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Planning Ahead and Person-Centered Planning

Planning Ahead for What You Will Need

It’s important to think about how your service needs may change when you are living in your own home. Your family or the staff at your group home may have helped you with many activities of daily living and now you will need to make a plan for how your needs will be addressed in your new place. Your case manager, CCS or Supports Planner can help you think this through. If you have a Housing Support Service (HSS) specialist, they can help you think about your needs as well.

One way to think about it is to list everything that happens in your day from the time you wake up to the time you go to bed. How do you get all of the daily things done? Does someone help you? Do you sometimes get up in the middle of the night and need help? How will you get your groceries, get to medical appointments, get to recreational activities, visit family, pay your bills, read and understand your mail? The answers to these questions and more will become part of your new person-centered plan.

Listed below are some support need issues that can help you think about your needs in a new home:

  • Bathing and hygiene
  • Transferring to and from a wheelchair
  • Toileting
  • Home maintenance and cleaning the home
  • Budgeting and paying bills
  • Staying safe and emergency preparedness

It’s important to have emergency preparedness plans that help you be safe if you need to shelter in place, such as during a snowstorm or if you need to evacuate such as during a hurricane. The Maryland Department of Disabilities has helpful information to guide you through creating emergency plans. You can also get more information from the Emergency Planning page on the MIH website.

 

Preparing Meals at Home

You don’t need to know how to cook to live in your own home. There are options for meal delivery, cooking classes and in-home supports that can help with meals, including special diets.

Some options are listed below:

Meal Services

Freshly Meal Kits for People with Disabilities

This is a meal delivery service that does not require assembly or cooking – each meal is already prepared in a limited-time window so the food doesn’t have any freezer taste. Every single meal is perfectly-portioned, certified gluten-free, contains extra vegetables (such as butternut squash or lentil pasta instead of wheat) and doesn’t use corn syrup or artificial sweeteners. Meals can be customized for extra protein, carb consciousness, low sodium or lean calories.

Tovala Meal Service

Tovala is a meal delivery service that has an intentional commitment to accessibility on their website, and their meals are also accessibility-friendly. Tovala’s meal delivery kit and system handles the cooking for you and prepares meals in 20 minutes or less. Its key feature is its Smart Oven, which cooks everything the meal kit delivers (except salads). Meals arrive fresh, not frozen, and ready to cook. Tovala meals are entirely prepackaged and require no chopping, mixing or meal prep. To cook them, simply place them in the Smart Oven, scan the meal’s bar code and let the oven cook the meal exactly as Tovala’s chefs intended. If you live in the continental United States, you can order anywhere between three and 16 meals a week and have two choices for your preferred delivery day. Because Tovala’s meals are prepackaged and ready to cook, they don’t call for the dexterity that chopping, dicing, mincing, slicing and stirring requires. Tovala’s Smart Oven app has VoiceOver support that allows users to easily browse menus, order and prepare Tovala meals at home.

Accessible Chef

Accessible Chef is a Baltimore-based website with a collection of free visual recipes and other resources to help teach cooking skills to individuals with disabilities. Visual recipes make use of task analysis, which is an evidence-based approach for breaking down a complex task into manageable steps. Each task is separated into discrete skills and individuals can learn to complete skills in a specific order to learn new tasks. Students may require visual, physical or verbal prompts to complete each skill and prompts may be gradually removed as the individual becomes more independent. Visual recipes share similarities with PECS (Picture Exchange Communication System) and curricula created with Boardmaker.

 

Medications

If you need help with preparing and taking medications, many people can get help through their waiver services. If you don’t have this assistance, you can ask family or friends to help you put your medications in pill organizers. Some people find it very helpful to use a pill box with a built-in alarm. The box can be filled with your medications once a week by your family or friends and locked. When it’s time for you to take your medication, the box will sound an alarm and open the compartment with your next dose of medication. The alarm will continue to sound until you take your medication and close the compartment. The box will then sound an alarm when your next dose of medication is due. Alarmed pill boxes are easy to find on the internet and there are many varieties that can meet your needs.

Transportation

If you have Medicaid, transportation to medical appointments can be provided at no cost. Be sure to make arrangements well in advance to ensure transportation is available.

Some people who have waiver services can get assistance from staff to go shopping to get to doctor appointments. If you have waiver services, you should include plans for this in your person-centered plan.

Creating a Housing Plan

People with DDA waiver services can get help from Housing Support Services (HSS) specialist to create their personal housing plan. The HSS specialist will talk with you about a number of topics including:

  • Where you want to live.
  • Who you want to live with.
  • Your resources including any financial and personal assistance from family and friends.
  • Any barriers to housing you that you may have.
  • Your support services.
  • Any additional services you can receive that may help you be successful in your own home.
  • Any housing assistance programs you may qualify for.

For people with DDA waiver services, the housing plan becomes part of the overall person-centered plan. The HSS specialist will coordinate with your Coordinator of Community Services (CCS) to ensure that your desires and needs are known and that supports and services are included to help you achieve your goals. The housing plan can be modified whenever needed to reflect changes in your wants, needs and status. It will also be changed when you get a housing opportunity. The HSS specialist will work closely with you to be sure that your housing application and documentation are given to the landlord and that a plan is made to help you transition to your new home.

If you don’t have DDA waiver services, you can get assistance from your case manager, Supports Planner or from your local Center for Independent Living.

Person-Centered Planning for People Receiving DDA Services

Person-centered planning is a process that begins with the understanding that all people have the right to live, love, work, play and pursue their aspirations in their community. To that end, people have the right to figure out and pursue their good life. What defines a good life is as individual and unique as the person being supported. Many people also have family and others in their lives who play a meaningful role as the person explores potential interests and opportunities not considered before.

If you have waiver services through DDA, you will have a person-centered plan that addresses the services and supports you need and want to achieve your goals. If you want to move to your own place, you will have a housing goal in your plan that includes information on the kind of support you need and steps along the way to help you reach your goal. Information on DDA person-centered planning can be found here.

 

Person-centered Planning for People Receiving Other Services

  • Community Options Waiver – People using the Community Options Waiver can get assistance with creating a housing plan from their supports planner.
  • Brain Injury Waiver – People using the Brain Injury Waiver can receive assistance from their case manager.
  • Behavioral Health Treatment Services – People receiving public behavioral health services can get assistance from their case manager to create a treatment plan.

Timing of Services and Signing the Lease

Sometimes, when you find just the right place to live, the landlord may say that you need to sign the lease as soon as possible and if you can’t they will rent the unit to someone else. This can be stressful if your service and supports plan is not approved. You know you can’t move into your new place without the supports you need.

What can you do? It is always best to make sure that your person-centered plan includes information about the services you will need when you have your own home. It’s also best to keep everyone informed about the progress you are making toward your housing goal. Your CCS or case manager should draft a new plan with most of the services and supports you know you will need and have it ready to submit for approval as soon as you start to look for a place to live. Your plan can still be updated if your needs change. Your CCS or case manager can also let those who approve the plan know that it needs to be expedited to ensure that you don’t lose the housing opportunity.

If you will pay part of your rent with a rent subsidy, it is important that you DO NOT sign a lease until the apartment you have chosen passes a required inspection. If you sign the lease before the apartment passes the inspection and the apartment doesn’t pass, you may not be able to use the rent subsidy and will be required to pay rent for a year without financial assistance.

 

Live-in Caregivers

Sometimes a person with a disability needs to have someone live with them to help with activities of daily living and to assist with safety. Fair housing laws provide “reasonable accommodations” for people with disabilities to have an additional bedroom to accommodate a live-in aide. The aide must be approved by the landlord who will usually do a criminal background check and medical documentation will be needed from a healthcare professional substantiating your need for a live-in aide. A live-in aide’s income is not counted as part of household income and they do not have rights of tenancy. This means that the aide cannot continue to live in your home if you are no longer living there. It also means that the aide must leave if you tell him/her you no longer want their services. It is important to discuss this with potential live-in aides. They need to understand that they are living with you to assist you at your request and that their housing depends on you being there and being satisfied with their services. This can be especially difficult when family members agree to be a live-in aide.

It is also important to have a written agreement with the aide that spells out the services they will provide, the hours they will work and any other conditions that may be important to you.

DDA Waiver – Live-in Caregiver Rent: Community Pathways Waiver

If you receive DDA Community Pathways waiver services, you may be able to take advantage of the Live-in Caregiver Service. The service provides funds for the additional rent for an apartment with a bedroom for the caregiver. It also pays for the additional food costs for a live-in caregiver. A written caregiver agreement must be approved by the DDA to receive this service.

Live-in Caregiver Services for live-in caregivers are not available in situations in which the individual lives in their family’s home, the caregiver’s home or a residence owned or leased by a DDA-licensed provider.

DDA and the State Medicaid agency will pay for this service for only those months that the arrangement is successfully executed and will hold no liability for unfulfilled rental obligations. Upon entering in the agreement with the caregiver, the individual (or his or her legal representative) will assume this risk for this contingency.