Call it a clan, call it a network, call it a tribe, call it a family. Whatever you call it, whoever you are, you need one.
Jane Howard, “Families”

Shared living, in concept, is a way of life that has been in existence for many years. Everyone at some level can probably remember as a child when cousin “Billy” came to stay with them while his family was going through a difficult time, or when Nana after Grandpa’s death, was no longer able to live independently, so family members moved in together to help Nana be able to stay in her lifelong home. Today, a grandparent helping to raise their grandchildren is common place. Generally however, when we do things such as this we don’t take the time to name what we are doing (ie: shared living), we just do what needs to be done. The days of households consisting of a husband, wife, 2.5 kids and a dog are far and few between. Households, families, shared living arrangements, (whatever you want to call it) are full of diversity in size and structure, and are weaved together with many different threads that bond them tight.

About sixteen years ago, after many of years of successfully running the standard group home model of living for persons with disabilities, Matson Community Services (MCS) staff started to think there should be more individualized service options available for people. A new concept was starting to emerge at that same time. In true fashion of our service system that loves to label things, the term Shared living (viewed as this new revolutionary idea) was given to what we as a society had been doing for years. The neat part was that the focus was on persons with disabilities, with person centered planning as the foundation. While nobody gets rich being a home care provider, this model also allows for some “difficulty of care” compensation to help support the arrangement. We began providing this service model and we were very successful.

Today over 60 people throughout the North Central and Greater Worcester areas receive services under this model. In addition to the Department of Developmental Services (DDS) funding for homecare, the program has also grown to become a large Division of Medical Assistance (DMA) Adult Foster Care (AFC) component as well. With the introduction of the Enhanced Family Care program a few years back, MCS now can also help support family members who are caring for a loved one with a disability in their home both financially and clinically. The vision for the program is one of continuity of care. Matson and Arc Community Services are working towards the goal of one day being able to support persons through all stages of adult life: transitioning into adult services, adult services and geriatric services, all possibly while living in the same homecare situation. Many of the current shared living families have lived together for many years, so we are optimistic that this vision can come to fruition.

Successful ventures such as this are only as solid as the persons who are administering the program, the persons involved in the program (providers and consumers), and the processes that govern the program.

The persons who are running the show are Division and Operation Director(s), Support Mangers, Nurses, Social Workers and others. In homecare, because providers are contracted persons, not staff, all of the typical employment related rules do not apply. So if you’re ever sitting in a meeting with a Support Manager and they say “we don’t do that”, they probably don’t. And when they say they ask personal, private and confidential information from applicants (a major no in employment law), not only can they, but they are expected to do this. Operations Directors and those in a staff supervisor’s role have the special challenge of remembering both the employment rules when talking with staff and the contracted person rules when talking with providers. If this isn’t already confusing enough, shared living has multiple funding sources, each with its own set of regulations to remember and of which to be in compliance. Did I also mention yet that no one in shared living works a traditional work week? When some staff are calling it a day at 5PM, the shared living staff could be en route to provide intervention to a homecare placement in crisis. On any given Saturday night, you could meet up with a shared living staff supporting a provider and individual at the local emergency room. When a placement terminates unexpectedly or emergency respite needs to be coordinated, it is the staff’s responsibility to find alternate living situations for the consumer. If locating emergency placements was not hard enough, the staff must always be mindful of the governing agencies regulations with the new situation they coordinate. Another very important component of the shared living staff’s role is to continually be recruiting and qualifying persons to be home care providers.

Home care providers come from a vast variety of backgrounds and household structures. There is no one cookie cutter mold for a great provider (although there are many we would love to clone). A willingness to share their home freely, their life and their experiences with another is the key piece. Home care providers undergo a very intensive screening process prior to becoming listed as eligible to provide services for MCS. The qualification is very personal in nature but considering the role that they will be fulfilling, many feel that the intrusiveness is justifiable. Two very important parts of the process include that the home must meet the required environmental standards and that all household members must have an acceptable CORI review. The next step after a provider is qualified is the matching process. On some occasions, providers will be contacted very quickly to meet a consumer; however, sometimes if there is not a good match, this process can take a while. Once a match is determined and all of the many steps involved have been coordinated, MCS and Homecare providers enter into contracts where all expectations of both sides are clearly outlined.

“Much more grows in the garden than that which is planted there”.
Japanese Proverb

One of the most fantastic things about homecare is that it thrives on building upon the uniqueness of everyone involved. For many of the staff, the ability to work in a non- traditionally structured program that is ever evolving is the draw for them. For many of the home care providers, it is the ability to be an independent contractor working from home in a career where the can feel like they are making a difference that keeps them committed. Whatever the motivator, it is apparent that Shared Living/Home Based Supports (in many different forms) will be around for a very long time.

P.S. MCS is always recruiting for homecare providers, so if you think you might be interested, give a call over to the Cascade St. (978-345-6301)office and we would be thrilled to tell you more about the process.

FOR EVERYONE:

• The individual has to qualify for the program clinically and financially.

• They can not have more than 3 hours of unsupervised time.

• The care provider can not be the guardian

• Financially: they must have mass health

• Clinically: they must go through an approval process

TO BE ON LEVEL ONE:

• Physicians order for AFC

• Medical or mental condition that requires daily physical assistance or cueing and supervision during the task in order for the person to complete successfully at least one of the following activities:

  1. Bathing (full body bath or shower)

  2. Dressing, including street clothes and undergarments but not solely help with shoes, socks, buttons, snaps, or zippers;

  3. Toileting, if the person is incontinent (bladder or bowel) or requires scheduled assistance or routine catheter or colostomy care;

  4. Transferring, if the person must be assisted or lifted to another position.

  5. Ambulating, if the person must be physically steadied, assisted, or guided one to one in ambulation, or is unable to self propel a wheelchair appropriately without the assistance of another person;

  6. Eating, if the person requires constant supervision and cueing during the entire meal, or physical assistance with a portion of the meal.

TO BE ON LEVEL TWO:

In addition to meeting eligibility for level one, the person must also:

• Require PHYSICAL assistance with THREE of the activities described above

OR

• Require PHYSICAL assistance with TWO of the activities described above and management of behaviors that require caregiver intervention such as: wandering, verbally abusive symptoms, physically abusive behavioral symptoms, socially inappropriate or disruptive behaviors or resisting care.

If you know someone that meets either of the above criteria you should contact MCS to find out more about the benefits of being on this program.

978-345-6301