People with disabilities have a right to live in the community instead of an institution or facility. There are many programs that may be able to help you live in the community. This packet briefly discusses these programs.
The Olmstead Supreme Court decision establishes that it is discrimination to keep people with intellectual, physical and mental health disabilities in an institution under certain conditions.
You have the right to live in the community if:
- You prefer to live in the community.
- Community placement is appropriate.
- Community placement can be reasonably accommodated.
What does it mean to be reasonably accommodated?
Accommodations are the supports that make it possible for a person with disabilities to live successfully in the community. But those supports must be “reasonable” and to determine this, the state looks at a couple of things:
- Available resources.
- Its obligation to provide community-based care that is equal to the care other people with disabilities get in the community.
The cost of living in the community cannot be more expensive than the cost of living in a facility. And it must be safe for you to be served in the community. Community-based services programs usually don’t offer 24-hour care. However, there are exceptions. Most of these programs also rely on natural supports like family or friends to help support you in the community.
Community Alternative Programs (CAP) are Medicaid programs that provide home and community-based services (HCBS) so people can live in the community rather than in an institution or facility. These programs “waive” some Medicaid rules and so they are called Medicaid “waivers”. Waivers help people stay out of institutions and even leave institutions by providing the services they need in the community setting.
North Carolina has 4 Waiver programs:
- Innovations Waiver for people with intellectual or developmental disabilities (formerly known as CAP-I/DD)
- CAP/DA (Community Alternatives Program for Disabled Adults)
- CAP/C (Community Alternatives Program for Children)
- TBI waiver (in certain counties only) for people who received a traumatic brain injury on or after age 22
This waiver is for people with an intellectual and/or developmental disability (I/DD) that is diagnosed before age 22. It is for people who want to stay in the community, but need the level of support provided by an institutional setting (such as an intermediate care facility for intellectual disabilities, ICF-I/DD). It can also be used to help someone with an I/DD who lives in a facility move back into the community.
You can contact your local LME/MCO to find out if you qualify for this program and to learn more.
The CAP-DA waiver is for disabled adults, age 18 or older, who need the level of support or services offered in a skilled nursing facility or adult care home in order to remain in or return to the community. The primary diagnosis cannot be I/DD or mental health disabilities. However, people with a dementia diagnosis may qualify.
These are example of the types of help provided by CAP-DA:
- Meal preparation
- Light housekeeping,
- Help with activities of daily living
- Help with medical needs, etc.
CAP-C (for children)
The CAP-C waiver is for children significant medical needs (I.e., the child is medically fragile or complex) and the family must need assistance to meet the child’s needs. The child must meet eligibility requirements for long term care, for example, the level of care provided in a skilled nursing facility.
Contact information for CAP-DA and CAP-C:
This waiver is for people with a traumatic brain injury that occurred after age 22. This waiver is currently only available in the Alliance LME/MCO catchment area (Wake, Durham, Johnston and Cumberland counties). Please note that the state is trying to expand the program to those who have experienced a traumatic brain injury after age 18 and this waiver program is expected to be available statewide within 5 years.
For more information, contact Alliance, 919-651-8401.
PACE is a community-based program that helps senior citizens remain at home, living independently and safely, for as long as possible. PACE provides medical care, social services, and personal care for people over the age of 55 who meet the criteria for round-the-clock nursing home care. The PACE program is not available in all areas of the state.
286 Overlook Rd.
Asheville, NC 28803
Buncombe and Henderson Counties
802 East Center St.
Lexington, NC 27292
Rowan, Davidson, Davie and Iredell Counties
Centralina Area Agency on Aging
525 N Tryon St.
Charlotte, NC 28202
2222 South 17th St.
Wilmington, NC 28401
New Hanover County and portions of Brunswick County
LIFE St. Joseph of the Pines
4900 Raeford Rd.
Fayetteville, NC 28304
Cumberland County and portions of Harnett, Robeson, Moore, and Hoke Counties
PACE @ Home
1915 Fairgrove Church Rd. SE
Newton, NC 28658
Catawba County and portions of Lincoln, Caldwell, Burke and Alexander Counties
PACE of the Southern Piedmont
6133 The Plaza
Charlotte, NC 28215
Mecklenburg, Cabarrus, Union and a portion of Stanly County
PACE of the Triad
1471 E. Cone Blvd.
Greensboro, NC 27405
Catawba County and portions of Lincoln, Caldwell, Burke and Alexander Counties
Piedmont Health SeniorCare at Burlington
1214 Vaughn Rd.
Burlington, NC 27217
Alamance, Caswell, Orange Counties
Piedmont Health SeniorCare at Pittsboro
163 Chatham Business Dr.
Pittsboro, NC 27312
Chatham, Lee, Orange Counties
Senior Total Life Care
1875 Remount Rd.
Gastonia, NC 28054
Gaston County and portions of Cleveland and Lincoln Counties
Randolph Health StayWell Senior Care
809 Curry Dr.
Asheboro, NC 27205
Randolph, Montgomery Counties and a portion of Moore County
VOA Senior CommUnity Care of NC
4022 Stirrup Creek Dr., Ste. 315
Durham, NC 27703
Durham and Wake Counties and a portion of Granville County
Though Medicare and Medicaid cover the costs for most patients, people who are not eligible for Medicare or Medicaid may consider private pay as an option. This option may cost less than care at a nursing facility.
All PACE Programs are federally required to provide a comprehensive array of services including:
- All Medicaid-covered services
- Primary care services
- Social work services
- Restorative therapies
- Personal care and supportive services
- Nutrition counseling
- Medical specialty services
- Recreational therapy
- Laboratory tests, x-rays, and other diagnostic procedures
- Acute inpatient care
- Nursing facility care
Money Follows the Person is a Medicaid-funded program that helps people move from a facility back to the community with supports.
To qualify, you must:
- Have lived in a skilled nursing facility, Psychiatric Residential Treatment Facility (PRTF), a state developmental center, intermediate care facility for people with intellectual/developmental disabilities (ICF-I/DD), or a state psychiatric hospital (very limited situations) for at least 60 days.
- Meet the Innovations Waiver, CAP-DA, or the PACE program eligibility requirements.
- Be a recipient of Medicaid services before the transition.
- Choose to move to one of the following “qualified residences”:
- Your personal home or apartment;
- Your family’s home or apartment; or
- If you are an Innovations waiver recipient, a community-based group home with no more than 4 people.
What are the benefits of the program?
- Community-Based Funding for Supports: Participants receive personal supports and other services through Medicaid’s CAP I/DD or CAP DA program (which set aside a certain number of slots specifically for MFP enrollees) or the PACE program.
- More Options in Long-Term Support: Provides eligible residents of inpatient facilities an option to receive supports and services in their communities.
- Transition “Start Up” Funding: Each participant may be eligible for up to $3,000 for items and services needed to transition, including:
- Security deposits
- Utility start-up expenses
- Accessibility modifications
- Other one-time items or services required to transition
View Money Follows the Person (MFP) DHHS Info Sheet or call 1-855-761-9030 for more info.
People diagnosed with severe and persistent mental are sometimes placed in institutions like Adult Care Homes or state psychiatric hospitals. They are placed in these facilities even when they would prefer to live in the community. This often occurs because there are few alternative options for adults with mental illness. Many are discharged to an Adult Care Home after a hospitalization. The Transition to Community Living Initiative (TCLI) program requires the State to provide supports and services to people who are in, or at risk of being sent to, an Adult Care Home. TCLI is a program designed to provide people with a serious mental illness a chance to live in the community with supports.
TCLI Program Services
- Finding and maintaining community housing, including vouchers or rental subsidies for community-based supportive housing
- Community-based mental health services and supports such as Assertive Community Treatment (ACT Team)
- Supported Employment services to help you prepare for, identify, and maintain community employment (if wanted)
- Discharge and transition planning from the adult care home or state psychiatric hospital
You can contact your local LME/MCO to find out if you qualify for this program and to learn more. If you have a legal guardian of person, you will need to notify your guardian before you apply for the program.
An “In-Reach” coordinator from your LME/MCO should be able to provide you with information about the TCLI program and what community-based mental health supports and supportive housing options are available.
People with a primary diagnosis of Alzheimer’s disease or dementia are not eligible for this program.
For more information, check out DRNC’s TCLI Fact Sheet
Independent Living Rehabilitation Program (IL)
The Independent Living Rehabilitation Program (IL) is through the Vocational Rehabilitation Program and helps people with significant disabilities manage their own lives and take a more active role in the life of their family, home and community.
What services does IL offer?
IL works with individuals to develop objectives and identify appropriate services. These may include:
- Guidance and counseling
- Rehabilitation engineering
- Home and vehicle modifications
- Independent living skills training
- Certain equipment purchases
- Assistance with leisure services
- Personal assistance services
- Registering a service animal (not legally required but may be helpful)
To qualify, you must:
- Have a significant disability that severely limits your ability to live independently.
- Show that receipt of services will significantly improve your ability to live independently.
An individual’s financial resources will be considered for eligibility of some services. Other services are available to eligible individuals regardless of financial need.
You can contact IL at 800-689-9090 or TTY (919)-855-3579 to find your local office.
Centers for Independent Living are non-residential organizations based in 7 locations across the state. They are consumer-controlled and community-based. CILs provide programs and services for people with all types of disabilities and their families. Different CILs may offer different programs and services. However, they all share the common goal of making it possible for people with disabilities to participate more fully in an integrated community. If you live in or hope to live in any of these counties, there is a CIL that serves your area.
Some CILs can help by phone to refer you to the right place even if you do not live in one of the listed counties. Below is a list of the CILs and the services offered:
Sylva office: Clay, Cherokee, Graham, Macon, Swain, Jackson and Haywood
525 Mineral Springs Dr.
Sylva, NC 28779
Innovation Waivers services for I/DD, including supported employment and alternative family living.
Asheville office: Buncombe, Henderson, Madison, McDowell, Polk Rutherford, and Transylvania
108 New Leicester Highway
Asheville, NC 28806
Employment services for age 18 to 64 receiving SSI and/or SSDI to return to work while protecting benefits.
5801 Executive Center Drive Suite 101
Charlotte, NC 28212
Peer mentoring; skill instruction; Information & Referral; Housing assistance for living independently for people who live in a facility in Mecklenburg, Cabarrus, Gaston, or Union Counties
Solutions for Independence
Keith Greenarch / Debbie Hennessy, Davie, Davidson, Forsyth, Stokes, Surry, and Yadkin
7744 North Point Blvd Winston Salem, NC 27106
Independent living skills training, peer support, advocacy, Information & Referral, transitions
Disability Advocacy Center (DAC)(new as of 10/20/2020 – no website yet)
Shana Ayscue, Executive Director
Alamance, Caswell, Guilford, Randolph, and Rockingham[
P.O. Box 5275
Greensboro, NC 27435
Wake, Durham, Franklin, Johnston, and Orange
Dr. Suite 105 Raleigh, NC 27612
Advocacy, Disaster response, independent living services, I&R, peer support, justice system reentry, transition support, travel training, business suits for interviews
Disability Advocates and Resource Center
Helen Pase, Executive Director
Beaufort, Pitt, and Wilson
702 A John Hopkins Drive
Greenville, NC 28734
Medical equipment loaner program, consumer transitions, independent living skills, peer support, advocacy
Columbus, Brunswick, New Hanover, Pender and Onslow
5041 New Centre Dr. Ste 201
Wilmington, NC 28403
Information & Referral, youth transitions, advocacy, housing advocacy and moving back to community, peer support, independent living
Options Counseling is a service that provides information about the types of long-term services and supports that may be available to an individual who is age 60 or older. This service is recommended for people whose life circumstances put them at increased risk for institutionalization or for people transitioning from a hospital or institution back to the community. Options Counseling helps people identify and understand their needs, and then make choices that fit well with those needs. This process helps people achieve and maintain independence and control in their daily lives.
Information, Assistance, and Options Counseling Contacts
Alamance Eldercare, Inc.
PO Box 202
Burlington, NC 27612-0202
Beaufort County DSS
632 W. 5th Street
PO Box 1358
Washington, NC 27889-4302
Council of Aging of Buncombe County
46 Sheffield Circle
Asheville, NC 28803-3423
Catawba County DSS
PO Box 669
Newton, NC 28658-0669
Chatham Co. Council on Aging
PO Box 715
Pittsboro, NC 27312-0715
Columbus Co. Dept. of Aging
PO Box 1327
Whiteville, NC 28472-1327
Cumberland Co. Council on Older Adults
339 Devers Street
Fayetteville, NC 28303-4750
Davie Aging and Adult Services
278 Meroney Street
Mocksville, NC 27028-2012
Durham Center for Senior Life
406 Rigsbee Ave., Ste 202
Durham, NC 27701
Senior Financial Care-Pathways
7820 North Point Blvd., Ste 100
Winston Salem, NC 27106-3116
Senior Services, Inc.
2895 Shorefair Drive
Winston-Salem, NC 27105-4237
Senior Resources of Guilford
1401 Benjamin Parkway
Greensboro, NC 27408
Mountain Projects, Inc.
2251 Old Balsam Road
Waynesville, NC 28786-7759
Jackson Co. Dept. on Aging
100 County Services Park
Sylva, NC 28779-9741
Community & Senior Services of Johnston Co.
1363 West Market Street
Smithfield, NC 27577-3340
Lee County Senior Services
1615 S. Third Street
Sanford, NC 27330-5663
Macon Co. Senior Services
108 Wayah Street
Franklin, NC 28734-3331
New Hanover Co. Senior Resource Center
2222 S. College Rd.
Wilmington, NC 28403-5545
Orange Co. Dept. on Aging
2551 Homestead Rd.
Chapel Hill, NC 27516-9087
Pender Adult Services, Inc.
901 South Walker Street
PO Box 1251
Burgaw, NC 28425-1251
Randolph Senior Adults Association, Inc.
347 Salisbury Street
PO Box 1852
Asheboro, NC 27204-1852
Sampson County Dept. on Aging
405 County Complex Rd., Ste 140
Clinton, NC 28328-4781
Resources for Seniors, Inc.
1110 Navaho Drive, Ste 400
Raleigh, NC 27609-7369
Wayne County SOA
PO Box 227
Goldsboro, NC 27533-0227
- These costs are determined on an aggregate rather than an individual basis. It also must be safe for you to be served in the community.