Lack of accessible, affordable, and safe housing is a major transition barrier. Waiting lists for both services and rental assistance present a major coordination challenge. Individuals may receive a rental assistance voucher after waiting a year but be unable to use it because a waiver slot is not yet available. Only those individuals with informal support may have the option of transitioning and then waiting for waiver services. In some cases, individuals may remain in nursing facilities solely because there are no other housing alternatives.
Housing requirements differ, depending on individual needs. States have been working with their regional and local housing authorities with varying degrees of success to come up with creative solutions to housing problems. Stronger partnerships between health/long-term care and housing authorities at both the state and Federal levels are often cited as the most important need in the search for comprehensive approaches to maintaining people in the community.
Successfully addressing housing issues often requires considerable time and effort. The services of a dedicated housing coordinator are invaluable in helping nursing facility residents find suitable housing. This individual can also work at the policy level to increase awareness of the need for housing for persons relocating and to address the need for affordable, accessible housing for all persons with disabilities.
If dedicated staff are not feasible, one way of finding affordable, accessible housing is to call housing unit managers and developers to let them know of unmet need and to impress on them the importance of notifying transition counselors of available units. Once potential housing has been identified, it is beneficial to have nursing home residents visit the prospective residence or apartment in order to identify any potential problems or barriers in advance--for example, a physical layout that does not accommodate their needs.
Some states are using Housing and Urban Development (HUD) Section 8 rental vouchers for individuals who are transitioning to help them secure affordable, accessible housing. Housing authorities in some Maryland counties changed their priority criteria on housing voucher set-asides to allow persons in a nursing facility who are on the housing voucher list to move to the top of the list when they become eligible for waiver services. Similarly, the Spokane Housing Authority in Washington State has designated individuals leaving nursing facilities as homeless, enabling them to bypass a 2-year waiting list for rental assistance vouchers. An Independent Living Center in Spokane now has an ongoing process for assisting nursing facility residents with housing voucher applications. Waiver transition funds or state general funds pay for this service.33 Other states have created rental assistance programs for individuals seeking diversion or transition from nursing facilities, such as Arkansass Bridge Rental Assistance Program, which bridges the gap between income and the cost of affordable apartments for persons transitioning or being diverted from nursing homes.34
Arkansass Bridge Rental Assistance Program
The Arkansas Supported Housing Office and the Governors Task Force on Supported Housing recommended the creation of a rental assistance program for individuals who are being diverted or are transitioning from nursing homes. Under the States Nursing Facility grant initiatives, Spa Area Independent Living Services, the Arkansas Development Finance Authority, and Arkansas Rehabilitation Services developed and implemented the Bridge Rental Assistance Program. Individuals who apply for Section 8 vouchers and are on a waiting list are provided a monthly rental stipend for up to 2 years, while case managers work with them to create and execute a plan for housing self-sufficiency. The Bridge Rental Assistance Program is being sustained through funding from the Arkansas Development Finance Authority.35
Assessments for Accessibility
Environmental modifications are often crucial to a states ability to serve an individual in the community. Federal financial participation may be available for the costs of assessing accessibility and the need for modifications in a persons home or vehicle in three ways. First, FFP may be claimed at the administrative rate for assessments to determine whether the persons home or vehicle requires modifications to safeguard the health and welfare of an HCBS waiver participant. (Assessment costs incurred to determine whether an individuals needs can be met under an HCBS waiver may qualify for FFP regardless of whether or not the person is eventually served under the waiver.)
Second, the cost of environmental assessment may be included in the cost of environmental modifications under an HCBS waiver. Third, the assessment may be performed by another service provider, such as a home health agency or an occupational therapist; if so, FFP is available at the service match rate for these providers when they perform the assessment in addition to their other duties. (See the Resource section of this chapter for the link to the State Medicaid Director letter regarding payment of assessments for accessibility and environmental modifications.)