“Community-based” gets a new definition. New expectations. Is there new money?

Apr 04, 19 “Community-based” gets a new definition. New expectations. Is there new money?

“Community-based” gets a new definition. Is there new money??

You come in to work the 3p-11p shift at a job you love. As you enter the house you can kinda guess how the day went by the smell. A pine scent could  mean there’s been a mess that needed to be cleaned up. Food smells could mean we’re on schedule but maybe a little too early since John, with hand-over-hand help, was supposed to help support staff make dinner. You roll your eyes because you worked all last week with John to make dinner and you’re frustrated because they didn’t take the time. Body smells are the worst because you don’t know if someone’s had a recent accident or if they just have not been tended to all day, OR, were they not tended to in a way you find acceptable. Did they take John to church earlier as written in the schedule? Did they play the soothing music during mindfulness hour so Vincent has a chance to relax? Charles enjoys calling his mother. Did they help him dial the phone in order to speak with her?

As you sit at the kitchen counter you go through the daily log and see that it hasn’t been completed so you start asking questions about what John, Vincent, and Charles have been doing today and their mood. Are they happy? Is anyone in distress? What hygiene and household needs haven’t been taken care of? No matter what is outstanding you will take care of it. You don’t need direction. You have read John, Vincent, and Charles’ support plans several times and even helped draft it when you attended their IP meetings. You communicate with the family and ensure that they feel like their loved ones are safe.

These fantastical support staff exist. They, and organization administrators, work hard to provide a home-like setting for disabled peoples. Integrated community is expected. As the infrastructure (utilities, licenses, upkeep, etc.) increases so does the cost of living for workers who are directly responsible for implementing support plans on a day-to-day basis.

Norms and expectations for community-based services continue to evolve. According to Disability Scoop

Federal officials have issued long-awaited guidance to help states determine what living arrangements for people with disabilities are considered community-based rather than institutional.

The new guidelines from the Centers for Medicare and Medicaid Services clarify a 2014 rule outlining criteria for programs provided through Medicaid home- and community-based services waivers.

The rule calls for home- and community-based settings to provide full access to the community as well as offer privacy, foster independence and allow people with disabilities to make their own choices about services and providers. The criteria apply to homes, day and job-training programs and other non-residential offerings provided through waivers.

The article goes on to say

CMS still defines settings as isolating and in need of further review if they offer limited opportunity to interact with the broader community. Other criteria include restricted choices for services or outside activities and locations that are “separate and apart” from the community, without opportunity for participation.

As many in the field have been working for years toward this goal, how does the aging and disabilities community incorporate expanding expectations of community integration into rural and farm areas? How does CMS plan to adjust funding to parody expectations and cost of living?

CLICK HERE to read the full article.



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External Resources

Genetics Home Reference – NIH

Support program: Autism Sibling Support Initiative

Support program: Sibling Support Project

Maryland Developmental Disabilities Council

Maryland Early Intervention and Special Education Services

Administration for Community Living

Pathfinders for Autism

Disability Scoop


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