Group Homes, Supported Living, and ICF/IID: Understanding and Visiting Residential Options

One of the hardest decisions any lifelong caregiver faces is where their adult child will live when home with a parent is no longer possible. For most of the 20th century, the only option for adults with significant disabilities was a state-run institution, often called a developmental center. Beginning in the 1970s, a slow national shift moved most residents into smaller community settings. Today, the residential options vary enormously by state, and the words used to describe them are not consistent. This guide walks through the four main types you are most likely to encounter, what each one feels like, and how to actually visit one.

A group home is the most common residential setting in most states. It is a regular house in a regular neighborhood, with two to six adults living together and direct support professionals on staff around the clock. Group homes are usually operated by nonprofit provider agencies under contract with the state Medicaid waiver program. Quality varies. The best group homes are warm, stable, and genuinely homelike. The worst feel institutional even though they sit on a residential street. The difference is usually staff turnover, supervision, and how the agency is run.

Supported living, sometimes called supported independent living or SIL, is a model where one or two adults live in an apartment or small house and direct support professionals come in for the hours of help that person needs. The person may live alone or with one roommate, and the staff support is built around the individual rather than the household. Supported living often works well for people with moderate needs and strong daily-living skills. And it is generally seen as the most person-centered residential option. It can be harder to access in states with limited supported living funding. And it costs more per person than group home placement.

ICF/IID stands for Intermediate Care Facility for Individuals with Intellectual Disabilities. This is a federally regulated residential model with higher staff ratios and medical oversight than a typical group home. ICF/IIDs may have 6 to 15 or more residents, depending on the state. They are funded directly by Medicaid (not the HCBS waiver) and they have detailed federal requirements about programming, medical care, and active treatment plans. Some families value the medical oversight. Others find the structure too clinical. ICF/IID is more common in states like Texas, Ohio, and Louisiana, and less common in states that moved aggressively toward smaller community settings.

Host family or shared living arrangements are a fourth option that exists in some states. Your adult child lives in the home of a family or single person who is paid by the state to provide live-in support. When this works, it can be extraordinary. The relationship resembles a family. When it does not work, the lack of oversight can be a serious problem, so the matching process and ongoing monitoring matter a great deal.

Whichever model you consider, the most important thing you can do is visit. Pictures lie. Brochures lie. The only honest information comes from spending time in the actual building, talking with actual residents, watching how staff interact during a normal afternoon. This guide walks you through the visiting process.

(Sources: The Arc — Residential Options Guide at futureplanning.thearc.org; Centers for Medicare and Medicaid Services — ICF/IID program description; Self Advocacy Resource and Technical Help Center (SARTAC) at selfadvocacyinfo.org)