This is an e-mail that Richard Stimson, executive director and pastor of Special Gathering wrote in response to the newest Florida proposal to provide Host Homes.

If you read nothing else please see the part in red below.

I want to go through this letter line by line.  I have been concerned this was going to happen.  Some of you I spoke to about this.  In fact yesterday someone emailed me this – “Oh NO, Richard – you were right. Foster homes for adults!.“  Not only does it not surprise me, at some level I agree with it.  I have had issue with my brother living totally free to him or his family at tax payer expense.  Med-waiver is welfare.  What can people needing welfare expect tax payers to pay (and does Bill need welfare)?  Part of the question here is about funding streams.  I think part of why things are as expensive as they are is because we are trying to fit it within a medical funding stream.  Do not misunderstand me.  I have no issue with society (the tax payers) saying we have a joint responsibility to persons with disabilities.  I just think there is a balance. 

 

Part of what is happening is about fairness to those on the waiting list.  I am convinced that local representatives and senators are contacted more by families of people on the waiting list than those that receive services.  I hear those families on the waiting list and some (maybe many) are upset with those on the waiver.

Part of what is happening is about the money.  If you want to either cut the budget and/or serve more people you have to find where the money is being spent.  Res Hab cost a lot of money. 

I do think Host Homes at the cost below is not workable.  I do think if they paid 1,000 dollars a month it would be.  Particularly if they allowed families to private pay a group home Res Hab.  This is assuming true independent case management.  At 1,000 dollars a month you would have people interested in being Host Homes.  If you had enough Host Homes and truly independent case management and clients could move easily from home to home (like they can now with ADT) then competition would insure quality.  Families that were able could go to a group home and pay extra for res hab (I personally would assume that since the state did not pay for this res hab they would not regulate it).       

I have made comments below in CAPS and in blue and red. 

APD – HOST HOMES

Letter from the acting director of APD Bryan Vaughan

A Host Home is a Non-Waiver service open to persons on the waiting list and all persons receiving assistance from Developmental Disabilities Medicaid Waivers.

SO THEY SEE WAIVER FOLKS IN HOST HOMES

A Host Home will provide a homelike (non-treatment oriented) environment

WE USE TO CALL THIS 3 HOTS AND A COT

for those not in need of residential habilitation services, close continuous supervision, or for those who are not suited for supported living services.

I THOUGHT ANYONE COULD LIVE ON THEIR OWN?

The provision of any in-home waiver services ( such as: behavioral, in-home support, personal care, nursing, residential habilitation, and like ) is prohibited unless approved in emergency situations by the Area Administrator. This is not a shift work model or in-home staff model.

WHAT WILL HAPPEN TO THE GROUP SUPPORTIVE LIVING SETUPS WHERE YOU HAVE 3 PERSONS SHARING A HOME AND THEIR IN-HOME SUPPORTS ECT.?

These homes are licensed “by APD” as three bed foster homes and the payment is made by the adult consumer in accordance with the currently established Room and Board rates for foster care placements. This rate is currently $543.42, or the federal SSI monthly benefit amount minus the personal needs allowance.

COST NEUTRAL TO THE STATE.  WHY WOULD SOMEONE JUST NOT TAKE IN 2 PEOPLE AND NOT DEAL WITH THE STATE AT ALL?

The Room and Board of $543.42 for children will be paid from Area room and board allocations, due to the limitations of Jenkins v. State. In some cases adults may not have sufficient SSI income to pay the entire rate.

HOW OFTEN IS THIS THE CASE?  WILL NOT MOST OF THE TIME THE CLIENT PAY IT ALL?

In those cases Areas will supplement the payment. Parental, trust fund and personal payment is allowed and encouraged.

I WOULD THINK IF A TRUST PAID THIS IT WOULD PIERCE TO PROTECTIVE STATUS OF THE TRUST.

Partial months of residence will be prorated to the daily rate. The Areas will visit each home monthly unless exempted by future policy changes.

SO HOST HOMES WILL HAVE A DAILY RATE?  LOL

Normal background check requirements remain in place as do the non-waiver specific training requirements. The Areas will give priority to Host Home Family applicants for access to background screening and training. The Host Home Family will keep a monthly attendance log, facilitate persons to access school and work and provide assistance tracking and accessing medical and dental appointments.

WHAT CAN YOU REALLY GET FOR 543 A MONTH.  WHAT IS ASSISTANCE IN TRACKING.  WHO IS THE HOST HOME ASSISTING?  THE CLIENT OR THE “AREAS” OR THE SUPPORT COORDINATOR (WHEN THERE IS ONE)?

Each resident and host family will sign an agreement to be approved by the Area Administrator that details the boarding agreement. Persons will be carefully matched by the Areas to host homes in accordance with consumer and host family needs and desires. This matching process is critical to predicting the future success of the relationship.

FREEDOM OF MOVEMENT WOULD BE MORE OF INTEREST TO ME. 

The consumer is expected to have made clear arrangements for two weeks of respite annually.

SO A PARENT DIES, LEAVING A MENTALLY CHALLENGED PERSON WITHOUT ANYWHERE TO LIVE AND WE PUT THEM IN A HOST HOME AND THIS MENTALLY CHALLENGED PERSON IS TO MAKE SURE THEY HAVE SOMEWHERE ELSE THEY CAN LIVE FOR TWO WEEKS A YEAR?  WHO PICKS THESE TWO WEEK (THE CLIENT OR THE HOST HOME)?  ALSO, IF THIS PERSON CAN NOT MAKE ARRANGEMENT FOR RESPITE CARE WILL THE STATE SAY, “OH WELL YOUR HOMELESS WE WILL NOT PUT YOU INTO A HOST HOME!”  WHAT A JOKE.

The area must ensure that the host parents have a back-up plan in place concerning personal emergencies. As indicated above, both children and adults are potential Host Home Program participants.

The program is particularly suited to:

  • ·         Persons on the waitlist who need a place to live.
  • ·         SO A DEATH OF A PARENT WILL NO LONGER BE A “CRISIS” IN MANY CASES.
  • ·         Persons who reside in residential habilitation facilities who are determined by assessment to have received maximum benefit from training.
  • ·         THIS IS THE ONE.  WE ARE GOING TO SEE PEOPLE DETERMINED NOT TO NEED RES HAB ANY MORE.  THE REASON FOR RES HAB IS TO ENABLE SOMEONE TO BE MORE INDEPENDENT AND MOVE INTO SUPPORTIVE LIVING.  IF YOU EITHER ARE NOT IMPROVING OR DO NOT WANT TO MOVE INTO SUPPORTIVE LIVING WILL YOU LOSE RES HAB?  THINK ABOUT IT.  MED-WAIVER IS MEDICAL.  INSURANCES DO NOT PAY FOR TREATMENTS (LIKE PT) THAT ARE NOT SHOWING IMPROVEMENTS.   IT APPEARS TO ME THAT THIS IS WHAT HAPPENS TO “SPEECH” IN THE SCHOOL SYSTEM.  “SPEECH” IS TAKEN AWAY IF IMPROVEMENT IS NOT SEEN.  THINK ABOUT THE CORE ASSURANCE OF REDUCING PAID SUPPORTS.  YOU REDUCE / REMOVE RES HAB BY MOVING INTO SUPPORTIVE LIVING AND NOW BY MOVING INTO A HOST HOME.
  • ·         (Special note: Persons assessed to have maximized the benefit of training may be allowed to remain in the residential habilitation facility on a room and board only basis.)
  • ·         WILL THIS MEAN THAT FAMILIES WILL BE ABLE TO PRIVATE PAY FOR RES HAB (OR SOME OTHER NAMED SERVICE)?
  • ·         Persons Considering living in an ALF.
  • ·         Persons stepping down from more restrictive facilities.
  • ·         I AM BETTING THE STATE WILL SAY THIS IS LESS RESTRICTIVE THAN A RES HAB HOME.
  • ·         Children currently in, or exiting foster care.

This program does not apply to:

  • ·         Private homes of families providing care to a relative with a developmental disability.
  • ·         SO IF MY BROTHER LIVES WITH ME AND I GET HIS SSI, ETC, WHY WOULD I WANT TO BE A LICENSED HOST HOME?
  • ·         Any home already licensed as a group home.
  • ·         HOW DOES THIS FIT WITH WHAT IT SAID ABOVE – “(Special note: Persons assessed to have maximized the benefit of training may be allowed to remain in the residential habilitation facility on a room and board only basis.)”
  • ·         Foster homes, or adult family care homes licensed by DCF or AHCA.
  • ·         WOULD THEY NOT BASICALLY BE THE SAME THING?

The Agency will continue to develop additional lower cost residential options in the near future.

IT HAS ONLY STARTED.  WE COULD END UP WITH THINGS THAT MAKE INSTITUTIONS LOOK GOOD. 

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