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Community Choice Act of 2009: From institutions to the community
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Amid regulatory pressure from the Olmstead Act, allegations of abuse and neglect, and the efforts of disability rights advocates, large state-run institutions are gradually being phased out in many states around the country. But the alternative, the transition from an institution to a community setting, can be frightening for all parties -- individuals, parents and guardians. For an individual with a disability, an institution may be the only home he or she has ever known, so even the thought of leaving it can be intimidating. For a parent or guardian, relocating their loved ones into a community without ironclad assurances of quality and continuity of care, can require an almost unimaginable leap of faith.
The Community Choice Act (H.R. 1670 and S. 683) is part of healthcare reform legislation that, if passed, can provide a person with a disability the choice of where to live, rather than being forced to stay in institutional care. Currently, every state that offers Medicaid is required to provide nursing facility services, but community-based services remain optional. The result is that seniors and people with disabilities are still forced into institutional settings. The Community Choice Act requires states to offer community-based services for Medicaid eligible people who want to stay in or return to their homes and communities.
If the Community Choice Act passes, then states will be eligible to receive grant funds and will be responsible for creating implementation plans. To be successful, states must be prepared to create plans that include:
1. Supports and back-up. What does the individual need to be able to live in the community? Often this includes not only medical needs and caregiver support, but also assistive technologies, such as home modifications (e.g. ramps or other accessibility devices) or services, such as help with cleaning and cooking. Similar demonstration grants such as Money Follows the Person require that plans are in place for continuity of said services, so that a replacement is guaranteed if caregivers are ill or cannot perform their duties for any other reason.
2. Housing solutions. Under the law, Medicare and Medicaid core services and waivers will follow the individual, but affordable housing poses the biggest funding challenge. Processes must be put in place to help make certain allowances for start up funds for apartment down payments, environmental adaptations and/or roommates/'adoptive' families to defray housing costs.
3. Controls. Although the most recent research establishes the fact that there are no increased risks related to health and wellness, abuse or safety with community affiliation, there is still concern about how to ensure proper care and financial stewardship. And, although the Act encourages greater individual choice and self-determination, states should implement guidelines that insist upon financial controls to avoid theft of the individual's funds, either overtly or by reducing the amount of services needed.
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