The Disability population is diverse and so are their housing needs. Housing considerations for people with disabilities can be categorized into three areas: affordability in the need for homes for individuals with extremely low incomes and who otherwise can’t afford market-rate and even much of the affordable housing; accessibility in how buildings are physically designed and located to support individuals’ access needs including mobility, cognitive disabilities, sensory disabilities, and the full range of support needs; and inclusivity in how people are not segregated or isolated but able to receive what services they need in the community alongside people without disabilities. In disability housing development, field building, and policy, these are key tenets for housing organizations to consider related to housing and disability.
Key Tenets
- There is a disproportionate need for extremely low income and very low-income housing1 due to higher rates of poverty, in part because of the need to remain on fixed incomes to qualify for a majority of Home and Community Based Services (HCBS).
- A disproportionate number of people with disabilities and those experiencing homelessness are people of color; therefore, any housing development that uses the lens of ending homelessness and racial equity must be disability-inclusive.
- Prior to the Supreme Court Olmstead ruling in 1999, it was the norm for people with disabilities to be institutionalized and separated from society. Even with progress, inclusion, and integration for people with disabilities, including in housing, has never been fully realized. The dark legacy of institutional bias still impacts people with disabilities in things such as requiring people with disabilities to live in facilities or hospitals in order to receive the services they need.
- By 2023, states must comply with the HCBS Settings Rule, standards that define the living arrangement of people receiving HCBS. This requires that people are given the option to live in a non-disability-specific setting – places that are integrated with people with and without disabilities – and that people are able to choose and control their services and providers.2
- The disability rights movement, specifically people who have survived institutionalization, continue to advocate that housing and services need to be decoupled. Now, it is widely known that service-linked/service ready housing is best practice.
- One way to ensure your housing development, advocacy, or other programming is disability oriented is to have people with disabilities part of the planning, design, and paid staff.
Housing is a path to services. Services help people stay housed. Getting people into stable housing means we can support people to transition into service delivery systems they were not previously accessing, like home and community-based services (HCBS). Getting people access to HCBS is critical to people being able to obtain, maintain, and be successful in their housing.
The following are additional definitions and terms helpful to understand as it relates to housing and disability.
Disability
Under the Americans with Disabilities Act3, a “disability” is defined as an “impairment that substantially limits a major life activity; an impairment that substantially limits a major life activity only as a result of the attitudes of others toward them; or doesn’t have any impairment, but is treated as if having an impairment.” Currently, 1 in 4 Americans has some type of disability which makes the Disability population one of the largest minorities in the country.
Extremely Low Income
A household income below 30% of area median income (AMI), as defined by the federal Department of Housing and Urban Development (HUD). According to the federal Social Security Administration, the 2020 unrounded annual amounts for individual recipients is 9,407.82, which is nearly 10% of the AMI for HUD Metro Fair Market Rent Area (HMFA) that Contains San Francisco. People relying on Supplemental Security Income (SSI) as income generally qualify as extremely low income.
Home & Community Based Services (HCBS)
HCBS are the services and supports that people with disabilities utilize in order to live with self-determination, choice, and in the community (with people with and without disabilities). Disproportionately, people with disabilities access Medicaid-funded HCBS, common examples that directly connect to housing include the following:
- Assistance with household chores and meal preparation;
- Transportation services;
- Direct support services or attendant care4
The largest funder of HCBS is Medicaid – the state and federal partnership that covers health care for very low-income people – to support people with disabilities in their home and community rather than in an institutional setting such as a nursing home. The vast majority of people prefer HCBS over institutional care. HCBS allow people to live independently and often provide services in a more cost-effective way.
In California, two of the largest HCBS programs are In-Home Supportive Services (IHSS) and regional center services. People with disabilities can access a rich array of HCBS that align with gaining and maintaining housing.
HCBS Settings Rule 5
In January 2014, the federal agency that oversees the Medicaid program, the Centers for Medicare & Medicaid Services (CMS), announced new rules that created standards for Medicaid-funded Home and Community-Based Services (HCBS), which is known as the HCBS Final Settings Rule. The final rule requires that housing settings where people receive HCBS must:
- Be integrated into and help provide full access to the greater community;
- Improve self-determination and independence in making life choices;
- Be chosen by the individual from among residential and day options, including settings that are not only for people with disabilities (called “non-disability specific settings”);
- Make sure of the right to privacy, dignity, respect, and freedom from coercion and restraint;
- Provide an opportunity to work in a typical job in the community “competitive integrated employment”