Last week we met the crew at 3801. It is a wonderful place with four apartments and nine amazing people who call it home. But what you might not know is that 3801 is an ICF.
What is an ICF? Technically 3801 is an ICF/IDD, which stands for Intermediate Care Facility for Intellectuals with Developmental Disabilities. When first established the goals for these types of settings were to help people transition from institutions to independent living. Eventually the Olmstead Act, a landmark United States Supreme Court decision ruling that requires states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs, defined apartments like 3801 as institutions. For that reason, we no longer open ICFs but can continue to serve people there. Regardless of licensing type, at 3801 they do a beautiful job of making the apartment complex feel like individual homes, and it is unique in the disability community when it comes to housing because of the individual apartments.
To fully understand the purpose of an ICF, you have to go back decades. Prior to the 1970s people with disabilities were housed in very large state Hospitals or Institutions, often with 1500 people or more. To really get a picture of what that looked like in Minnesota, back in the day there were 21 institutions throughout the years that housed that many inside their walls. Institutions were kind of what you would expect, smaller staff ratios, less opportunity for community integration, and isolation either to the spot where they lived or the facility itself. Residents ate with dozens of people, bedrooms were shared by 2-6 people, and bathrooms were large and communal. There was little privacy, limited exposure to culture, minimal staff, and less opportunities to gather and enjoy the cities where they lived. Someone who lived in a large institution often never left the grounds or may never have visited the town where the campus was located.
Of course, the workers did what they could, but with that many people it was virtually impossible for one-on-one attention. Which is why the eventual push was for ICF facilities where people could live in places with 6-100 people. While 100 may seem like a lot, compared to 1,500, it is obvious there was more room for quality attention at an ICF versus blending in with the masses at an institution. Basically, ICFs were created to bring about opportunities to live in community which at the time meant anything other than an institution—somewhere people served could hold a job, be a part of church and businesses, and attend local activities. It was all about community. It was also a numbers game, giving people the chance to thrive in a more home like environment, adding more opportunities to help enrich their lives.
Things started to shift twenty years ago when waivers were introduced. The fundamental difference between an ICF and a waiver is that a waiver is not a type of home, it is funding. ICFs get a check for the same amount every day per person. Money follows the facility. A waiver follows the person. They can go purchase services with the waiver which is customized per person and based on level of need. Individuals were given purchasing power, and no two waivers pay the absolute same. Waivers are evaluated on an annual basis and offer more control to the person served and their family or guardians.
Living Well has 21 waiver homes with 4-6 people, and 16 ICFs, with 6-9 people. When Victoria Rd. closed a few weeks ago it had 12 people and we split them into three waiver homes, as the plan has always been to downsize the larger homes.
For reference there are 114 ICF homes left in Minnesota, and thousands of waivers in use in Minnesota. And because it wasn’t confusing enough already, Living Well is unique in the state as we are one of the largest nonprofit ICF providers in Minnesota. We also had legislation passed that allows us to serve more than 4 people in a few of our waiver homes, because it was not cost effective at the time to close the places entirely. We are the only organization to have legislation allowing a few waiver homes to have six people, and with that we have six, six bed waivers. We also have two waiver homes that are owned by families, who then contract with us to provide services. Living Well owns our other homes, which is also fairly unique as many smaller organizations have to rent as they cannot afford to purchase and renovate homes in the current market.
Most people will never need to know the difference between the housing offered at a waiver home or ICF facility. But we feel it is important information as it helps shine a light on the history of disability care, the need to occasionally change course, and the importance of caring for others in smaller more intimate spaces.
A general concern in disability services, and ICFs in general, is that there isn’t an innate understanding in society of the people we serve. The staff at 3801, its sister building 3807, and the 14 other ICFs in our lineup, know that if we are to be successful, we need to help them transition and blend into community seamlessly. We are beyond lucky to have staff that have been with us for decades and have seen the changes in the arc of care both in the facilities and the services.