Supported living

Supported living or supportive living refers to a range of services and community living arrangements (CLAs) designed with individuals with disabilities and their families to support disabled citizens to attain or retain their independence (see independent living) or interdependence in their local communities. Supported living is recorded in the history of the NASDDDS (National Association of State Directors of Developmental Disabilities Services), celebrating its 50th anniversary. Community Supported Living Arrangements (CSLA) was a landmark federal multi state demonstration to illustrate the federal role in community living in the US. Supported living is considered a core service or program of community living programs funded through federal state local partnerships.

Supported living also developed along different trend lines in the US, two of which included a broadening of the community living concepts in the new community paradigms of community membership of support and empowerment of conversion from an institutional to a community paradigm of person centered planning of community regeneration (and neighborhood assets) and the service system change to housing, homes and personal assistance and supports in quality community living. Supportive living was an ally of independent living to assure that special population groups could also obtain the benefits of IL services and concepts.

First, part of leadership (e. g., federal financing, state leaders, agency providers, knowledge dissemination networks) was back to the broadened concept of "community living" based on emerging concepts and practices in "community participation." Supported living linked with the concepts of integrated recreation, inclusive education with community opportunities, community membership, self determination, "community seeding", "person centered", and personalized supports. This resulted in projects such as the Community Opportunities Project of the Louisiana Developmental Disabilities Council, which were based on roles and relationships such as: Paul becoming a church member, fiancée, health club member, good neighbor, regular at Fred's Country Western and coffee shop, and self advocate with statewide recognition.

Second, the concept of supportive living was broadened from a service category of a residential program (i. e., facility based program model with bundled services) to bridge the gap toward the independent living concept of housing and personal assistance services (health funded), the concept of regular homes with the availability of "intensive support services" (special population groups, "severe disabilities"), a "range of community support services" (e. g., community counseling, recreation support personnel), decent community life (e. g., community employment, financial security), and principles of community and self determination/choice. This agency and systems change work was based on the identification of leading practice of organizations supporting people with disabilities in the community, including the following program design components: the separation of housing and support, home ownership and leasing, individualized and flexible supports, and individual choice. This program design requires "service coordination/case management/service broker/support facilitator", "individualized funding" and "person centered approaches to planning and supports". This framework has been used in the design of a person centered course in community services and frames the supported/ive living approach of university doctoral students to graduates.

Generally, though the focus remained on making people's places into "homes of their own" which became a federal initiative to also explore other housing and support options on the local levels. On the service configuration and program design levels, a multi case study research design was used to explore the five identified characteristics of a "housing and support" approach: the separation of housing and support, "home ownership", including tenancy, close tie among assessment, individual planning and individualized funding, and flexible and individualized support services, and choice. Separate developments were proceeding on personal assistance services which began with the independent living movement led by leaders such as now Honorable Judith E. Heumann and late Ed Roberts; it remains current today (E. g., Center for Personal Assistance Services in the US of San Francisco State University, California; then the Rehabilitation Research and Training Center on Center for Personal Assistance Services of the World Institute on Disability, 1990). A state policy study in South Dakota explored the relationship of state systems change necessary to move to a full range of regular housing and support options from the current facility based service design in comparison to modifying the current small apartment/home structures such as those in Connecticut. To date, there is no evidence of this type of systems transformation in the US (as of 2012)though we have moved to reporting on homes of one's own, personal assistance services and supportive living approaches, including over 189,000 participants of the latter two categories. In 2013, Robert Agranoff reported in the "Public Administration Review", that leading state systems in the US (in Intellectual and Developmental Disabilities) indicated an 80 90% conversion from a large institutional system to small, dispersed community homes and services in the community. These changes were based on efforts in states which involved major organizational changes in the NGO (non profit agency) sectors (e. g., Fratangelo, 1994), and with variability in state government public policies, departments and financing (e. g., Braddock, Hemp & Rizzolo, 2008).

Supportive living in the US is an important movement within the context of decades of federal policies, sometimes reluctantly, for community support services in communities nationwide as part of community integration, community participation, independent living and inclusion. This movement has been accompanied by a strong emphasis on self determination, with roots in rehabilitation in the 1950s and also, in education in the 2000s. In the 1990s, this movement emphasized the skill standards of personnel, including direct service workers who were called "human service workers" and their "community managers" (2013, Department of Labor statistics). Increasingly, in 2013 with the consumer directed services developed in these fields, education and training standards are being revamped within the context of the new US Direct Support Workforce and the Centers for Medicaid and Medicare.

The term community living was an outgrowth of the development of "residential services" in the communities in the US (e. g., Wolfensberger, Racino, Bersani, Nisbet, Taylor, and Bogdan of Syracuse University, Graduate Studies in Education, 600), and a departure from the development of institutional facilities. As part of this development and growth, different typologies of these services occurred beginning with group homes, staffed apartments, foster care, and then a variety of new and innovative services such as early intervention, family support services, supportive living and "related services" (e. g., supported employment, supported housing). Today, community living may involve over 43 residential typologies (e. g., Pynoos, Feldman & Ahrens, 2004), including board and care homes, personal care homes, nursing facilities, independent living facilities, supportive living and homeownership, family caregiving, personal assistance services, medical homes, and for elders, assisted living facilities.

As Linda Ward (1995) wrote in her edited text on "Values and Visions: Changing Ideas in Services for People with Learning Difficulties", "the flaws of the "group home model" were recognised sooner in the USA than the UK." (p. 12). Termed "supportive living", she says these developments have been richly documented by Racino, Walker, O'Connor, & Taylor (1993). Written at the time of the nine state pilots by the federal government on Community Supported Living Arrangements in the US, she noted great interstate variability in what it was and did identify the primary principles near the 1991 national organizational study (separation of housing and support, one individual at a time, full user choice and control, rejecting no one, and a focus on relationships, with maximum use of informal support and community resources). For comparisons, about the same time, Paul Williams (1995) identified the residential services available in Great Britain, including life sharing, hostels, staffed houses, living alone, lodgings, family placements, group homes, living with families, short term care, hospitals and village communities, among others. One of the most important initiatives of the 1980s and 1990s on homes and community living in the United Kingdom was the "influential paper "An Ordinary Life"" which was shared in the US through our internationally known colleague David Towell, then of the King's Fund and Great Britain's National Development Team. One of his books, An Ordinary Life in Practice, was paired with his strategic framework for principled national change. Within the comprehensive book (1988), Richard Brazil and Nan Carle describe an ordinary home life, Linda Ward describes developing opportunities for an ordinary community life, Paul Williams and Alan Tyne values for service development (normalization based, Wolf Wolfensberger), Alice Etherington, Keven Hall & Emma Whelan as service users (where I live, where I work), Philippa Russell on children and families, Jan Porterfield on regular employment, the late James Mansell on training, David Towell on managing strategic change, and Roger Blunden on safeguarding quality, among others. In 2013, the current framework is inclusive and sustainable housing and communities, similar in both the US and UK with sustainability worldwide. In 2017, these inclusion initiatives were discussed in relationship to community integration theories at the American Society for Public Administration in Atlanta, Georgia. (Racino, Rolandi, Huston, & Begman, 2017)

Canadians, while not typically using the term supported living which is current in the US, were partners in the institution to community movement which included the "reallocation of some funds toward support and services for community living options" (Prince, 2002). Termed in historical texts, the deinstitutionalization movement, the Nordic countries, and New Zealand and Australia, were early partners in community development.