The document provides an overview of residential service options for adults with developmental disabilities, including living at home with family or in settings outside the home such as skilled nursing facilities, intermediate care facilities, supported living services, and family homes. It describes different types of facilities and services and provides considerations for families in choosing appropriate housing arrangements to meet an individual's needs. The roadmap is intended to help families and individuals understand their options and make informed decisions in discussion with their regional center service coordinator.

1. Roadmap to Residential Services: Adults
with Developmental Disabilities
A self-guided, self paced decision tree intended to assist families
and individuals on what housing and residential placement options
are available for adults receiving services through regional center.
Click on individual squares in the decision tree to learn more of the
service.
• Click on the title of each page to return to the decision tree.
• Click on the arrow to return to the particular branch of services.
• Click on words in blue or red to get detailed definition of service.
• Click here to go to the decision tree.
Note:
• For residential placement in the community the guiding principle directing the services to be
arranged is the need to maintain the health and safety of the individual.
• This roadmap is not to replace the importance of a discussing residential service options with
the regional center service coordinator.
• The roadmap does not address housing trends or describe services or availability.
• The definitions for the services described in this roadmap are from the Department of
Developmental Services, http://www.dds.ca.gov/

2. Vendor Directories
Santa Clara, Santa Cruz, San Benito, Monterrey Cnties
Questions to Consider

3. Where will my adult child live?
• At home with family
• Somewhere outside the home.

4. At home with family
• In home support service
• Independent living services
• Respite Services
• Natural supports
• Other supports

5. In Home Support Service (IHSS)
In-Home Supportive Services (IHSS) provides personal care and domestic
services to persons who are aged, blind or disabled and who live in their own
homes. IHSS is provided to those who otherwise might be placed in an out-of-
home care facility but who can safely remain in their own home if IHSS services
are received.
Regional centers have a mandate not only to serve persons with developmental
disabilities, but to provide services in the most cost-effective manner possible.
They are required by the Lanterman Act to use all other sources of funding and
services before using regional center funds to provide services. Persons who
receive services from a regional center and are eligible for IHSS are expected to
use IHSS services available to them.
The In-Home Supportive Services (IHSS) program is administered by each
county with oversight by the California Department of Social Services (CDSS).
For application and eligibility information contact your local county welfare
department, adult services section. Look for them in the county government
section of your local telephone directory
In home Outside the home

6. Independent Living Services
Independent Living is a service provided to adults with developmental disabilities
that offers functional skills training necessary to secure a self-sustaining,
independent living situation in the community and/or may provide the support
necessary to maintain those skills. Individuals typically live alone or with
roommates in their own homes or apartments. These homes are not licensed.
Independent living programs, which are vendored and monitored by regional
centers, provide or coordinate support services for individuals in independent
living settings. They focus on functional skills training for adults who generally have
acquired basic self-help skills or who, because of their physical disabilities, do not
possess basic self-help skills, but who employ and supervise aides to assist them in
meeting their personal needs. Generally the level of support is not as extensive as
what is available through supported living services. Often services can be provided
at a less than daily level.
For more information about Independent Living Services, contact your
local regional center.
In home
Outside the home

7. Respite Services
Respite (In-Home) Services means intermittent or regularly scheduled temporary non-
medical care and/or supervision provided in the person's home. In-Home Respite services
are support services which typically include:
• Assisting the family members to enable a person with developmental disabilities to
continue living in the family home.
• Providing appropriate care and supervision to protect that person's safety in the absence
of a family member(s);
• Relieving family members from the constantly demanding responsibility of providing
care; and
• Attending to basic self-help needs and other activities that would ordinarily be
performed by the family member.
• Respite (Out-of-Home) Services are provided in licensed residential facilities.
• Respite services typically are obtained from a respite vendor, by use of vouchers and/or
alternative respite options. Vouchers are a means by which a family may choose their
own service provider directly through a payment, coupon or other type of authorization.
For more information about respite services contact your regional center representative.

8. Somewhere outside the home.
• Nursing: Residential arrangements to meet
involved nursing and health needs.
• Non-nursing: residential arrangements that
do not require more involved nursing or
health care needs.

9. Nursing: Residential arrangements to
meet involved nursing and health needs.
Skilled Nursing
Intermediate Care Facility
Adult Residential Facility for Persons
with Special Health Care Needs
(ARFPSHN) aka 962’s
Supportive Living Services

10. Intermediate Care Facility: General
Definition
Intermediate Care Facilities for Individuals with
Developmental Disabilities (ICF/IID) are health
facilities licensed by the Licensing and Certification
Division of theCalifornia Department of Public
Health (CDPH) to provide 24-hour-per-day
residential services. There are four types of
ICF/IID's, which primarily provide services to
regional center clients with developmental
disabilities
Four Types

11. Intermediate Care Facility
The four types of homes are:
ICF/DD (Developmentally Disabled)
ICF/DD-H (Habilitative)
ICF/DD-N (Nursing)
Developmentally Disabled-Continuous
Nursing Care (DD-CNC)

12. Intermediate Care Facility:
ICF/DD (Developmentally Disabled)
ICF/DD (Developmentally Disabled)"Intermediate
care facility/developmentally disabled" is a facility
that provides 24-hour personal care, habilitation,
developmental, and supportive health services to
developmentally disabled clients whose primary
need is for developmental services and who have a
recurring but intermittent need for skilled nursing
services.

13. Intermediate Care Facility
ICF/DD-H (Habilitative)
ICF/DD-H (Habilitative)"Intermediate care
facility/developmentally disabled-habilitative" is a facility
with a capacity of 4 to 15 beds that provides 24-hour
personal care, habilitation, developmental, and
supportive health services to 15 or fewer
developmentally disabled persons who have intermittent
recurring needs for nursing services, but have been
certified by a physician and surgeon as not requiring
availability of continuous skilled nursing care.

14. Intermediate Care Facility
ICF/DD-N (Nursing)
ICF/DD-N (Nursing)"Intermediate care
facility/developmentally disabled-nursing" is a facility
with a capacity of 4 to 15 beds that provides 24-hour
personal care, developmental services, and nursing
supervision for developmentally disabled persons who
have intermittent recurring needs for skilled nursing care
but have been certified by a physician and surgeon as not
requiring continuous skilled nursing care. The facility shall
serve medically fragile persons who have developmental
disabilities or demonstrate significant developmental
delay that may lead to a developmental disability if not
treated.

15. Developmentally Disabled-Continuous Nursing Care (DD-CNC)There is an
additional facility type, the Developmentally Disabled – Continuous Nursing
Care (DD-CNC). The DD-CNC Waiver program provides 24-hour continuous
skilled nursing care in home and community-based residential settings to
persons with developmental disabilities who are medically fragile. Eligibility
criteria requires that DD-CNC Waiver participants be Medi-Cal eligible,
enrolled in, and certified by a Regional Center as having a developmental
disability, exhibit medical necessity for 24-hour continuous skilled nursing
care and free of any clinically active communicable disease. Participants must
also meet specific minimum medical criteria as described in the waiver. The
program provides home and community-based services that assist Medi-Cal
beneficiaries to live in the community and avoid institutionalization. The DD-
CNC program is initially licensed as an ICF/DD-N type facility. However, the
license is suspended while the facility operates under a Waiver program. DD-
CNC development is currently limited by a regional center’s assessed need for
this program
Intermediate Care Facility
Developmentally Disabled-Continuous Nursing
Care (DD-CNC)

16. Adult Residential Facility for Persons with Special Health
Care Needs (ARFPSHN) aka 962’s
• “Adult Residential Facility for Persons with Special Health Care
Needs (ARFPSHN)” means any adult residential facility that
provides 24-hour health care and intensive support services in
a homelike setting that is licensed to serve up to five adults
with developmental disabilities.

17. Supportive Living Services
Supported Living Services (SLS) consist of a broad range of services to adults with developmental disabilities who,
through the Individual Program Plan (IPP) process, choose to live in homes they themselves own or lease in the
community. SLS arrangements assures up to 24 hours of daily support. SLS may include:
• Assistance with selecting and moving into a home;
• Choosing personal attendants and housemates;
• Acquiring household furnishings;
• Common daily living activities and emergencies;
• Becoming a participating member in community life; and,
• Managing personal financial affairs, as well as other supports.
These services help individuals exercise meaningful choice and control in their daily lives, including where and with
whom to live. SLS is designed to foster individuals' nurturing relationships, full membership in the community, and
work toward their long-range personal goals. Because these may be life-long concerns, Supported Living Services are
offered for as long and as often as needed, with the flexibility required to meet a persons' changing needs over time,
and without regard solely to the level of disability. Typically, a supported living service agency works with the
individual to establish and maintain a safe, stable, and independent life in his or her own home. But it is also
possible for some individuals to supervise their services themselves, to secure the maximum possible level of
personal independence.
The guiding principles of SLS are set down in Section 4689(a) of the Lanterman Act. The Department's regulations for
SLS are found in Title 17, Division 2, Chapter 3, Subchapter 19 (Sections 58600 et seq) of the California Code of
Regulations (CCR).
Individuals who choose to live in their own homes, and their agencies or other people who support them, often will
need information about affordable housing options, sources of financial support such as Supplementary Security
Income (SSI), and how to stretch a limited budget to meet living expenses. These are the ordinary challenges that
are inseparable from a truly self-directed life in the community. For the many adults for whom SLS makes great
sense, such challenges are often also road signs on the path to a satisfying life.
Nursing Outside the home

18. Non-Nursing:
No, or limited medical needs
• In their own apartment or home.
• In someone else’s home.
• Intentional Community

19. In their own apartment or home.
• Market rate rents.
• Subsidized Housing.
• Owned or rented by self or family.
• Shared financial responsibilities with roommates.
Services and supports provided to keep secure
these housing arrangements.

20. Services and supports provided to keep
secure these housing arrangements.
• Supported Living Services
• Independent Living Services
• IHSS

21. In someone else’s home.
• Department of Social Services Licensed Homes
Community Care Facilities.
• Family Home Agencies.

22. Department of Social Services Licensed
Homes, Adult Residential Facilities
• Community Care Facilities (CCFs) are licensed by the Community Care Licensing Division of the
State Department of Social Services to provide 24-hour non-medical residential care to children and
adults with developmental disabilities who are in need of personal services, supervision, and/or
assistance essential for self-protection or sustaining the activities of daily living. Based upon the
types of services provided and the persons served, each CCF vendored by a regional center is
designated one of the following service levels:
• SERVICE LEVEL 1: Limited care and supervision for persons with self-care skills and no behavior
problems.
• SERVICE LEVEL 2: Care, supervision, and incidental training for persons with some self-care skills
and no major behavior problems
• SERVICE LEVEL 3: Care, supervision, and ongoing training for persons with significant deficits in self-
help skills, and/or some limitations in physical coordination and mobility, and/or disruptive or self-
injurious behavior.
• SERVICE LEVEL 4: Care, supervision, and professionally supervised training for persons with deficits
in self-help skills, and/or severe impairment in physical coordination and mobility, and/or severely
disruptive or self-injurious behavior. Service Level 4 is subdivided into Levels 4A through 4I, in
which staffing levels are increased to correspond to the escalating severity of disability levels.

23. Family Home Agencies
• A Family Home Agency (FHA) approves family homes which offer the opportunity
for up to three adult individuals with developmental disabilities per home to
reside with a family and share in the interaction and responsibilities of being part
of a family. The individual with developmental disabilities receives the necessary
service and supports from the family, agencies and the community to enable the
individual to be a participating member of the family and the community where
the family resides. The family home arrangement allows the sharing of food,
shelter, experience, responsibilities and love.
• The FHA is a private, nonprofit organization under contract to, and vendored by
a regional center. FHAs are responsible for recruiting, training, approving and
monitoring family homes, as well as providing ongoing support to family homes.
Social service staff employed by the FHA make regular visits to the family home to
ensure that necessary services and supports are in place, and that the match
between the family and the new family member is viable, and continues to be
viable.
• FHA and family home services and supports are a new option which enables adults
with developmental disabilities to enter into partnerships with families that
promote self-determination and interdependence.

24. Intentional Community
• Family Investment Model
• Co-Op Housing
Modeled loosely on retirement villages or farmsteads that offer not just housing but
a community and programming aspect not available in individual apartments or
group homes.

25. Family Investment Model
• An intentional community is privately owned by
investors (private or non-profit), who may or may not
be parents and family members. In this model, the
investors pool their funds as an LLC to acquire or build
a multifamily property with the specific intention of
renting at least a portion of the units to adults with
developmental disabilities. The investors earn income
through rental payments which cover mortgage,
operations, and maintenance. The LLC does not
provide services or supports, which would need to
funded separately through the Regional Centers.

26. Co-Op Housing
• Co-ops are typically single-family homes
owned by a landlord, parents, or nonprofit
where 2 to 4 tenants with developmental
disabilities live in separate bedrooms but
share the living space. Co-ops are unlicensed.
Tenants typically rely on SLS or ILS support
funded by regional center and provided by a
vendor. Along with the safety and security of
the individual, the services are delivered to
assure the stability of this housing
arrangement.

27. Vendor Directories
• http://sarc.org/
– Click: About Us
– Click:Transparency &
Public Access Information
– Click: Vendors
– Click:
http://www.php.com/resources
San Andreas Regional Center
Parents Helping Parents

28. Further Questions to Consider
• The first and most important place to start when arranging housing is the
service coordinator at regional center. Having an open conversation with
the coordinator is vital. Share needs and wants. It is through creative
planning and open give-and-take dialogs that housing arranged for
individuals with developmental disabilities becomes a home for our family
members. If difficulties are encountered it may be a good idea to include
the coordinator’s managers. Keep in mind, for residential placement in
the community the guiding principle directing the services to be arranged
is the need to maintain the health and safety of the individual.
• Arranging housing is not easy, and decisions made today may often change
over time. Hopefully the definitions about residential services found in
this roadmap will help build the understanding and awareness needed to
ask the right questions and search for the best housing. It may be helpful
to get advice from other parents and providers, and organizations like
Parents Helping Parents, Area Board 7, the Office of Client’s Rights,
Housing Choices Coalition, and other members of the Disability
Collaborative.
Questions to Consider

29. Further Questions to Consider
• Who pays the rent, what’s the cost?
• What’s P & I money?
• What’s a license?
• What’s available?
• What about the high cost of housing?
• How to arrange a tour?
• How to find out about quality, safety, and
individual choice?
• What about health care needs and medical
emergencies?
• What about individuals rights and responsibility?
• How to find out about staff qualifications, wages,
and turnover?
• Who oversees and monitors the operation of the
home?
• What training opportunities are offered?
• What activities and social opportunities are
offered?
• What’s a typical day?
• What if I want to purchase or rent a home for my
child?
• How financially secure is the organization?
• What if the placement is not a good fit for the
person?
• What about behavioral support?
• What is the entry criteria for the residence or
program?
• What is the visiting policy?
• How is money handled?
• What are the home’s vision, mission, and beliefs?
• What are the policies and procedures toward: diet,
meals, pets, church, visits from family, friends, and
romances, personal belongings, privacy, smoking,
use of phone and internet, watching TV, going out,
group activities, choosing staff?
• What’s the best way to work with the staff and
management?
• How to work with regional center?
• How are complaints handled?
• What are the rules about discharge, and what is a
30 day notice?
• What if there are no services that are meeting the
needs of the person?
• Who can help in the decision making?
• What are the community activities arrangements?
• Anything else?
• When do I start to consider residential services?