Thinking about operating an adult care home for people with intellectual or developmental disabilities (I/DD)? Review the following questions and answers for the most complete information.
AFTER reviewing the information, contact staff listed at the bottom with your questions.
- Multnomah County Adult Care Home Program (ACHP) licenses adult care homes for individuals with intellectual/developmental disabilities (I/DD), and enforces the rules.
- Multnomah County Administrative Rules (MCARs) for adult care homes govern the licensing and operation of adult care homes in Multnomah County, including licensed DD adult care homes.
- Multnomah County is an exempt county as determined by the State Department of Human Resources, Seniors and People with Disabilities Division (SPD). An exempt county provides licensing and inspection of adult care homes that is equal to or exceeds requirements of state administrative rules.
- Beginning in 2015, ACHP’s training curriculum and testing requirement for new licensed DD providers and their home caregivers is different from the training and testing for other adult care home providers licensed in Multnomah County.
- Enjoy the opportunity to share your family’s skills and strengths;
- Stay active with your residents as you enjoy community social events and activities together;
- Receive excellent support, training, and resources through Multnomah County Developmental Disabilities Services Division
- Delight in sincere, friendly companionship, and meeting a person’s need for acceptance and belonging;
- Recharge while many residents go to work or spend time in the community through a structured program.
Developmental Disabilities (or “DD”) are:
- Conditions people are born with or obtain prior to age 22, such as cerebral palsy, autism, Aspergers, fetal alcohol syndrome, acquired brain injury, Down Syndrome, or epilepsy, and
- Considered to be lifelong and cause significant delays in at least 2 areas of everyday functioning, such as communicating, grooming, dressing, safety and social skills, and
- Diagnosed by a qualified doctor.
Intellectual Disabilities (or “ID”) are:
- Conditions that in the past may have been described as “mental retardation,”
- Present when people have significantly below average intellectual and adaptive skills, as measured by a standardized test administered by a qualified psychologist, and
- Diagnosed for people with consistent IQ results of 75 or below with significant impairment in adaptive behavior, and
- When the onset of the impairment occurs prior to age 18, and
- Diagnosed only when considered to be lifelong.
Adults with I/DD . . .
- Much like everyone else, have a basic desire for friendship, social interaction, leisure activities, and satisfying work!
- Differ individually in their varying levels and types of supports needed to perform daily living activities, handle money, read, express emotions, communicate their choices, and interact with the world;
- All must be determined eligible for services through a county developmental disabilities program (CDDP) to be placed in your home;
- All have a County DD Case Manager or Support Services Brokerage Agent and an Individual Support Plan (ISP) Team.
What kinds of situations are adults with I/DD living in BEFORE they are referred to DD Licensed Adult Care Homes?
- Their own homes with in-home supports that no longer meet their needs or preferences;
- Homes they share with parents or other family members, where the living arrangement no longer is safe or feasible, OR the adult simply chooses to make a change;
- Another adult foster care home or DD group home, from which a change is needed or wanted;
- A nursing home, drug & alcohol rehabilitative facility, or medical or psychiatric hospitalization;
- Homeless shelters or homeless with no safe place to stay;
- County jail or state corrections facility;
- Ready to move from a higher level of care at the State Crisis and Stabilization Unit for adults with I/DD to a less intensive home setting;
- From Multnomah County or another location in the state of Oregon
Placement Specialists look for . . .
- Friendly and responsible supervision consistent with the person’s Individualized Support Plan (ISP);
- Physical and emotional acceptance into a household or family;
- Caring encouragement and support to performing daily tasks, such as personal hygiene, toileting, eating healthy meals, and other Activities of Daily Living (ADL’s);
- Support in increasing their own abilities to safely live more independently in the home and community;
- Managing behavior and emotions in positive ways;
- Support to minimize risk of harm to themselves or others due to challenging behaviors or limitations in cognition;
- Assistance preparing for employment or structured day activities;
- Help in managing personal spending money;
- Implementing medical, behavioral, and mental health support plans;
- Coordinating and accompanying residents to medical and mental health appointments;
- Managing and administering medication;
- Facilitating active lifestyles, social/recreational activities in the home and the community;
- Assisting residents to communicate their preferences, needs, and ideas to others, and to understand those kinds of communication from other people;
- Sometimes, special assistance to achieve stability during a crisis or major transition in their lives, and help to assess next steps in their long term support plan;
- Accommodations for pets or service animals
- Implement closer levels of supervision in some or all situations for some residents, such as “one-to-one exclusive-focus” (which usually means being within visual AND hearing distance), within visual OR hearing distance, or within arm’s length;
- Acknowledge the team’s need to balance the interest of each resident’s safety with the dignity of risk, to allow some residents to be unaccompanied in the community for specified periods of time;
- Participate fully in Individualized Support Plan (ISP) team meetings and Support Needs Assessment Profiles (SNAP);
- Document and communicate in a timely manner with DD Program Case Managers or Brokerage Personal Agents, nurses, behavior support specialists, and other team members about resident needs, supports, critical events, and patterns of behavior;
- Facilitate phone calls, emails, and visits with family members, friends, and other service providers, reflecting the resident’s preferences, with their permission;
- Navigate conflict among residents or between residents and other individuals in their lives;
- Implement formal positive behavior support plans and track behavior incident data for behavior consultants, when residents need this type of support;
- Comply with Standards & Procedures set by Office of Developmental Disabilities Services (ODDS) in order to be paid for services.
- The ISP Team utilizes the ISP Process to develop and update a written ISP;
- The Adult Care Home provider implements the written ISP
The ISP Team is composed of:
- The adult receiving services;
- Representatives of all the adult’s current service providers;
- The adult’s DD case manager;
- The adult's legal guardian and/or advocate, if any;
- Any others determined appropriate by the adult receiving services
The ISP process is designed to:
- Reflect the Support Needs Assessment Profile (SNAP);
- Identify types of services and supports necessary;
- Identify the barriers to providing those preferred services;
- Develop strategies for reducing the barriers;
- Identify strategies to assist the adult in exercising his or her rights
Payments are made in 3 ways:
Room & Board Payment
- $570/month in 2015
- Paid from personal funds of each individual or his/her representative payee.
- Source is usually SSI or SSDI, and very rarely, private funds
- Amount established by federal government to pay for 3 nutritious meals and snacks/day, sleeping quarters, laundry and basic services such as heat, phone (land line), & water
- NOT paid for “Relief Care” Placements
- For care and support provided to residents;
- Calculated as a monthly rate;
- Paid by State of Oregon for long term placements; “long term” usually means “longer than 2 weeks”;
- Vary widely: as low as $849, but higher when individuals require a higher amount of caregiver support during the day or night, or one-to-one “exclusive focus” supervision;
- Higher Service Payment = more complex supports and/or more time in caregiver support;
- Determined by a standardized State of Oregon resident needs assessment tool: Support Needs and Assessment Profile (“SNAP”);
- SNAP is facilitated by a qualified staff member from the Multnomah County DD Services Division or the Region 1 Crisis Diversion Program ;
- Information about the individual’s support needs is collected for the SNAP from a team of people who best know the individual;
- Service Payment amounts and required supports are shared with adult care home providers BEFORE providers are asked to accept an individual as a resident in their home;
- For some situations, a portion of a Service Payment is paid by the resident; (this is called “Client Offset”); “Client Offset” amount is determined by the State.
Relief Care Payments
- For short term care and support provided in the absence of the regular caregiver;
- Calculated as a daily rate for a 24-hour placement;
- Services expected to be only for 14 days or fewer;
- Supports determined by the ISP (Individualized Support Plan);
- Rates established by the State of Oregon ODDS (in 2015, $232.25 per day);
- Residents do not pay Room & Board or Client Offset to the adult care home;
- Payments are authorized and paid by DD Brokerages or County DD Programs.
Strongly suggested (but not required) that BEFORE you decide WHICH kind of adult care home license you want to pursue, contact:
Mehdi Karim, DD Adult Foster Home Program Specialist,
Multnomah County Developmental Disabilities (DDSD) Program
- To discuss whether Developmental Disabilities Services is the right match for you. Compare your skills and experience with what is currently needed by adults with I/DD and what Placement Specialists look for.
- Make contact with Multnomah County DDSD early in the licensing process! This is crucial in helping you decide whether you and your home can offer what is truly needed for supporting adults with I/DD.
- Substantial experience in professional adult residential or foster home settings, focused on supporting people with I/DD and behavior support challenges, is the greatest need.
- When you start the licensing process with the Adult Care Home Program, have a clear goal regarding the population focus you want for your home.
Additionally, for information about the Region 1 DD Crisis Provider Network, contact:
- Prospective adult care home providers with at LEAST the equivalent of 1 year of full time experience in professional care giving for individuals with I/DD, who meet all other ACHP licensing requirements, BUT do NOT meet the minimum qualifications for the Region 1 Adult Crisis Foster Network, may still qualify for a DD Adult Care Home license.
- Network members are licensed DD adult foster care homes in area served by the Region 1 Crisis Diversion Program, a collaborative partnership of County DD Programs (CDDPs) in Multnomah, Clackamas, Clatsop, Columbia, & Washington counties;
- Each Crisis Provider Network home reserves 1 vacancy exclusively for placement referral by the Region 1 Crisis Diversion Office for adults with I/DD who are in crisis or transition;
- Region 1 Crisis Diversion Office frequently facilitates short term, "relief care" and longer term placements for individuals supported by the 5 Region 1 County DD Programs and 7 Support Services Brokerages into Region 1 Crisis Provider Network homes;
- Region 1 Crisis Provider Network homes may be utilized by other Oregon Regions, when an adult’s preferences or needs cannot be met among care homes in those counties;
- Sometimes, an individual may move in to a “Crisis Network Vacancy,” then later, by agreement among of the adult’s ISP team and Multnomah County DD, the adult may remain in that same home long term – IF there is an available long term vacancy.
- Crisis Network providers and Crisis Network candidates receive access to wide variety of affordable training in best practices for quality care & support;
- Strategic personalized coaching in budget projection, staff retention, home siting, and environmental modification, during licensing process and after, provided by Region 1 Crisis Network;
- Professional technical assistance in placement practices, person-centered services, resident skill enhancement, and positive behavior support strategies provided by Region 1’s staff of Placement & Behavior Support Specialists.
- Positive peer support enjoyed by Crisis Provider Network colleagues.
Qualifications for Region 1 Crisis Provider Network Membership — “The 3/3/3s” (updated Feb. 1, 2015)
Qualifications exceed what is required simply to obtain a DD adult care home license.
Qualifications are driven by the challenges of adults who need the support of specialized adult foster homes with enhanced skills, experience, and knowledge.
- Be a DD-licensed Adult Foster Care Home in good standing.
- Licensed Operator (and, if applicable, Resident Manager) has 3 years of verifiable fulltime progressively responsible direct care and mid-management level work experience in I/DD focused adult residential services, such as Supported Living, Group Homes, or DD Adult Foster Care Homes, AND most of that experience supporting minimum of 3 people with any of the 3 following support needs:
- Intense physically or sexually aggressive or potentially dangerous behaviors with comprehensive Behavior Support Plans;
- Autism spectrum disorders and structured environmental supports;
- Dual diagnosis (psychiatric or mental illness and I/DD).
- RN operated DD-Adult Care Home that includes all the following:
- A live-in RN in a fully wheelchair accessible home;
- Operator (and, if applicable, Resident Manager) with 2+ years of verifiable full time work experience supporting a minimum of 3 different people with I/DD;
- Staff with skills implementing Nursing Care Plans and delegated nursing tasks.
Region 1 Crisis Network Providers and staff must maintain certification in the Oregon Intervention System (OIS) and agree to access other training specific to each home’s particular care focus, after licensed and ongoing;
Region 1 Crisis Network Providers must demonstrate proficiency in the DD Core Competencies
- Offer a good match in your home and skills with the prevalent needs of people with I/DD
- The more practical experience in I/DD focused residential settings, and training you have, the more success you’ll have in attracting referrals of individual residents into your home.
- The more day-to-day experience, training, and success you can demonstrate in supporting people with complex and challenging behavioral or medical needs, as described in the “3/3/3 Qualification” for the Region 1 Crisis Provider Network, the more likely you are to be successful in attracting referrals and maintaining stable residents.
- It is often wiser to wait to open a licensed DD adult care home until you obtain additional work experience, specialized skills, and training.
To explore a DD Adult Care Home license WITHOUT meeting Region 1 Crisis Provider Network minimum qualifications, you may contact
Mehdi Karim is not a licensor, but can provide reliable information about needs of clients with I/DD in adult care home settings. Prospective providers still must follow all ACHP licensing requirements, training, and testing.
- Licensed DD adult care homes send an email to DDSD Program Specialist, briefly describing the home, services available, and interests in supporting residents;
- The DDSD Program Specialist will send a Vacancy Profile Form by email. Licensed adult care home providers complete the form thoroughly and send back to the DDSD Program Specialist.
- Licensed DD Providers who believe they may meet the Region 1 Crisis Provider Network qualifications may also email a request for screening to email@example.com, briefly describing the home, services available, and interests in supporting residents in crisis and transition.
- Staff of Multnomah County DD Services Division or Region 1 Crisis Diversion Office contact providers by phone or email if there is a potential match between the needs of an individual and the specific skills and environment in the home’s Vacancy Profile;
- A “Referral Packet” containing details of the individual’s personal support needs and history is sent to the provider by secure email or fax; Service Payment or Relief Care Rate information is included;
- Adult Care Home Providers screens the Referral Packet completes the ACHP screening form to determine whether the individual MAY BE an appropriate match for their home and license, then, replies to the Multnomah County DD or Region 1 placement staff;
- County DDSD Case Manager or a Brokerage Personal Agent facilitates a personal visit between the provider and the adult referred;
- If the provider, the referred individual and their ISP team agree, the individual plans to move into the adult care home;
- County DDSD Case Manager or Brokerage Personal Agent coordinates the entry meeting and a written Individual Support Plan (ISP), whether it is for a long term, crisis stabilization, or relief care placement;
- The ISP outlines specific needs and support expectations for the adult care home placement;
- DD Case managers monitor ongoing services identified in the ISP through regular contact with the individual and adult care home provider, assist in problem solving, facilitate future support assessments, and help access available additional supports.
- Support Service Brokerages employ Personal Agents (comparable to County DD Case Managers) who help enrolled adults with I/DD to develop an Individualized Support Plan (ISP), obtain available funding and other resources necessary to implement the plan in their own or family home;
- DD adult clients have a choice of receiving their In-Home Support Services through Brokerages or County DD Programs;
- Support Service Brokerages help their adult clients select Personal Support Workers, Independent Contractors, or Agencies to provide specific supports, complete needs assessments, and evaluate the outcomes of delivered services;
- Brokerage clients may need “Relief Care” (also known as “respite care”).
- Relief Care is an intermittent service provided in the temporary absence of the adult’s primary caregiver, or sometimes in the event of a crisis;
- Although not required, Relief Care may be provided by a licensed adult care home operator;
- Relief Care can be provided hourly or on a 24-Hour Basis; 24-Hour hour relief care cannot exceed 7 consecutive days or 14 days total per year, without permission from the State ODDS;
- The Brokerage Personal Agent (or County Case Manager) and the individual, or the legal representative of the individual, must document that the specific adult foster home is a safe Relief Care setting for the individual;
- The care needs and number of Relief Care residents must be within the classification and capacity of the adult care home license;
- DD Brokerage Personal Agents must first obtain written permission from the Multnomah County DD Program before referring brokerage clients for Relief Care to DD licensed adult care homes;
- Relief Care rates are set by the State ODDS and paid by the Brokerage.
Is there a different license for operating a home for people with I/DD than there is for operating a home for elderly or younger people with physical disabilities?
In Multnomah County all licenses are issued by the Adult Care Home Program (ACHP), but licensing criteria differs for each specific population, such as Mental Health, Aging & People with Disabilities, or Developmental Disabilities;
License applicants must choose a specific population and meet the specific licensing criteria.
Are residents with different disabilities or from different agencies allowed to live in the same adult care home?
NO, THIS IS NOT PERMITTED, BY RULE, WITHOUT EXCEPTION APPROVAL.
The Exception Process includes:
- An Interagency Placement Assessment, with an individual risk assessment on each resident;
- Review by each resident’s case manager;
- Approval by the ACHP Licenser;
- Adult Care Home operator’s commitment to responsibly promote a harmonious and safe mix of individual residents within the home;
- Consideration by the home operator of risks, activity and “lifestyle” factors of all the residents in the home before attempting a mix.
Direct day-to-day work experience, especially with guidance from skilled mentors, in-person, with adults who have intellectual/developmental disabilities is extremely valuable preparation for becoming a DD Adult Care Home Operator.
- Check worksourceoregon.org or popular job search websites where applicable openings may be posted, (such as Craigslist, Indeed, Glassdoor, Monster, Career Jet, CareerBuilder, SimplyHired, etc.);
- Enter “direct support professional jobs” and similar search terms to look for jobs specifically working with people with developmental disabilities;
- Explore job opportunities with existing DD licensed adult foster care homes;
- Look for paid work opportunities with agencies that provide residential (group home and supported living), recreational, or employment supports to adults with I/DD;
- Focus your job search specifically on supporting adults who have more intense behavior support needs, autism, or co-occurring mental health diagnoses.
- Check the list of Support Service Brokerages: www.dhs.state.or.us/spd/tools/dd/BrokerageDirectory-2014.pdf
- Support Services Brokerages assist their clients to connect with independent contractors who meet qualifications to provide support in the person’s own home;
- WHEN CONSIDERING VOLUNTEER OPPORTUNITIES to gain work experience with individuals who have I/DD:
- Remember your work experience must be documented and verifiable when you apply for a DD adult care home license;
- Make certain you and the organization document
- WHAT kind of work you did,
- WHERE you performed the work
- HOW LONG you volunteered each time
- WHAT SUPPORT NEEDS the individuals had
Training & Networking:
- For low cost, relevant, basic classes in supporting people with I/DD, check frequently the Region 1 DD Training Co-Op website
- Check Oregon Technical Assistance Corporation (OTAC)
- Attend classes you find through Region1 DD Training Co-Op and OTAC for professional networking opportunities that could connect to job leads and additional valuable training.
- Connect with professional networking, volunteer, & training resources, such as:
- Look for web-based educational opportunities; some have higher costs than others:
- Check out American Network of Community Options and Resources
Read all information on this webpage, then write down your questions before making contact.
Adult Foster Care Program Specialist, Multnomah County Developmental Disabilities Services Division
Adult Foster Crisis Network Developer, Region 1 Crisis Diversion Program