For decades, residential programs have played a crucial role in I/DD service delivery, by providing housing for individuals that encourages independence while also integrating continuous support. Residential programs have evolved tremendously to reflect ongoing changes in government policy, community demands, and research. Like other parts of the I/DD services network, residential programs have followed a progression towards greater community integration, personal choice, remote service delivery, and preparing for alternative models of payment.
Community Integration & Individual Choice
To enhance the quality of care and personal choice of individuals, residential programs have consistently trended towards smaller residential settings. According to an ANCOR Foundation report, an estimated 90% of individuals with I/DD were living in homes with 15 or fewer people as of 2014. There has also been a greater emphasis on connecting residents to community-integrated activities, such as supported employment, community classes, and volunteering.
Agencies have developed innovative methods to expand housing availability while promoting individual choice. A service called Rumi was established in the hopes of fostering autonomy while also reducing extensive housing waitlists and providing incentives to caregivers. Rumi, run by I/DD agency Bridges in Minnesota, connects individuals with caregivers and assists the pairs in the process of signing long-term leases. Since the caregiver and individual become housemates, this ensures consistent support for the individual with a disability while also enabling them to live an independent life. The caregiver, in turn, is able to provide ongoing support in the home and earn their income tax-free.
With the onset of the pandemic, residential programs faced unique challenges in ensuring the safety of their residents, while also managing the concerns of staff, visitors, and family members. While many day and community programs were closed during the pandemic, residential programs had to adapt to fill hours in the day which residents typically would have spent outside the home. Some residential programs met this need by bringing in additional staff to run activities during the day. Others agencies have partnered with local organizations to deliver virtual yoga classes, music classes, and other virtual activities.
While remote programming has been quite successful, there are still uncertainties around future reimbursement rates and how to keep individuals feeling engaged virtually. Even after the pandemic passes, some agencies could see the benefits of continuing to include virtual activities in their service models. Individuals might prefer virtual services for their convenience and flexibility. Agencies can consider maintaining virtual activities as an option to allow individuals to choose what works best for their lifestyle.
Other agencies are using remote supports to further promote independence and reduce the need for staff to travel to and from multiple service locations. Examples include remote medication reminders, door sensors, and motion monitoring.
Alternative Payment Models
As more states explore managed care and value-based payment models for I/DD services, residential programs will need to effectively report on the outcomes of their work. As the need for I/DD services continues to grow, states will be looking to serve as many individuals as possible through sustainable funding models.
Residential programs can be prepared for these alternative payment models by continuing to implement technology and processes that effectively track outcomes, document service delivery and incidents, and enable accurate reporting.