A lot of you missed a nice Zoom about a $38 million state-funded initiative that provides subsidized housing for people with SPMI (Serious and Persistent Mental Illness). It allows folks to leave things called “adult care homes”–which are not the same as I/DD group homes or ICFs–in order to live in their own apartment in the community. The speaker, Josh Walker, who is DHHS’ Olmstead Housing Director, recorded the session and we are trying to work out ways to make it accessible to you.
TCL is a little complex, but a fascinating feature is that, in addition to subsidized housing, each person gets a medical team of appropriate composition and size assigned to them…like a mini-hospital…to back up the transition.
HOWEVER, Josh also said that when the state offers to move a person out of their adult care home and into a well-subsidized apartment in the community, staff are sometimes met with refusal on the grounds that the person doesn’t want to lose contact with the friends they’ve developed in the adult care home. Moreover, TCL is finding that a number of the people that do accept the move are then unhappier due to their isolation. It’s perhaps a lesson to consider if I/DD residents are forced to leave due to ICFs being eliminated, or, even if ICFs somehow don’t shut down, if people are rapidly rotated through ICFs via “temporary placements”.
Living in the community is terrific for those with the ability to access to a rich array of social opportunities, as might be the case for those who work and/or drive. But simply parking people in isolated apartments is not a good method for de-institutionalization. I don’t think Dotty Foley–the original parent champion for Supported Living Levels 2 and 3–would mind me telling you that despite the many things she did to get her high-needs son out in the community he was still isolated in his apartment complex. DSPs and family members remained his only source of real friendship.
It is WRONG to prohibit the creation of housing developments that serve a high proportion of adults with I/DD (e.g., more than 20-25%). Threatening to remove Medicaid from residents living in a “concentrated” setting means only the wealthy can afford to forgo it and buy into private-pay developments. Yes, there is some wiggle room if the development can prove the residents have ready access to integrated settings, such as the ability to leave for work, but the burden of proof is on the development. This discourages developers.
A final key point here: While there is no fixed time limit, TCL was devised to provide subsidized housing temporarily until the person is stable enough to hold a job and earn a living wage. Some folks with mild I/DD might aspire to getting out of subsidized housing and off supports, but a large portion of adults with I/DD cannot. They will need permanent subsidized housing (and services) indefinitely. And as Josh said last night, the legislature hates to hear the word “indefinite”. We need to work at getting our representatives comfortable with this notion, because that’s the reality many of our families face.