One of the more challenging and complex issues in developing alternative ways to support people with significant needs is the area of live-in support. When an individual is physically challenged or has other needs for round-the-clock support in their home, how can those needs best be addressed? What roommate arrangements work best for the consumer? How can roommate quality and stability be maximized? How should roommate roles be defined? How much will it cost to have paid roommate arrangements work in the long run? These and other questions are now being explored by CSLA agencies across the state.
The types of arrangements that have developed thus far share some common themes. Individuals with significant physical challenges need 24 hour available support and are eligible for the maximum number of attendant hours (250-283) from In-Home Support Services (IHSS). Most paid roommate arrangements make use of this IHSS funding to pay some or all of a live-in roommate's salary, while also hiring additional support staff as needed for the roommate to get time off. CSLA funding is used to pay for the costs of such arrangements beyond those provided by IHSS and housing subsidies (individuals with Section 8 rental subsidies who require live-in roommates are able to offer free rent to their roommates as well).
There is a lot of variation, however, in how these arrangements are designed. One individual in southern California has a roommate who receives free rent, 250 hours of IHSS pay per month, and gets one day off each week with two days off on alternating weeks (6 days off per month. The CSLA agency pays for the relief staff.
Another person served by the same agency has two roommates in her house. One is an unpaid roommate while the other is paid a small salary ($635 per month gross) to be "on duty" from 8 pm to 6 am five nights per week. This roommate is "off" every Friday and Saturday but helps a couple of those nights each month with bedtime routines. In this situation, the woman served through CSLA has chosen to keep the bulk of her attendant needs separate from her roommate relationships. She hires attendants and uses a nursing agency for the hours she needs them.
In Sacramento, a slightly different arrangement was created for a woman who moved from an Intermediate Care Facility (ICF) to her own townhouse apartment. Her roommate receives free rent, $800 per month (from IHSS and the CSLA agency), and full benefits from the CSLA agency. The roommate's on-duty hours are 6 pm to 9 am daily except for getting two weekends off per month. Day time and relief attendant care are provided separately by a combination of IHSS and CSLA funding.
There are many more variations. For example, one man with 250 IHSS hours lives with a good friend who receives free rent and the IHSS pay but has no regular days off (he can take off by special arrangement). Instead, five evenings a week a CSLA paid attendant comes in for about 1.5 hours to assist with bathing.
Another more cognitively-challenged man with uncontrolled seizures has two roommates. One is on-duty for 12 hours from evening to morning each weekday and on alternating weekend shifts. He receives $700 per month plus free rent and benefits. The other roommate receives $200 per month in exchange for doing the alternating weekend shifts.
Similarily, another man without physical disabilities but who has difficulties keeping roommates arranged for an existing roommate to receive a small salary ($164 per month gross) as a means of providing more incentive for him to assist with occasional needs around cleaning and shaving.
The key to these and other paid roommate arrangements appears to be responsiveness. Every individual has different needs and different interests for how their needs might be supported. CSLA agencies are now exploring various ways that people with significant support needs can get what they want in ways that work for them and for the people that support them. There is clearly no one or two models that will be best for everyone. As the director of a southern California CSLA agency said, "Don't get hung up on doing it a certain way. Ask the consumer, listen, and be responsive."
Imagine That! is a quarterly newsletter about supported living published by Allen, Shea & Associates, 1040 Main Street, Suite 200 B, Napa, CA 94559, (707) 258-1326 under contract with the California Department of Development Services HD390061.