If someone uses a word here you do not know, stop them and ask. It is their job to explain it. A professional who makes you feel foolish for asking has told you something about how they will treat the person you care about.
The two that confuse everyone
Medicaid vs Medicare
| Medicaid | Based on income and assets. Run jointly by the state and federal government, so rules differ by state. This is what pays for supported homes, through waivers. |
| Medicare | Based on age or disability, not income. Federal, same everywhere. Pays for medical care — hospitals, doctors, some short-term rehabilitation. It does not pay for long-term residential care. |
Many people have both. If someone says "Medicare will cover it" about a supported home placement, they are almost certainly mistaken.
SSI vs SSDI
| SSI | Supplemental Security Income. Based on need — low income and few assets. Usually comes with automatic Medicaid eligibility. Has strict asset limits that a lump sum can accidentally breach. |
| SSDI | Social Security Disability Insurance. Based on work history — what the person or a parent paid in. No asset limit. Leads to Medicare after a waiting period. |
Which one someone receives changes what they can keep, what they qualify for, and how much they contribute toward room and board.
Paying for it
- HCBS Waiver Home and Community-Based Services
- A Medicaid programme that pays for support in a home or community setting instead of an institution. Each state runs its own, with its own eligibility rules, its own covered services, and usually a waiting list measured in months or years. Get on it early; the list does not start moving until you are on it.
- Level of Care Determination
- An assessment finding that a person needs the amount of support a programme funds. Usually required before a waiver will pay. Being disabled is not sufficient on its own — the assessment has to land in the right band.
- Room and Board
- The housing and food portion of the cost, as distinct from the care. Medicaid generally pays for care, not room and board — that usually comes from the resident's SSI or SSDI.
- Personal Needs Allowance
- What the resident keeps for their own spending after room and board. The home may not withhold it, and the resident is entitled to an accounting of any money the home holds for them.
- Spend-down
- Reducing assets or income to qualify for Medicaid. Rules are strict, mistakes are expensive, and transfers can trigger a penalty period. Get advice from an elder-law or disability attorney before moving money.
- Private Pay
- Paying out of pocket. Commonly around $4,000–$5,000 a month for a supported home, varying widely by state and level of care.
- Olmstead Olmstead v. L.C., 1999
- The U.S. Supreme Court decision holding that the unjustified institutional segregation of people with disabilities is discrimination under the Americans with Disabilities Act. States must provide services in the most integrated setting appropriate to a person’s needs — the legal backbone of community-based housing over institutions. Source: U.S. Dept. of Justice, ADA.
- ADRC Aging and Disability Resource Center
- A state/local single point of entry for information, options counseling, and access to long-term services and supports. Free and available nationwide through the Eldercare Locator, 800-677-1116. Source: Administration for Community Living (ACL).
Care and daily support
- ADLs and IADLs Activities of Daily Living
- ADLs are the basics: bathing, dressing, eating, toileting, moving around. IADLs are the ones that let you live independently: cooking, shopping, managing money, taking medication, using transport. Assessments measure both, and they drive funding.
- ISP Individual Service Plan, or Individualized Support Plan
- The written plan describing what support a person gets and what they are working toward. The resident has the right to take part in writing it. Any restriction on their freedom — visitors, going out, phone — should appear here, individually justified, not as a blanket house rule.
- Awake Overnight
- Staff who stay awake through the night, as opposed to sleeping overnight staff. A different service at a different price. This is the question that decides whether someone gets help at 3am, and it is worth asking directly.
- PRN pro re nata, "as needed"
- Medication given when required rather than on a schedule — for pain, anxiety, agitation. Ask how often PRN medication is actually given and who decides. Frequent PRN use for behaviour can be chemical restraint wearing a different name.
- MAR / eMAR Medication Administration Record
- The record of every dose given, refused, held, or missed. Increasingly electronic. Ask how errors are recorded — every home has them, and a provider claiming none is not recording them.
- Behaviour Support Plan
- A written plan for supporting someone whose behaviour puts them or others at risk. Required where restrictive practices are used at all. A restriction with no written plan behind it is a serious finding.
- Restraint and Seclusion
- Physical, chemical, or mechanical limits on someone's movement, or isolating them. Prohibited for discipline or staff convenience. Where permitted at all, each use must be authorised, documented and reviewed.
- Respite
- Short-term care giving a family carer a break. Sometimes funded by a waiver. Worth asking about long before it becomes urgent.
Rights and oversight
- Long-Term Care Ombudsman
- A free, independent advocate for residents. Handles complaints and discharge appeals. Not employed by any provider. You do not need permission to contact them and you do not have to tell the provider first. Find yours.
- APS Adult Protective Services
- The agency investigating abuse, neglect and exploitation of vulnerable adults. Reach yours by dialling 211. Reporting is usually anonymous, and retaliation against a reporter is prohibited.
- P&A Protection and Advocacy
- Every state has one, with federal authority to investigate abuse and neglect of people with disabilities, and to provide free legal representation. Underused and genuinely powerful. Find yours.
- Involuntary Discharge
- When a home makes someone leave. Normally requires at least 30 days written notice, a stated reason, a real destination, and the Ombudsman's contact details on the notice. An appeal filed before the discharge date generally stays it — the person remains and care continues while it is decided.
- Grievance
- A formal complaint to the provider. Residents have the right to raise one without fear and to get an answer within a stated time. Ask how many were filed last year; "none" usually means the process is not real.
- 42 CFR Part 2
- Federal rules giving substance use treatment records stronger protection than ordinary medical records. A general medical release does not cover them — consent has to name the recipient specifically. 38 U.S.C. §7332 does the same for veterans' records on substance use, HIV and sickle cell.
- Guardianship, Power of Attorney, Supported Decision-Making
- Guardianship is a court removing someone's legal right to decide, and it is the most restrictive option. Power of attorney is granted voluntarily and can be withdrawn. Supported decision-making keeps the person's authority while giving them help to use it — increasingly recognised as the alternative that should be tried first.
Veterans and housing
- DD-214
- Discharge paperwork proving military service. Needed for most VA benefits. Replaceable free through the National Archives if lost.
- SSVF Supportive Services for Veteran Families
- VA-funded prevention and rapid re-housing for veterans and their families.
- HUD-VASH
- Housing vouchers paired with VA case management. Combines a rent subsidy with ongoing support.
- GPD Grant and Per Diem
- VA funding to community providers running transitional housing for veterans.
- Continuum of Care and Coordinated Entry
- The local body coordinating homeless services, and the single front door into them. Rather than applying to each programme, you are assessed once and prioritised. Start by dialling 211.
- HMIS Homeless Management Information System
- The database homeless services use to coordinate. Entering someone requires their consent.
- Chafee
- Federal programme funding support for young people ageing out of foster care — housing, education, and life skills. Ask about it before the eighteenth birthday; options narrow sharply once a case closes.
Missing a word? Tell us at hello@maiheaven.com and we will add it. If you were confused by it, so was somebody else.
Common questions about supported homes →
Resident rights and reporting abuse →
Printable checklist for touring a home →
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