learning how to schedule a health appointment;, identifying transportation options; and developing skills to communicate health status, needs or concerns).
3. Personal care assistance services during in-home skills development and community activities. These include assistance with activities of daily living and instrumental activities of daily living, which may include meal preparation and cleaning when the person is unable to do for themselves only when in combination with other allowable Personal supports activities occurring.

The purpose of assistive technology is to maintain or improve a participant’s functional abilities, enhance interactions, support meaningful relationships and promote his/her ability to live independently and meaningfully participate in their community. Assistive technology refers to an item, computer application, piece of equipment or product system. Assistive technology may be acquired commercially, modified or customized. Assistive technology devices include:

1. Speech and communication devices also known as augmentative and alternative communication devices (AAC) such as speech generating devices, text-to-speech devices and voice amplification devices;
2. Blind and low-vision devices such as video magnifiers, devices with optical character recognizer (OCR) and Braille note takers.
3. Deaf and hard of hearing devices such as alerting devices, alarms and assistive listening devices.
4. Devices for computers and telephone use such as alternative mice and keyboards or hands-free phones.
5. Environmental control devices such as voice activated lights, fans and door openers;
6. Aides for daily living such as weighted utensils, adapted writing implements, dressing aids.
7. Cognitive support devices and items such as task analysis applications or reminder systems.
8. Remote support devices such as assistive technology health monitoring such as blood pressure bands and oximeter and personal emergency response systems.
9. Adapted toys and specialized equipment such as specialized car seats and adapted bikes.

Assistive Technology service refers to a service that directly assists an individual in the selection, acquisition, use or maintenance of an assistive technology device. Assistive technology services include:

1. Assistive technology needs assessment.
2. Programs, materials, and assistance in the development of adaptive materials
3. Training or technical assistance for the individual and their support network including family members.
4. Repair and maintenance of devices and equipment.
5. Programming and configuration of devices and equipment.
6. Coordination and use of assistive technology devices and equipment with other necessary therapies, interventions, or services in the Person-Centered Plan.
7. Services consisting of purchasing or leasing devices.

An environmental assessment is an on-site assessment, conducted by an occupational therapist, with the participant at his or her primary residence to determine if environmental modifications or assistive technology may be necessary in the participant’s home. Environmental assessments include:

1. An evaluation of the participant.
2. Environmental factors in the participant’s home.
3. The participant’s ability to perform activities of daily living.
4. The participant’s strength, range of motion and endurance.
5. The participant’s need for assistive technology and or modifications.
6. The participant’s support network including family members’ capacity to support independence.

Environmental modifications are physical changes to the participant’s home based on an assessment designed to support the participant’s efforts to function with greater independence or to create a safer, healthier environment. Environmental Modifications include:

1. The following types of environmental modifications:
   1. Installation of grab bars;
   2. Construction of access ramps and railings;
   3. Installation of detectable warnings on walking surfaces;
   4. Alerting devices for participant who has a hearing or sight impairment;
   5. Adaptations to the electrical, telephone and lighting systems;
   6. Generator to support medical and health devices that require electricity;
   7. Widening of doorways and halls;
   8. Door openers;
   9. Installation of lifts and stair glides (with the exception of elevators), such as overhead lift systems and vertical lifts;
   10. Bathroom modifications for accessibility and independence with self-care;
   11. Kitchens modifications for accessibility and independence;
   12. Alarms or locks on windows, doors and fences; protective padding on walls, floors or pipes; Plexiglas, safety glass, a protected glass coating on windows; outside gates and fences; brackets for appliances; raised/lowered electrical switches and sockets; and safety screen doors which are necessary for the health, welfare and safety of the participant;
2. Training on use of modification; and
3. Service and maintenance of the modification.
4. Cost of services must be customary, reasonable, and may not exceed a total of $50,000 every 3 years unless otherwise authorized by DDA.

Housing Support Services are time-limited supports to help participants to identify and navigate housing opportunities, address or overcome barriers to housing, and secure and retain their own home.

1. Housing Support Services include:
   1. Housing information and assistance to obtain and retain independent housing;
   2. Housing transition services to assess housing needs and develop individualized housing support plan; and
   3. Housing Tenancy Sustaining Services which assist the individual to maintain living in their rented or leased home.
2. Housing Information and Assistance includes:
   1. Reviewing housing programs’ rules and requirements and their applicability to the participant;
   2. Searching for housing;
   3. Assistance with processes for applying for housing and housing assistance programs;
   4. Assessing the living environment to determine it meets accessibility needs, is safe and ready for move-in;
   5. Requesting reasonable accommodations in accordance with the Fair Housing Act to support a person with a disability equal opportunity to use and enjoy a dwelling unit, including public and common use areas;
   6. Identifying resources for security deposits, moving costs, furnishings, assistive technology, environmental modifications, utility deposits and other one-time costs;
   7. Reviewing the lease and other documents, including property rules, prior to signing;
   8. Developing, reviewing and revising a monthly budget, including a rent and utility payment plan;
   9. Identifying and addressing housing challenges such as credit and rental history, criminal background and behaviors; and
   10. Assistance with resolving disputes.
3. Housing Transition Services include:
   1. Conducting a tenant screening and housing assessment including collecting information on potential housing barriers and identification of potential housing retention challenges;
   2. Developing an individualized housing support plan that is incorporated in the participant’s Person-Centered Plan and that includes:
      1. Short and long-term goals;
      2. Strategies to address identified barriers including prevention and early intervention services when housing is jeopardized; and
      3. Natural supports, resources, community providers, and services to support goals and strategies.
4. Housing Tenancy Sustaining Services assist the participant to maintain living in their rented or leased home and includes:
   1. Education and training on the role, rights and responsibilities of the tenant and landlord; how to be a good tenant; and lease compliance;
   2. Coaching to develop and maintain key relationships with landlord/property manager and neighbors;
   3. Assistance with housing recertification process;
   4. Assistance with bill-paying services (e,g., assistance with setting up and monitoring systems to pay rent, mortgage, utilities, and other related housing expenses).”
   5. Early identification and intervention for behaviors that jeopardize tenancy;
   6. Assistance with resolving disputes with landlords and/or neighbors;
   7. Advocacy and linkage with community resources to prevent eviction; and
   8. Coordinating with the individual to review, update and modify the housing support plan.

Remote support services provide oversight and monitoring within the participant’s home through an off-site electronic support system in order to reduce or replace the amount of staffing a participant needs, while ensuring the participant’s health, safety and welfare. The purpose of remote support services is to support the participant to exercise greater independence over their lives. It is integrated into the participant’s overall support system and reduces the amount of staff support a person uses in their home while ensuring health and welfare.

Remote support service include:

1. Installation, repair and maintenance of an electronic support system to remotely monitor the participant in the participant’s primary residence;
2. Provision of training and technical assistance in accessing, using, and operating the electronic support system for the participant and individuals supporting the participant; and
3. Provision of staff to: (i) monitor the participant via the electronic support system; and (ii) stand-by and intervene by notifying emergency personnel, including, but not limited to, police, fire and participant’s direct support staff.

Supported Living Services provide participants with a variety of individualized services to support living independently in the community. Supported Living Services are individualized to the participant’s needs and interests as documented in the participant’s person-centered plan and must be delivered in a personalized manner.

1. Supported Living Services assists the participant to:
   1. learn self-direction and problem-solving related to performing activities of daily living and instrumental activities of daily living required for the participant to live independently; and
   2. engage in community-based activities of the participant’s choosing within the participant’s personal resources.
2. Supported Living Services enables the participant to:
   1. live in a home of his or her choice located where he or she wants to live; and
   2. live with other participants or individuals of his or her choosing (not including relatives, legal guardians or legally responsible persons as defined in Appendices C-2-d and C-2-e).
3. This service includes Nursing Support Services and Nurse Case Management and Delegation Services. The scope of the Nursing Support Services and Nurse Case Management and Delegation Services is defined under the stand-alone service in Appendix C.

Supported Living Services are provided in the participant’s own house or apartment.

This Waiver program service includes provision of:

1. Direct support services for provision of coordination, training, supports and/or supervision (as indicated in the person-centered plan) as provided in Section A above;
2. The following services provided in combination with, and incidental to, the provision of this Waiver program service:
   1. Transportation to and from and within this Waiver program service;
   2. Delegated nursing tasks, based on the participant’s assessed need; and
   3. Personal care assistance, based on the participant’s assessed need.

Transition services provide funding for allowable expenses related to the participant moving from:

1. an institutional setting to a group home or private residence in the community, for which the participant or their legal representative will be responsible; or
2. a community residential provider to a private residence, for which the participant or their legal representative will be responsible.

For purposes of this service definition, “allowable expenses” are defined as actual costs associated with moving and establishing a new household.

Examples may include:

1. Cost of a security deposit that is required to obtain a lease on an apartment or home;
2. Reasonable cost, as defined by the DDA, of essential household goods, such as furniture, window coverings and kitchen, bed and bath items which cannot be transferred from the previous location to the new one;
3. Fees or deposits associated with set-up of, initial access to or installation of essential utilities and for telephone, electricity, heating and water; and
4. Cost of services necessary for the participant’s health and safety, such as pest removal services and one-time cleaning prior to moving in;
5. Moving expenses

Transportation services are designed specifically to improve the participant’s and the family caregiver’s ability to independently access community activities within their own community in response to needs identified through the participant’s Person-centered plan.

For purposes of this waiver program service, the participant’s community is defined as places the participant lives, works, shops or regularly spends their days. The participant’s community does not include vacations in the state or other travel inside or outside of the state of Maryland.

Transportation services can include:

1. Orientation services in using other senses or supports for safe movement from one place to another;
2. Accessing mobility and volunteer transportation services such as transportation coordination and accessing resources;
3. Travel training such as supporting the participant and their family in learning how to access and use informal, generic and public transportation for independence and community integration;
4. Transportation services provided by different modalities, including public and community transportation, taxi services and non-traditional transportation providers;
5. Mileage reimbursement and an agreement for transportation provided by another individual using their own car; and
6. Purchase of prepaid transportation vouchers and cards, such as the Charm Card and taxi cards.