When am I ready?
Readiness is a very individual decision. Some people are ready to live in their own place when they are in their 20’s, and some feel ready when they are much older. Some people want to have enough income to pay for the things they think they will need in their own place. They may apply for SSI or SSDI and it may take time to get these benefits. Some people want to get a job to add to their income. Others may have help from family or friends and are not as concerned about finances.
Whatever your situation is, it is important to begin thinking about where you will live when you are young. This will give you time to gain experiences and skills, learn about programs that can help you pay for your housing costs, learn to create a budget and live within its guidelines, apply for credit and establish a good credit rating, consider the supports you will need when you have your own place and talk with your family and friends to gain from their experiences and to learn about their concerns.
Concerns of family/friend
Sometimes, a person with a disability may be eager to move to their own place, but family/friends are not as eager or supportive of this plan. Common concerns that family/friends may have about you getting a place of your own may include:
- Who will make sure my loved one’s needs are met when I’m no longer around?
- My loved one will not have the supports they need
- Staff may not show up and my loved one will be alone
- Staff won’t understand my loved one’s specific needs
- My loved one won’t receive as good care from someone other than family
- My loved one will be vulnerable to people who may take advantage of them
- My loved one is sometimes disruptive and may be evicted for disturbing others
- My loved one needs a special environment that meets their unique needs and a housing provider won’t allow the unit to be modified to address these needs
- My loved one can’t handle money and won’t be able to keep up with housing payments like rent and utilities
- If fewer people are around, who will hold staff accountable for taking care of my loved one? Who will make sure they are not being abused, neglected or victimized?
The best time to plan for your loved one to live in their own place is when you are available to assist with the transition and monitor how things are going.
DDA has several services that can be used to hepp support an eligible person in their home. These models include:
- Live-In Caregiver Supports: The purpose of Live-in Caregiver Supports 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: A. A caregiver is defined as someone that is providing supports and services in the individual’s home. B. Live-in Caregiver Supports must comply with 42 CFR §441.303(f)(8) and be approved by DDA. C. 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 for submission to the DDA as part of the service request authorizations. D. The individual in services has the rights of tenancy but the live-in caregiver does not, although they are listed on a lease. E. Live-in Caregiver Supports 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: Personal Supports are individualized supports, 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); and 3. Personal care assistance services during in-home skills development and community activities. Personal care assistance services 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 of other allowable Personal Supports activities occurring.
- Assistive Technology and Services: 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 means 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, 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; and 9. Adapted toys and specialized equipment such as specialized car seats and adapted bikes. Assistive Technology service means 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; and 7. Services consisting of purchasing or leasing devices.
- Environmental Assessment: An environmental assessment is an on-site assessment 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 assessment includes: 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; and 6. The participant’s support network including family members’ capacity to support independence.
- Environmental Modifications: Environmental modifications are physical modifications 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: a. Installation of grab bars; b. Construction of access ramps and railings; c. Installation of detectable warnings on walking surfaces; d. Alerting devices for participant who has a hearing or sight impairment; e. Adaptations to the electrical, telephone, and lighting systems; f. Generator to support medical and health devices that require electricity; g. Widening of doorways and halls; h. Door openers; i. Installation of lifts and stair glides (with the exception of elevators), such as overhead lift systems and vertical lifts; j. Bathroom modifications for accessibility and independence with self-care; k. Kitchens modifications for accessibility and independence; l. 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.
- Housing Support Services: 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. 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. C. 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, utilities, 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. D. Housing Transition Services includes: 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: a. Short and long-term goals; b. Strategies to address identified barriers including prevention and early intervention services when housing is jeopardized; and c. Natural supports, resources, community providers, and services to support goals and strategies. E. 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. Early identification and intervention for behaviors that jeopardize tenancy; 5. Assistance with resolving disputes with landlords and/or neighbors; 6. Advocacy and linkage with community resources to prevent eviction; and 7. Coordinating with the individual to review, update and modify the housing support plan.
- Remote Support Services: 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. C. Remote Support Service includes: 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: 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. 2. Supported Living services assists the participant to: (a) 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 (b) engage in community-based activities of the participant’s choosing within the participant’s personal resources. 3. Supported Living services enables the participant to: (a) live in a home of his or her choice located where he or she wants to live; and (b) 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). 4. This service includes Nursing Support Services/Nurse Case Management and Delegation Services. The scope of the Nursing Support Services/Nurse Case Management and Delegation Services is defined under the stand alone service in Appendix C. B. Supported Living services are provided in the participant’s own house or apartment. C. 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: a. Transportation to and from and within this Waiver program service; b. Delegated nursing tasks, based on the participant’s assessed need; and c. Personal care assistance, based on the participant’s assessed need.
- Transition Services: Transition Services provides 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 in the community, 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 deposits 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: 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.
Concerns About Staffing
- Staff may not show up and my loved one will be alone.
Concerns about staffing can be addressed in the Person Centered Plan (PCP) and with the service provider. Contingency plans for when staff do not show or are late can be part of the PCP.
- Staff won’t understand my loved one’s specific needs.
Family can help with hiring staff who will support their loved one and can be an important part of training staff to care for their loved one in the best way possible. In addition, the PCP will detail the needs of your loved one and the supports they will receive to address those needs. Delivery of these services and supports is monitored by the Coordinator of Community Services and by the Maryland Department of Health.
- My loved one won’t receive as good care from someone other than family.
No one can replicate the love and care provided by family. However, staff can be taught to provide for a loved one’s needs in a caring and supportive way. Family can participate in training staff and in monitoring service delivery.
- My loved one will be vulnerable to people who may take advantage of them.
Vulnerabilities can also be addressed in the PCP through skill building activities, staff training and oversight by management, use of assistive technology to monitor care settings and family oversight.
- My loved one is sometimes disruptive and may be evicted for disturbing others.
The needs of loved ones with disruptive behavior can be addressed in the PCP through behavioral support, staff training and providing increased choice and control. It is not uncommon for behavioral challenges to become less frequent and intense when a person has acclimated to their own home. Needs can also be addressed through careful choice of a place to live. Some people may prefer to live on the top floor so that they do not hear people above them, while others do better on the first floor because they don’t like heights. Some people benefit from sound proofing, changes in lighting or changes in the color of their rooms. Thinking carefully about needs when making choices in the location of the home is very important.
- My loved one needs a special environment that meets their unique needs and a housing provider won’t allow the unit to be modified to address these needs.
Special environments can be addressed in most housing situations through “reasonable modifications.” Fair Housing law provides people with disabilities additional protections to enable them to use and enjoy housing like people without disabilities. Modifications can be individualized and must address a disability related need of the person needing the modification. Examples include ramps, grab bars, different light fixtures, technology to assist people who are deaf or vision impaired, lowered door handles, sound dampening wall coverings, wall coverings to prevent damage from wheelchairs, changes to floor coverings for people using wheelchairs or walkers, etc. Sometimes the person needing the modification must pay for it, and other times it is the responsibility of the property owner. See the Fair Housing and Reasonable Accommodations/Modifications section of the website for more information.
- My loved one can’t handle money and won’t be able to keep up with housing payments like rent and utilities.
Money management concerns can be addressed in the PCP. People can receive supports for managing their money. They can also gain skills through training and experience. Some waivers have a self-directed services option which provides fiscal management services that help people pay salaries to staff as well as other expenses.
- If fewer people are around, who will hold staff accountable for taking care of my loved one? Who will make sure they are not being abused, neglected or victimized?
A loved one’s safety is paramount! Careful hiring and training of staff as well as oversight by the provider and family/friends can help to address these concerns. In addition, when a loved one gets to know neighbors, the mail carrier, maintenance staff, the property manager and people working at local businesses they have established a caring community that will also look after their wellbeing.
Talking through concerns with the case manager, housing specialist and service provider can bring new and different ideas for alleviating concerns. Talking to other parents who have been through the process of having a loved one move to their own home can be very helpful as well.
Making an informed choice
Making a choice about where to live is a big decision that can affect many parts of your life. Having information and experiences that help you understand the type of place you are considering as your new home are critical to the decision making process. Will you live in an apartment, a townhouse or a single-family home? If you have never been to one of these types of housing it will be difficult to decide if it is right for you. Could you live on the 9th floor of an apartment or condo building? Do you need outdoor space to walk, exercise or help you calm down? Can you walk up and down steps multiple times each day? Do normal noises from neighbors disturb you? Do footsteps above your head make you anxious? Do the sounds of children playing upset you? Thinking through your own needs and how they could be impacted by where you live is very important for the decision making process.
Some suggestions for getting information and experience are listed here:
- Visit people living in different settings, including apartments, townhomes, single family homes, condos, tiny homes
- Watch videos/TV shows with people living in different settings (HGTV)
- Talk with people who have lived in different settings
- Go to open houses at apartment communities
- Go to open houses at single family homes, townhomes and condos
- Read reviews of communities to see if there are common concerns among current or former residents that you think will also be of concern to you
- Check with the police to get information about crime in the community
- Visit the particular community you are considering for your home. Try to go at different times of day. Walk around the community if you can. Is the lighting good? Do people seem friendly? Is there outdoor space for you to enjoy? Are there a lot of children? Is there a playground? Is the community on a busy street or on a quiet cul-de-sac? Do people seem to take good care of their homes? Is there ample parking? Are the apartment community grounds clean and free of trash and debris? Is the community close to shopping, medical facilities and other things you want to access frequently? Is there public transportation? How often do busses or other transit vehicles come to the community? Is the nearest transit route within ¼ mile of where you would live? The answers to these and many more questions will help you make a decision.