{"report_id":186,"form_id":"23","user_id":81,"organization_id":10,"question_id":"132","question_type":"Free_Text","text_answer":"Influencing why this person was placed in what was seen as an atypical placement was that the person had never stayed at an ICF\/DD before and the other people in the home were seen as having more medical needs than behavioral challenges. Despite these differences, the team, including the case manager, guardian and the provider thought this could be a good fit for the person because they could have more attention from staff and the person wouldn\u2019t see the other roommates as a \u2018threat\u2019. \r\nAnother factor into this placement was that the provider had an open ICFs\/DD bed. The fact it was an ICF\/DD bed was one of the reasons why the bed was open. The providers in the room noted that there isn\u2019t much interest in ICF\/DD beds any more. Regionally, statewide and nationally, ICF or other institutional placements are seen as undesirable and passed over for foster care or other community-based settings. A number of factors have influenced this opinion about ICFs\/DDs, including; public sentiment shifting away from institutions and large settings; the HCBS settings rule which has required systems to move towards community settings; the Minnesota Olmstead Plan which reflects the Supreme Court\u2019s 1999 Olmstead ruling determining people should be served in the \u201cmost integrated setting\u201d, and; the Jensen Settlement Agreement which resulted in both Minnesota\u2019s Olmstead Plan and the closure of some institutional services.\r\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\/DD bed that needed to be filled and hadn\u2019t had much interest from other people in. The provider was also willing to take a risk because they determined the person could do well at the site.  This determination impacted the placement and was impacted by a number of factors. While the other people in the home didn\u2019t have similar needs as this person, the team thought this might work well in this case. The other five people in the home had higher Activities of Daily Living (ADL) needs than this person so it was thought the person wouldn\u2019t add much to the staff\u2019s workload in this area. The five people also exhibited challenging behavior that was more easily redirected and managed by staff, so it was thought the house wouldn\u2019t be overwhelming for staff to manage challenging behavior in the home as a whole. Additionally, it seemed to the provider that the person\u2019s challenging behavior appeared manageable. This was due to a number of influences such as the case manager reporting there weren\u2019t major recent behavioral concerns and the paperwork received from the person\u2019s previous provider before intake. Beyond the concerns around the person\u2019s challenging behavior, the paperwork from the previous provider supported the new provider\u2019s assessment that the person could do well at this site. The person\u2019s psychiatrist also weighed in and supported this particular placement, contributing to this assessment.\r\nAlong with the provider being willing to take a risk by accepting the person\u2019s placement in this atypical setting was that both the case manager and the person\u2019s guardian were willing to take a risk by placing the person in a home that didn\u2019t fit the \u2018typical\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\u2019t meet the supervision needs of the people living there.","created_by":81,"updated_by":81,"updated_at":"6\/11\/2021 1:55:25 pm","created_at":"6\/11\/2021 1:55:25 pm","id":44204}