Service name and California service codes as per rate model

Independent Living Services (520)

Conceptual Definition of Independent Living Services

Independent Living Services (ILS) provide functional skills training and assistance to adults with intellectual and/or developmental disabilities to:

• Become more independent if they are living with others (for example, with family)
• Achieve living independently in their own home or apartment (on their own or with roommates).
• Maintain their independent living skills and provide ongoing assistance so that they can stay living independently in their home in the community.
• Access all available natural supports and generic resources.

Other relevant terminology and definitions or models described in official documentation.

Independent living services are also currently available through participant directed services. The conceptual and operational definitions of ILS will also apply.

Participant-directed ILS (457). This option was added to the list of services that could be made available via Participant Directed Services model during the COVID pandemic. These are now written into the CA HCBS Waiver. Individuals must use a Financial Management System (FMS) to hire and pay staff. Individuals must also take on the legal responsibilities associated with being an employer. Individuals can hire a family member, friend, or other qualified person to provide ILS.

The conceptual and operational definitions of ILS will also apply to those who are vendorized as an Independent Living Specialist (635).

Eligibility and limitations in California

Who is eligible?

• Adults with developmental disabilities (age 18 and older or once they are no longer receiving services from their local education agency)

Living situation

• ILS can be provided to a person living in their own home or the family home.
• ILS Cannot be provided to people living in a licensed home except where:

o ILS is to prepare someone to move out to live more independently.

o ILS is used as a short-term solution, as identified in the IPP process, in response to exceptional issues identified in the service provided by a licensed home.

Intensity and duration of support

• Number of hours and length of program are assessed and agreed as part of the IPP process. By law, there is no maximum length of time for which an individual can receive ILS if the individual and their Interdisciplinary Team agree that the individual continues to need and to benefit from the service.
• Even after the skills initially identified in the IPP have been achieved, people can continue to be provided support to maintain the skills they need to remain living independently. More support can be provided if people’s needs change and as new skills are needed to remain living independently, for example as people age or develop a health condition that needs management.

Other conditions

• Generic services (IHSS and Department of Rehabilitation programs) and natural supports must be maximized before Regional Center can provide funding for ILS.

Type of support provided

Independent Living Skills regulations state that ILS will include functional training, as needed, in the following areas:

(A) Cooking.

(B) Cleaning.

(C) Shopping in natural environments.

(D) Menu planning.

(E) Meal preparation.

(F) Money management, including check cashing and purchasing activities.

(G) Use of public transportation in natural environments.

(H) Personal health and hygiene.

(I) Self-advocacy training.

(J) Independent recreation and participation in natural environments.

(K) Use of medical and dental services, and other community resources.

(L) Community resource awareness, such as police, fire, or emergency help.

(M) Home and community safety.

ILS may provide other supports necessary, beyond those listed in A to M, for a person to maintain a self-sustaining, independent living situation in the community.

Examples of other support that can be provided by ILS include, but are not limited to:

• Coordinating access to public benefits for the person they serve.
• Assessment of functional skills
• Support finding a home in the community and/or a roommate.
• Support to move home.
• Support to access counseling services, including psychological and psychotherapeutic.
• Access to rehabilitation/assistive technology and the development of sensory or motor skills that impact on functional skills.
• Support to hire and train personal assistants or other support professionals.
• Support for community participation and inclusion – to interact with people without disabilities who are not paid caregivers.
• Support for decision-making.
• Support to learn how to look after a pet.

Support to learn or access parenting skills.

In addition to learning NEW skills, ILS can provide support for people to MAINTAIN existing skills in all these areas to ensure living independently in the community can be sustained.

ILS is typically provided on a one-to-one basis. However, it is possible for ILS to be provided in small groups 1:2 or 1:3.

ILS CANNOT:

• include overnight support.
• include on-call support.
• provide personal assistance/direct support with personal care.
• serve as a transportation service, except in exceptional situations as agreed in the individual’s IPP.
• provide support in the workplace (but can support people to develop the skills they need to get a job and to get to work (on time, appropriately dressed, etc).
• advocate or provide representation for an individual for services such as social security (but can and should assist the person to access the appropriate agency or individual who can advocate for them should this be needed).
• be used to teach skills that require a specific certification or curriculum (e.g. drivers education, parent training, etc). 

Funding source in California

• Regional Center

Can be combined with public benefits such as Medi-Cal, In-Home Supportive Services (IHSS), housing subsidies, Personal Assistance. Can be combined with Supported Employment and other employment-related benefits.

How to access Supported Living Services

1. A person (or their chosen representative) expresses an interest in living independently or becoming more independent where they live. They request an IPP meeting.

2. Service Coordinator/Case Manager, in conjunction with the individual and their circle of support, considers all potential options for the individual and identifies the most appropriate and cost-effective way to meet the individual’s needs.

3. If agreed that ILS is the best option, the Service Coordinator/Case Manager requests an ILS assessment and proposed Individual Service Plan (ISP) from a potential vendor.

4. Once they have this assessment, the Service Coordinator/Case Manager reviews this and a decision about the hours needed to meet the goals and overcome the barriers identified by the assessment and in the ISP is made by the planning team/Circle of Support.

5. A Purchase of Service (POS) is then created by the Service Coordinator/Case Manager and a provider engaged to provide the agreed service.

Other terms/names associated with this service type

Independent Living Skills Services.

Independent Living Program.

ILS falls under Habilitation - Day Service in the CMS Waiver categories.

Vendor requirements

Vendor requirements (including required staff training and qualifications) are set out in: California Code of Regulations. Title 17, , Chapter 3, subchapter 2 – vendorization and in Chapter 3 Subchapter 5 Article 2 Standards for all community-based day programs.

Key characteristic/Principle

Description of principle/characteristic

Expectations and evidence that a service is providing independent living – what should you see?

Increase or maintain Independence

ILS services support individuals to:

• Live on their own or with people they choose
• Gain the self-help skills they need to do as much as possible for themselves at home and in the community.
• Gain the skills and support they need to access and make the most of the paid and natural supports available to them.

People would be living, or working towards living, on their own or with people they choose – this might include their spouse or partner or their children, for example. It might include a roommate or two to help cover the cost of housing and bills. The support they are receiving might include (but is not limited to):

• Support to search and apply for housing that is appropriate, affordable and adequate for their needs.
• Support to understand their rental agreement and what is expected of them.
• Support to arrange any adaptations needed to the home.
• Support to set up utilities and pay bills.
• Support to find roommates, if needed.
• Support to negotiate “house rules” and build relationships between the individual and the people they live with.

People would be receiving training and ongoing support to enable them to do as much as possible for themselves at home and in the community. This would include training and the use of mobility and assistive technology and environmental supports in one or more of the following areas:

• Personal health and hygiene.
• Looking after their belongings, home and garden.
• Menu planning and meal preparation including cooking.
• Shopping.
• Home and community safety – including using public transportation.
• Managing finances and accessing and understanding benefits.
• What to do in an emergency.
• Support to use computer, search engines and other technology. 
• Support to access educational opportunities and opportunities to build job skills and work experience.

  People may also be receiving support from other services such as personal assistant or in-home support services to help them do the things they cannot physically do so they can remain in their home. ILS services would be providing individuals with the skills and support they need to make the most of both paid and natural supports available to them. This might include:

  • training on how to manage or work with personal assistants, support to train their personal assistants, support to communicate with provider agencies, regional center, case managers, etc.
  • Connecting people and supporting communication with volunteer organizations, family members and others who can provide support for shared interests and activities without the need for formal supports

1 https://www.medicaid.gov/sites/default/files/2019-12/requirements-for-home-and-community-settings.pdf 

2 https://publications.ici.umn.edu/rtcom/briefs/brief-three-development-of-hcbs-outcome-measures

Goal and commitment driven

• Individual has a goal to live independently or to become more independent where they are currently living.
• Individuals agree to receive training and work towards the goal.

Individuals have a goal of living independently in their Individual Program Plan (IPP).

• In order to receive ILS services, individuals have to express a desire to live independently or to become more independent if living with parents, another family member or another person, which will be set out in their IPP.
• Individuals agree to participate in training sessions and work with their ILS instructor to make progress towards this goal.

Choice, control and informed decision-making

ILS services:

• Enable people to be in control as much as possible; involved in decisions about all aspects of their lives.
• Support people to gain the skills to speak out for themselves
• Advocate on behalf of individuals in certain situations.

People receiving ILS are in control of their own lives

• Individuals are supported to decide how they spend their time and how they wish to live their lives. When choice over what the person does is not possible, then they are supported to have control over how, when and where things are done.

• They are supported to understand both their rights and responsibilities as a member of society.

• Individuals are supported in a way that meets their needs and preferences at all times – including when they receive ILS support. Finding a way that works best for the individual to learn and generalize skills is a key element of ILS.

Individuals receiving ILS services will be receiving support to make informed decisions:

• People are learning how to find out information to help them make the decisions they need to make. When necessary, they are receiving support to find the information they need. Decisions might be in any life domain – work, education, living situation, relationships, leisure, etc.

• They will have this information presented to them in the language they understand best and using their preferred form of communication.

• Support will be provided for decision-making in a way that is unbiased and without prejudice.

• Where possible, they will be provided with opportunities and support to have direct experience of options available for informed decision making

Individuals are supported to advocate for themselves as much as possible.

• Individuals are receiving training and support in self-advocacy and when communicating with people who support them, organizations and agencies in the community.

• Where needed, ILS professionals may also be advocating for the individual or will be referring them to clients rights advocates.

Social inclusion and relationships

ILS services:

• Provide support in the community (not in a center).

• Assist individuals to gain the skills and support they need to independently access and use community facilities and activities.

• Support people to build and maintain 

safe and positive relationships.

• Work with people positively and respectfully.

Community-based – not center-based.

• Individuals are learning skills in the natural environments where such skills would be used - this promotes generalization and maintenance.
• Individuals are receiving training and support to find, access and make use of community facilities and activities as independently as possible. This might include:

o Medical and dental services,

o Shops, banks, post office, and other community facilities,

o Sports, leisure and recreation facilities and activities,

o Cultural, religious or identity-based activities and events.

• Where needed, individuals are receiving support and training related to using public transportation, navigating in their community and staying safe while in the community.
• Individuals are receiving training and support to communicate with those they meet in the community, as needed.
• Individuals are, if needed, receiving support and training related to attending social events and meeting new people, building friendships and having intimate and personal relationships.
• Individuals who have children are receiving training and support to care for their child(ren), as needed.
• Individuals are supported to learn about and access other services relevant to health, sexual health, family planning, and relationship counseling, if needed.
• Individuals are receiving training and support in a way that is positive, respectful and dignified.

Self-sustaining and tailored 

ILS services:

• aim to provide enough training and support so that individuals can continue to independently live safely and successfully without substantial outside assistance.

• Respond to the changing needs of the individual if they still wish to remain living independently.

• Support people to remain as independent as possible over time.

Long-term and responsive

• People can receive the support they need to achieve sustainable independent living – if they are making some progress towards their goal(s).

• If people’s needs change, ILS services will be supporting them to access different or more support as required to help them remain living independently.

• If people are experiencing deterioration in skills, ILS services will be helping them maintain their ability to live independently for as long as possible.

Living within resources available

• People are receiving support to identify, access or build natural supports in the community for areas they may need support.

• People are receiving support to access all relevant benefits and funding sources to ensure they can afford to live independently.

• People are receiving support to move house to be closer to a job, to have better access to transport and public services, to improve their health, to reduce their rent etc.

• People are receiving training and support to manage their finances, budget their spending, and make informed decisions about purchases.

Having a good life

• People are not simply coping or surviving on their own – the aim of ILS services is to ensure that people can live their best lives while living independently. To be self-sustaining, an independent living situation needs to ensure that people are safe, healthy, successful and productive.