A few years ago, the director of a Regional Office for disability services received a phone call regarding six individuals with a disability who were at the library. The caller reported that the individuals, and a "worker", were sitting at a large table in the library. The “worker” was busy doing “paperwork”. The individuals with a disability each had a book or a magazine in front of them, but……they were all sleeping!
The Regional Office director called the provider to get a little more information about what was going on. The provider said that they brought the individuals with a disability to the library to help them “integrate” with the “community.” The provider was attempting to comply with the CMS HCBS Settings Rule.
Although the provider had good intentions.....they were by no means in compliance with the CMS HCBS Settings Rule. Compliance does not come from just moving a person’s body from one location to another (e.g. from the provider’s facility to the library). Compliance comes from implementing a person-centered plan that is developed through a person-centered planning process. Compliance comes from providing choices, ensuring rights, and providing opportunities for integration.
The provider was attempting to comply with one part of the Rule (i.e. opportunities for integration), while at the same time violating other parts of the Rule (i.e. person-centered, choices, and rights). The provider made the decision that all six people would go to the library. No one asked the individuals if they wanted to go to the library or not. And given the fact that the individuals were all sleeping.....it is probably safe to assume that they did not want to be there! And as for the provider saying that they were providing "opportunities for integration"....well...you can't really "integrate" when you are sleeping!
Where did the provider go wrong?
The provider overlooked the most important part of the CMS HCBS Settings Rule….the person-centered part! Compliance with the CMS HCBS Settings Rule is achieved by implementing a person-centered plan that is developed through a person-centered planning process. And compliance occurs through providing choices to individuals, ensuring rights, and providing “opportunities for integration”……that are person-centered. These components are a package deal. You can't violate one to accomplish the other.
3 Tips on Community Integration:
1. Know the person.
If you want to support a person to integrate with their community, you need to know the person. You need to know what is important TO them? What are they interested in? What do they like to do? Would they like to try something new? Where do they like to go? Who do they like to spend time with? Is there someone new who they would like to spend time with? What would they like to learn? What would they like to experience?
2. Know what “community” means.
Most people think of community in terms of a physical area…… such as a neighborhood or town (and all the people who live there). But community is so much more than that! “Community” is “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.” One of the main reasons people GO into the physical community is to make connections with others....and those connections are made with others who share common attitudes, interests, and goals.
3. Know the levels of engagement
Compliance with the CMS HCBS Settings Rule means providing “opportunities for individuals to ENGAGE in community Life.” The definition of “Engage” is “to do or take part in something.” But there are different "levels of community engagement," meaning that people “take part in their community” in different ways.
Think about your local college football community. All the people who share an interest in that college football team are part of that "community." There is a natural “feeling of fellowship” with the others who also have an interest in that team. If one person who associates with that community sees someone wearing the football team's colors on game day....there can be an instant connection. They know that the person is part of their community. But....each person might engage with the college football community in vary different ways.
Here are some of the ways that individuals might engage with their college football community:
• Wear sports clothing
• Play football (on the team)
• Coach football
• Attend home games
• Attend out of town games
• Attend tail-gaiting parties
• Host parties at home
• Visit campus
• Talk to others about the team
The Bottom Line....
Community integration is a major component of the CMS HCBS Settings Rule, but it is not the only component. You don't want to violate one component of the Rule, while trying to comply with another. Using the tips above can help you meet the requirements of the CMS HCBS Settings Rule.....and in doing so, you will be providing meaningful opportunities for individuals to truly engage in community life.