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Written by: Roy Martz, TSBVI Social Worker

image002Studies of residential arrangements for special education students show that a majority of the students continue to live at home with their parents after high school, at least initially. In one study only 15% of the participants lived independently with a roommate or spouse.

Traditionally people with disabilities have received most of their assistance from formal service providers. Funding and access to the service system have heavily influenced this assistance. There also exists, however, a whole system of informal support that comes from family, friends, and the community through personal relationships. We have, therefore, divided the Section of Housing between formal and informal supports. In many cases, individuals are getting assistance in more natural ways and are less reliant on the service system for something that is so basic and personal as housing.

For young adults who are visually impaired and/or have other disabilities and who are unable to live independently or without supervision from service providers, it will be important to analyze housing options to ascertain whether these options can provide appropriate supports and services.

LIVING WITH SUPPORT

Families

Many people with disabilities choose to live with their families for a variety of reasons. Economics and personal safety are primary factors. Family and friends can be expected to know the individual needs of a disabled family member better than anyone else, and therefore may be in the best position to help. Personal safety is better assured, as well as dependability of care and support. However, insecurity exists about the longevity of this type of arrangement. Many parents live in fear of what will happen to their disabled child when they are no longer able to care for him or her. Typically friends or relatives step in to continue providing care. A variety of program supports also exist to help families care for their disabled child in their own homes.

Respite Care

Families, who do not receive short breaks on a regular basis from their caregiving tasks, are at high risk for burn out. Respite care provides short term, in-home, or out-of-the-home, care services to individuals of all ages with disabilities. Most respite care programs offer this service on a sliding fee scale with an hourly or daily rate.

HCS (Home and Community-Based Services

The HCS Program provides services to individuals with mental retardation who either live with their family, in their own home, or in a residence with no more than four individuals who receive services. The HCS Program provides services to meet the individual's needs so that he/she can maintain him/herself in the community and have opportunities to participate as a citizen to the maximum extent possible. As opposed to ICF-MR Group Homes where most all expenses are covered by the home, individuals in the HCS Program pay for their room and board either with their SSI check or other personal resources.

Services include: respite care, homemaker services, habilitation services, case management, OT/PT, speech, psychological, and social work services.

Eligibility

  • eligible for SSI and Medicaid
  • eligible for a group home
  • have a mental retardation diagnosis
  • client consents to the HCS Program as an alternative to group home

HCS is administered by The Texas Department of Mental Health and Mental Retardation. However, the waiting lists for HCS are long and can take many years to enter. As of May 2002 over 20,000 applicants were waiting for services statewide.

CLASS (Community Living Assistance and Support Services)

This program provides home and community-based services to people with related conditions as a cost-effective alternative to placement in group homes. CLASS provides services similar to those of the HCS program, but eligibility differs in that the primary disability is one other than mental retardation. The disability must originate before age 22, and affects the client's ability to function in daily life.

In-Home and Family Support through DHS

This service provides direct grant benefits to individuals with physical disabilities to purchase services that enable them to live in the community. Eligible individuals are empowered to choose and purchase services that help them remain in their own home.

image004Services

  • purchasing special equipment or architectural home modifications
  • medical, surgical, therapeutic, diagnostic, and other health services related to a person's disability
  • counseling and training progrms that help provide proper care of an individual with a disability
  • attendant care, home health services, home health aide services, homemaker services, chore services that provide assistance with training, routine body functions, dressing, preparing and consuming food, and ambulating
  • respite care
  • transportation services

In-Home and Family Support through MHMR

This program provides another means of funding service on an annual or one-time basis.

Services

  • medical services and equipment
  • medications
  • modifications to a home to accommodate the special needs
  • therapies
  • skills training
  • adaptive aids
  • community inclusion training
  • personal assistant services for the medically fragile
  • transportation
  • respite provided by a person of the family's choice
  • limited number of other services not available from another funding source

Families are required to provide receipts and other proof that the grant funds were used as stated in the contract. Eligibility for grant funds is based on family size and income; funding per individual is limited to $3,600 in a year.

Residential Care

The Residential Care program provides services to eligible adults who require 24-hour access to care, but do not require daily nursing intervention. Services include, but are not limited to, personal care, home management, escort, 24-hour supervision, social and recreational activities, transportation, food, and room. Services provided under this program are delivered through one of two arrangements: supervised living or emergency care.

Supervised Living

A state-funded 24-hour living arrangement in which the clients are expected, if able, to contribute to the total cost of their care. Clients keep a monthly allowance for personal and medical expenses, and the remainder of their income is contributed to the total cost of care.

Emergency Care

A state-funded living arrangement that provides services to eligible clients while caseworkers seek a permanent care arrangement. Emergency care clients do not contribute toward the cost of their care.

Pertinent Questions for Families

  • If a prospective resident is a blind diabetic, is the staff knowledgeable of the adaptive health care aids available, such as insulin syringes with tactile marking, automatic syringe injectors, and marked dosage mixers?
  • Do staff in the facility know basic sighted guide techniques?
  • Do staff know how to orient an individual without functional vision to a room, a task, or a meal placed before them?
  • Will the facility personnel allow residents who are blind or have low vision to do things they are capable of doing for themselves, such as cooking, housework, personal care, and so forth?

Adaptations and Modifications

  • Are appliances marked with raised lines and Braille?
  • Is the living space well organized and uncluttered?
  • Are alarms or security systems accessible without vision?
  • Is there adequate space in the living environment for adaptive computer equipment or low vision devices like closed circuit television sets?
  • Is lighting adequate for individuals with low vision?
  • Is the facility in an accessible neighborhood (with sidewalks, well-lit streets, controlled street crossings, and shops and services close at hand?
  • Is the facility located on or near public transportation routes?

Eligibility

  • must be age 18 or older

Financial

The individual must be a Medicaid recipient or be determined financially eligible for Title XX services. The caseworker applies allowable exclusions to income and resources.

Countable income must not exceed:

  • $1,635 per month for an individual
  • $3,270 per month for a couple

Countable resources must not exceed:

  • $5,000 or less for an individual
  • $6,000 or less for a couple

Functional Assessment

The individual must meet functional need criteria. Level of impairment is measured in a client needs assessment interview by a DHS caseworker.

On-Line Resources

www.respitelocator.org/index.htm

Find respite services in any state or local area.

www.dhs.state.tx.us/programs/communitycare/index.html

State of Texas Department of Human Services Community Care Program.

www.dhs.state.tx.us/programs/

State of Texas Department of Human Services Programs. List the services available for families and children, people who are elderly or have disabilities, and services for all Texans in need.

www.resna.org/taproject/policy/community/HMRG.htm

Resources and links to accessible housing, laws, guidelines, funding sources, home modification plans.

Group Homes

What is a group home? A group home, sometimes referred to as an ICF-MR program (Intermediate Care Facility for Mentally Retarded), provides persons with mental retardation a home in which they can live and learn, according to their needs.

Questions to Ask when Exploring Group Homes

  • How many people live there?
  • How old are they?
  • What is the best and worst possible staff to client ratio you have experienced?
  • What is staff turnover like? Do you have ample backup staff?
  • What types of communication is staff able to use (sign language, Braille, calendar system)?
  • What skill level is required of staff?
  • Have you ever had a client like mine? How did it work out?
  • What do residents do during the day?
  • What do they do after work?
  • Do you take them to community, social and recreational events such as church, concerts, fireworks displays, etc.? Which ones?
  • What skills are necessary for the clients in order to be included in the activities?
  • Is it possible for the client to come here on a trial basis?
  • Can visitors drop in whenever they want?
  • Are there any hazards in the home that the residents need to learn about?
  • What types of situations do you contact parents about? (e.g., illness, injuries, permission to do something?)
  • How do you manage behavior problems?
  • How is the resident's personal money handled?
  • Have you ever had a problem with crime?
  • Can the residents leave the group home? For how long?
  • What personal items can they bring with them?
  • What type of transportation does your program provide? How many vehicles do you have?
  • Do you have a reference list of families that I could talk to regarding the services your organization has provided to their family member?
  • Have they served a visually impaired resident in the past?

Observations When Visiting a Group Home

  • Are the rooms clean and free of unpleasant odors?
  • Do the rooms appear safe?
  • How many other people share the room?
  • Is there space for personal belongings and visitors in the room?
  • Are the residents encouraged to help with meal planning, preparation, and serving?
  • Does the food appear to be of high quality?
  • Are dietary needs and preferences respected?
  • Do residents assist in clean up?
  • Are the common areas comfortable and inviting?
  • Are there signs of resident activity and use n the common areas?
  • Do the residents seem happy?
  • Do the residents participate in activities?
  • Do the activities appear to be well supervised?
  • Are the residents clean, well groomed, and appropriately dressed?
  • Does the staff show concern for the residents?
  • Are staff members available and helpful when family members have questions?
  • Does the staff speak so that residents can understand them easily?
  • Does the staff interact with the residents professionally yet pleasantly?

Costs

Group home providers use the client's SSI check plus Medicaid to cover the home's expenses. The client receives $25 from their SSI check as an allowance for incidentals.

Who qualifies for financial assistance for group home living?

  • medicaid eligible
  • citizen of USA
  • persons with mental retardation as determined by their local MHMR center
  • The Texas Administrative Code, ICF-MR Programs, Eligibility and Review, 406.203 states:
  1. Individuals with an IQ of 69 or below as measured by a standardized psychometric instrument.
  2. Individuals with related conditions that have an IQ of 75 or below and deficits in adaptive behavior. These individuals with related conditions must be diagnosed through formal testing and evaluation.

Persons with related conditions are individuals who have a severe, chronic disability that is attributed to cerebral palsy or epilepsy OR any other condition, other than mental illness, found to be closely related to mental retardation. The condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with mental retardation, and requires treatment or services similar to those required for mental retardation.

The related condition must be manifested before the person reaches age 22; and results in substantial limitations in at least three of the following areas of major life activity:

  1. self-care
  2. understanding and use of language
  3. learning
  4. mobility
  5. self-direction
  6. capacity for independent living

LIVING INDEPENDENTLY

Rental

altWhen home ownership is not a consideration because of economic factors, renting a home or apartment is the next step toward independence, especially for the young adult. Although advertisements in newspapers are an effective means of finding rental property, many people rely on friends and family to help identify safe and affordable housing. Commercial apartment finders can also be helpful. Funding support may be obtained through HUD/Housing Choice Vouchers (see below).

Public Housing

Public Housing Authorities

These organizations are governmental entities, authorized to develop and/or own housing units to be occupied by low and very low income families. They may also administer the tenant-based Housing Choice Voucher program under a contract with HUD, which provides rental vouchers to eligible tenants.

Housing Choice Vouchers (formerly Section 8)

Under this program, the Department of Housing and Urban Development (HUD) provides vouchers to cover the difference between the resident contribution and the rent established for the unit.

Local Housing Departments

Many large cities and counties in Texas have their own housing departments that administer related funds bypassing the state entirely. These local housing departments are known as Participating Jurisdictions and are responsible for housing issues in their respective city or county.

Home Ownership

Most young adults with or without a disability would like to live independently. Part of the American Dream is home ownership. It offers independence from landlords' rules and regulations, increasing rents, and greater privacy. Home ownership offers many tax advantages as well. There are a variety of assistance programs for first time home buyers such as the Texas Department of Housing and Community Affairs which operates a first time homebuyer program for buyers with low incomes.

alt

However, Region XIII Educational Service Center's Transition Manual reminds us that ownership of one's home need not mean buying or mortgaging a house, although it might. Instead, let us use the word "ownership" more broadly, to refer to the idea that home is where a person feels he or she belongs. It means choosing a desired neighborhood, a preferred type of housing which people will one day live, and what community resources one wants nearby. It means finding a place that matches one's preferences, and it usually means having one's name on the lease.

On-Line Resources

www.tdhca.state.tx.us/hf_sfbp.htm

Texas Department of Housing and Community Affairs website for first-time homebuyers, down payment assistance, Section 8 Housing Trust Fund, energy assistance, real estate analysis, etc.

www.hud.gov

United States Department of Housing and Urban Affairs website for buying, owning, selling, or renting a HUD home. Information about grants, vouchers, fair-housing assistance, elderly and persons with disabilities.

HOUSING CONSIDERATIONS

Bills

The most important issue relating to living in the community is finding a place that a person can afford. To decide how much a person can pay for rent and bills, first figure total monthly income.

Add up:

  • Monthly salary
  • Social Security payments
  • Other income such as family support
  • Rent subsidies

altTo figure expenses, calculate rent, electricity, gas, and telephone. Generally, the total expenses should not be more than 30% of the total monthly income.

Location

In choosing a place to live, it is important to consider safety, affordability, and convenience. Tenants should inquire:

  • How safe is the neighborhood? The local police department can provide crime statistics for different areas of town.
  • How far is the house/apartment from work?
  • Is there a public transportation route near the home?
  • How close are medical and community services?
  • Is the home within easy transportation to recreational and social activities such as church, theaters, shopping?

Roommates

Before finding a home, most people consider whether they would like to live alone or with a roommate. Some people prefer the privacy of living alone while others like to have another person around to share expenses, for company, and for safety. Before agreeing to share living space it is important for people to examine and/or discuss:

  • Do you trust this person? Do you feel safe around them?
  • Is this person financially stable?
  • What are the rules about visitors, alcohol, drugs, etc.?
  • Discuss the sharing of chores.
  • Both people should decide on whose name(s) would go on the lease and utilities.

When renting, the individual needs to determine which responsibilities are theirs and which ones are the owners. Home management skills can be learned through demonstration at home or with the assistance of a rehabilitation teacher. Students should learn any needed alternative techniques for performing home management skills without vision or with low vision and be introduced to adaptive equipment and tools. In addition, these teachers can provide students with resources for procuring adaptive equipment and tools for themselves.

Home Management

Home management skills include taking care of one's living space (e.g., sweeping, mopping, vacuuming, dusting, bed making) and taking care of the things in one's environment both indoors or out (e.g., preparing meals, storing food, washing dishes, maintenance and repair of appliances and tools, taking care of one's wardrobe, and outdoor spaces). Students should learn any needed alternative techniques for performing home management skills without vision or with low vision and be introduced to adaptive equipment and tools. In addition, students should have resources for procuring any needed adaptive equipment and tools for themselves.

CENTERS FOR INDEPENDENT LIVING

Centers for Independent Living are non-residential resource agencies that provide services for people with disabilities and education to the community on disability related topics. The Centers are governed and staffed by a majority of people with disabilities who bring a wide range of knowledge and experience to their work in assisting other people with disabilities. Assistance and education are provided in the areas of:

  • Housing
  • Transportation
  • Learning independent living skills
  • Advocacy
  • Community Integration
  • Peer Counseling
  • Employment
  • Information and Referral

Rights

A person with a disability has the right to request reasonable modifications of his or her new home. They include changes in policies and rules that enable a person with a disability to have an equal opportunity to use and enjoy the housing available. Accommodations must be practical and reasonable.

Fair Housing Amendment of 1988

The amendment protects people with disabilities from discrimination and mandates residential rights and architectural access. New apartment buildings and condominiums with four or more units first occupied after March 1991 must have access to every ground floor unit, and in all units if the building has an elevator.

Although the landlord is not required to pay, they can not refuse to make reasonable accommodations or let people with disabilities make reasonable installations or renovations to the property. This includes widening doors, installing grab bars, floor covering, etc.

On-Line Resources

http://www.bcm.edu/ilru/html/publications/directory/texas.html

REACH Resource Centers on Independent Living. A directory of centers in Texas.

www.onr.com/user/texashoyo/

The Texas Home of Your Own Coalition (HOYO) is committed to making homeownership a reality for Texans with disabilities. Through HOYO, disability advocacy organizations, government housing agencies, realtors, private lenders and others join forces to help people with disabilities.

5555 N. Lamar Boulevard, Ste. L-139
Austin, TX 78751
1-800-988-4696