STATEWIDE TRAUMATIC BRAIN INJURY HOUSING NEEDS

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					       STATEWIDE
 TRAUMATIC BRAIN INJURY
HOUSING NEEDS ASSESSMENT
                        Prepared for
       The Washington Traumatic Brain Injury
        Strategic Partnership Advisory Council
                                     &
       The Department of Social and Health Services

                        Funded from
               The Traumatic Brain Injury Fund
                                     &
                      Contracted through
The Washington State Department of Commerce Housing Trust Fund




                             Prepared by
                            By Terry Home
                             June 30, 2011




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                Statewide TBI Housing Needs Assessment June 2011
                                                        TABLE OF CONTENTS


                               SECTION TITLE                                                 SECTION    MAIN     ATTACHMENT
                                                                                             NUMBER     PAGES       PAGES
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              1         4
Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               2         6-7
Demographic Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             3        9-10       11-15
Washington State Legislative History on Brian Injury. . . . . .                                4        17-19
SURVEYS AND INTERVIEWS
    Individuals with a Traumatic Brain Injury. . . . . . . . .
                                                                                               5        21-23      24-25
         Family Members, Care Providers and Friends. . . . . .
                                                                                               6        27-28      29-34
         Professionals and Policymakers. . . . . . . . . . . . . . . . .
                                                                                               7        36-37      38-45
         Adult Family Homes. . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                               8        46-49      50-51
         Boarding Homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                               9        53-55      56-57
         Nursing Homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                               10       59-60      61-62
         Affordable Housing Providers. . . . . . . . . . . . . . . . . .
                                                                                               11       64-68      69-70
         Housing Authorities. . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                               12       72-74      75-97
         Affordable Housing Funders. . . . . . . . . . . . . . . . . . .
                                                                                               13      99-101     102-111
         Homeless Shelters. . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                               14      113-114    115-118

Focus Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          15      120-121
Homeownership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             16      123-126    127-146
Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     17      148-149    150-152
Innovative Housing and Services. . . . . . . . . . . . . . . . . . . . . .                     18      154-157    158-187



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                                                 Statewide TBI Housing Needs Assessment June 2011
   SECTION 1
Acknowledgements




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   Statewide TBI Housing Needs Assessment June 2011
                                        Acknowledgments
                          The Department of Social and Health Services
   Chris Imhoff

                       The Department of Commerce Housing Trust Fund
   Susan Butz

        The Washington Traumatic Brain Injury Strategic Partnership Advisory Council

        Mark Stroh (Chair)                                   Laura Dahmer-White (Vice-Chair)
        Traci Adair                                          Michelle Bogart
        Samuel Browd                                         Susan Butz
        Penny Condoll                                        Deborah Crawley
        Barbara Curtis                                       Mark Fischer
        Maureen Guzman                                       Maralise Hood
        Arlene House                                         Avreayl Jacobson
        Marylouise Jones                                     Tommy Manning
        Consance Miller                                      Carol Munsey
        Andrea Okomski                                       Kara Panek
        LynnSiedenstrang                                     Kathy Schmitt
        Valerie Wootton

                                     TBI Council Coordinator
   Terry Redmon

                 Former TBI Council Coordinator
   Samantha Asbjornsen

                                              Terry Home
   Myla Montgomery (Board President)
   Joanne Norman (Administrator)

                                             Project Staff
   Michael Pollowitz (Lead)
   Jan Navarre
   Valerie Wootten
   Alison Pollowitz
   David Scheiber
   Sherry Marlin
   Anne Butigan
   Jacob Pollowitz

                                    Contracted Support
   Deborah Crawley ( Executive Director, Brain Injury Association of Washington State


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                              Statewide TBI Housing Needs Assessment June 2011
    SECTION 2
Executive Summary




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    Statewide TBI Housing Needs Assessment June 2011
                                     EXECUTIVE SUMMARY
The Washington Traumatic Brain Injury Strategic Partnership Advisory Council (TBI Council) and the
Department of Social and Health Services (DSHS) have collaborated to have this Statewide TBI Housing
Needs Assessment completed. The funding for this project is funded by the State TBI Fund and
contracted through the Department of Commerce Housing Trust Fund (HTF).

The purpose of this Statewide TBI Housing Needs Assessment is to:
    collect information on housing and housing-related supports, activities, and needs;
    provide a detailed overview of important housing and housing-related themes; and
    make recommendations that will assist individuals with a traumatic brain injury, family members,
       service providers, housing providers, state agencies, and other stakeholders to prepare for a better
       housing future for people with a traumatic brain injury and their families.

What is Traumatic Brain Injury?

"Traumatic brain injury" is an injury to the brain caused by physical trauma resulting from, but not limited
to, incidents involving motor vehicles, sporting events, falls, and physical assaults. Documentation of
traumatic brain injury shall be based on adequate medical history, neurological examination, mental status
testing, or neuropsychological evaluation. A traumatic brain injury shall be of sufficient severity to result
in impairments in one or more of the following areas: cognition; language memory; attention; reasoning;
abstract thinking; judgment; problem solving; sensory, perceptual, and motor abilities; psychosocial
behavior; physical functions; or information processing. The term does not apply to brain injuries that are
congenital or degenerative, or to brain injuries induced by birth trauma (RCW 74.31.010 Definitions).

Recommendations

The following recommendations are based on the information that was provided and the suggestions that
were made by over 800 participants in this housing needs assessment process. The recommendations
below are not in any priority order.

   1. Assign a full-time person to be the lead on providing information, tracking resources, and
       instigating the development of affordable accessible housing. It didn‘t appear that anyone
       regionally or statewide was coordinating or updating information on the variety of housing and
       service related options. This included case managers, housing developers, discharge planners, or
       agencies providing support services.

    2. Develop through a pilot project an age and disability appropriate Adult Family Homes (AFH), as
       well as other housing and service related options. It was stated throughout the needs assessment
       process that young adults were living with elderly roommates and that staff had little to no
       training on how to support a people who had a traumatic brain injury.

   3. Provide homeless shelters with TBI resource related materials for display and for those individuals
      who self-disclose. Most shelters that were contacted did not provide anything to folks that self-
      disclosed as having a TBI.




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                                 Statewide TBI Housing Needs Assessment June 2011
                                                                                 Executive Summary (continued)

1. Encourage existing homeownership programs to work with people with a traumatic brain injury
   and their families. One individual noted in this needs assessment with a TBI purchased a
   condominium unit using over $100,000 in down payment assistance that required no payments.

2. Develop a community-based residential option where state employees provide the 24/7 support
   and training services. This could be modeled after the State Operated Living Alternatives (SOLA)
   program that the State Division of Developmental Disabilities operates. This program would be
   for the very difficult to manage individual who is waiting at Western State Hospital and other
   restrictive setting waiting to be placed.

3. Develop a legislative advocacy strategy to start a TBI funding set-aside in the State Housing Trust
   Fund to develop affordable, accessible housing. To date, there are only (3) housing projects
   statewide that were developed using affordable housing dollars to support people with a traumatic
   brain injury.

4. Modify and expand the Cluster Care Model of services that offers personal care services to a
   group of Medicaid clients who live near each other. The theoretical significance of this model is
   that it brings a level of service provision efficiencies to allow someone to live independently who
   might otherwise need to live in an AFH because they did not have enough funded hours of
   support. For a better part of 10 years, Sunrise Services has been the only provider to offer Cluster
   Care. m

5. There should be a focused effort to cultivate an existing non-profit or to start a new non-profit to
   develop housing regionally or on a statewide basis. There aren‘t any non-profits in Washington
   State that are dedicated to developing affordable, accessible housing for people with a traumatic
   brain injury.

6. The TBI Council should have an exhibit at the Housing Washington conference 9/26-28 in
   Spokane to educate and encourage housing developers and affordable housing funders to develop
   housing for individuals with a traumatic brain injury.

7. Start a dialogue with housing authorities to set-aside vouchers for people with TBI. Some of the
   housing authorities are reporting closed waiting lists with up to a 6 year wait.

8. Work with housing authorities to develop stand-alone housing or to set-aside units in lager
   projects. No housing authority has developed or set-aside units for people with a TBI.

9. The Care Assessment tool may need to be modified or an additional assessment tool might need to
   be included when measuring the complex cognitive challenges that a person might have who has a
   traumatic brain injury. Given that the score on the assessment then translates into hours of service,
   this would have a profound effect on the housing options that might be available to someone with
   more or less hours of support.




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                              Statewide TBI Housing Needs Assessment June 2011
                SECTION 3
               Demographics
Attachments

  1. Traumatic Brain Injury Prevalence, Causes and Risk Factors
  2. Traumatic Brain Injury in Washington State
  3. Traumatic Brain Injury Federal Statistics




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                     Statewide TBI Housing Needs Assessment June 2011
Attachment #1


                      Demographics on the Incidence and the Prevalence
                               of a Traumatic Brain Injury

 Washington State
  From the Department of Health report:
 ―Traumatic Brain Injury: Prevalence, External Causes, and
 Associated Risk Factors‖ (2009)
 (See attachment #1 for this report.)

      •   5,500 people are estimated to be hospitalized each year for a TBI

      •   23,913 people are estimated each year to have a TBI-related injury but are not hospitalized.
          This number is based on a national estimate that only 23% of all the people with a TBI-related
          injury are hospitalized (5,500 divided by .23%).

      •   1,300 people die in this state each year from a traumatic brain injury

      •   123,750 state residents are estimated to be living with a traumatic brain injury based on a
          national estimate that 2% of the US population has a TBI-related disability

 See attachment #2 to view a map of Washington State that identifies every county by boundary and
 name. Under each county name is a number, which represents the number of non-fatal TBI
 hospitalizations
 from the years 2005-2009 based on the Department of Health statistics.

      Nationally

      From the Centers for Disease Control and Prevention (CDC) report:
      ―Get the Stats on Traumatic Brain Injury in the United States‖
       (2002-2006)
 (See attachment #3 for the report.)

      •     52,000       average number of deaths each year

      •    275,000       hospitalizations

      •   1,365,000      emergency room visits

      •     ????         The CDC makes no estimates of those receiving other medical care or
                         no care.




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                                  Statewide TBI Housing Needs Assessment June 2011
                                                                      Demographics (continued)



      Washington State General Population Demographics
                          (U.S. Census Bureau, 2009)

Population:                                                                  6,664,195

                                          Age:
Persons under 5 years old                                                        6.8%
Persons under 18 years old                                                      23.6%
Persons 65 years and over                                                       12.1%

                                        Gender:
Female                                                                          50.0%
Male                                                                            50.0%

                                     Ethnicity:
White                                                                           83.8%
Black or African American                                                        3.9%
American Indian and Alaska Native                                                1.8%
Asian                                                                            7.0%
Native Hawaiian and other Pacific Islander                                       0.5%
Persons reporting two or more races                                              3.1%
Persons of Hispanic or Latino origin                                            10.3%




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                   Statewide TBI Housing Needs Assessment June 2011
Attachment #1




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Statewide TBI Housing Needs Assessment June 2011
Attachment #2




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                Statewide TBI Housing Needs Assessment June 2011
Attachment #3




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Statewide TBI Housing Needs Assessment June 2011
      SECTION 4
Washington State History
          of
 Traumatic Brain Injury




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       Statewide TBI Housing Needs Assessment June 2011
         A History of Washington State Legislation on Traumatic Brain Injury
                                (up to May 1, 2011)
There are countless ways that legislation or the lack of legislation affects, shapes, and sometimes directs
our lives. Housing related to Traumatic Brain Injury (―TBI‖) has for the most part been under the
legislative radar. There has been only one TBI-related housing project completed, Terry Home in 1995,
using funding from the State Housing Trust Fund (HTF). The HTF is funded through the State Capital
Budget that is passed by both the Senate and the House and then signed into law by the Governor.

The history of TBI-related legislation in Washington State can be divided into two eras, with the 21st
century mark providing a tidy divide. Before 2000, there had been 40 pieces of legislation introduced,
including budget-related bills, with 8 passed into law (a 20% success rate). These bills primarily focused
on the prevention of TBI. Bills generally were public safety-related bills like bicycle and motorcycle
helmet laws (there were bicycle helmet laws introduced in nearly every year of the 1990s) and some
efforts at public education about preventing TBI.

Since 2000, legislation has shifted towards a greater awareness for the need for services and the impact
that TBI has on our communities. Nearly 60 bills that reference TBI have been introduced since 2000, but
of that 60, 21 arrived just since 2009. Clearly, the interest in TBI is increasing with each passing year.

Joint Base Lewis McChord, located near Tacoma, is one of the largest US military bases, and its members
have played a prominent role in the combat in Afghanistan and Iraq. Injuries from these combats during
the past decade, most notably with head injuries, have prompted the need for some of the TBI legislation.
Indeed, TBI has been designated as the ―signature injury‖ of the Iraq War. Federal legislation has also
driven some of the action at the state level.

Whether it was the creation of the Washington Traumatic Brain Injury Strategic Partnership Advisory
Council, the Traumatic Brain Injury Account, legislation addressing youth concussions or annual
Resolutions to honor the work of TBI advocacy groups, there has been dramatically more attention paid to
the issue of TBI in the Legislature over the past decade. The following will touch on a few of the main
areas in which legislation affecting people who have experienced a traumatic brain injury has been
introduced and passed by the Washington State Legislature.

Housing
Any housing related bills that affected people with TBI in the pre-2000 period were generally related to
institutional living: Residential Habilitation Centers (RHCs), nursing homes, Adult Family Homes, etc.;
focusing on payment systems, assessments of clients, etc. Very little legislative attention was paid
towards independent living for people with a TBI. SB 6319 was passed in 1992 to clarify that mental
hospitals are for those whose primary diagnosis is mental illness. This was put in place to discourage the
inappropriate placement of, among other categories, people with a head injury; instead, care would be in
the community or an RHC.
Legislation that affected a variety of disabilities often served to benefit people with TBI. For example, in
2000, SB 2454 was passed to establish support programs for unpaid care providers, with one of the goals
of the legislation to prevent institutionalization of functionally disabled adults. This bill recognized the
important work being provided by family members and was implemented to help maintain support for
people with TBI; without family members and loved ones provided home care services, more people with
TBI would likely have been institutionalized.


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                                 Statewide TBI Housing Needs Assessment June 2011
                                                                                              History (continued)

HB 1332 was introduced in 2007 to address affordable housing issues for people with a variety of
disabilities, including TBI. It would have required the State to allow affordable housing developers to
have priority at developing surplus state property into affordable housing for people with special needs.
While it did not pass, it was one of the relatively few bills to focus on affordable housing for special needs
populations, and not solely on an income-based eligibility.

Funding for Services
There was a valiant effort for a string of years in the 1990s in which legislation to create a Brain Injury
Trust Fund to help fund services was introduced but failed to gain traction. Bills were introduced in 1995,
1996, 1997, 1998, and 1999; they generally called for adding $25 to the ticket associated with driving
under the influence (DUI), to provide community services for TBI. None of these succeeded. Attempts
were made also to amend other pieces of legislation but these amendments invariably failed (for example,
1997‘s HB 2885 dealt with increased penalties for drunk driving. While the bill ultimately passed, an
amendment was offered which would have created a TBI fund, financed by $25 tacked onto DUI tickets.
The amendment failed). Clearly, there wasn‘t sufficient support in the Legislature to pass this type of
legislation at that time. It wasn‘t until several years later that the Legislature was compelled to create a
TBI fund, through House Bill 2055.

By 2007, the time had come for a bipartisan-supported effort to help fund some of the needed services for
people who experience TBI. The groundwork laid by the Brain Injury Advisory Board in the early 2000s
after Washington State received a federal assessment and implementation grants for TBI was also bearing
fruit. HB 2055 was introduced that year to bring attention to the needs of people with TBI. One of the
faces of TBI as HB 2055 made its way through the Legislature was Tommy Manning, who had suffered a
TBI in 1972 as a 10 year old passenger in a head-on car crash on the Tacoma Narrows Bridge. HB 2055
came to be known as ―the Tommy Manning Act‖ (as a constituent of the prime sponsor, former
Representative Dennis Flanagan of Tacoma, Manning advocated strongly for the need for support services
for people like himself who experience a traumatic brain injury.)

Passage of HB 2055 in 2007 created the Washington Traumatic Brain Injury Strategic Partnership
Advisory Council and a TBI Fund. The Advisory Council was tasked with developing a statewide plan to
address the needs of individuals with TBI and to provide recommendations to the state on how to
implement a comprehensive statewide information and referral system, a registry to collect data on
individuals with TBI, and ways to provide services. Along with the Advisory Council, HB 2055 also
provided a revenue stream for services ($2 on most traffic infractions are funneled into the Traumatic
Brain Injury Account for services and comprehensive planning). Money in the account could only be
spent after appropriation by the Legislature, and has been dedicated to funding a public awareness
campaign and services relating to TBI, for information and referral services, and for costs of required
DSHS staff providing support to the Advisory council.

HB 1614 passed the Legislature in 2011 and made some changes to the composition of the Council,
removed many of the duties that had been assigned to DSHS (specifically, the requirements that DSHS
secure funding to develop housing for individuals suffering with TBI by leveraging federal and private
fund sources; expand support group services with an emphasis on individuals with TBI returning from
active military duty; establish training and outreach to first responders and emergency medical staff for
care for individuals with TBI; and improve awareness of health insurance coverage options have been
removed.)


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                                  Statewide TBI Housing Needs Assessment June 2011
                                                                                        (History continued)


Public Safety
Several pieces of legislation over the years, but especially since 2000, have addressed issues of persons
with developmental disabilities, including TBI, who are in correctional facilities or jails. Legislation was
passed in 2009 to establish a workgroup to create a screening tool and other issues related to offenders
with a developmental disability, including TBI.

In 2011 the definition of mental health court was expanded to allow participation by offenders who may
benefit from treatment related to an intellectual or developmental disability or TBI, as well as access to
services while in a correctional system. This bill came out of the recommendations of a work group that
looked at ways to deal with issues surrounding people with developmental disabilities in jail. This bill will
help systems work better for people with developmental disabilities, including TBI, when they are in jail.
Testimony at public hearings on this legislation, HB 1718, noted that ―TBI is often hidden and not
properly diagnosed or treated, and is a special concern for veterans returning from war."

In a different vein of public safety, the Zackery Lystedt Law (House Bill 1824) was passed in the 2009
Legislative session. This is said to be the country's most rigorous law protecting young athletes from
severe brain injuries. The law requires that when an athlete has suffered an apparent brain injury - whether
in a game or practice - he or she cannot return to play without the approval of a licensed medical
professional, which includes certified athletic trainers.

Resolutions
Over the last several years members of the House and Senate have regularly introduced ceremonial
Resolutions honoring the work of TBI advocacy/support groups and the people who experience TBI.
Legislative Resolutions are read on the Floor and become part of the permanent record of legislative
activities. Resolutions are often signed by many members and are an opportunity for elected officials to
recognize groups from their legislative district as well as groups that are active statewide. There are a
limited number of resolutions that can be introduced in a legislative session, so members have to carefully
discern who receives a resolution. This newer trend of Resolutions honoring people with TBI is perhaps
one more indicator that awareness of TBI is on the upswing and has become increasingly more visible to
the Washington State Legislature.




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                                 Statewide TBI Housing Needs Assessment June 2011
        SECTION 5
   Surveys and Interviews
                        Individuals

Attachments

  1. Housing Needs Assessment Survey for Individuals
  2. Generic Interview for In Person/Phone Contact




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                     Statewide TBI Housing Needs Assessment June 2011
                          Individuals with a Traumatic Brain Injury
                                        Survey Results
                                         Methodology
Surveys (see attachment #1) were mailed and emailed out to 440 people. They could be completed and
mailed back or there was a link for SurveyMonkey.com provided on the survey where the survey could be
completed online.

The following key questions were asked on the survey:

   1.   Where do you currently live?
   2.   If you live in a house or apartment/condo, who do you live with?
   3.   At this time, is this the best housing arrangement for you?
   4.   In the next 3-5 years, do you think you might benefit from a different housing arrangement?

A follow-up phone interview was scheduled for individuals:

   1. Responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could
      we contact you?‖
   2. They provided us with an email address and/or a phone number.

See attachment #2 for a copy of the phone interview script.

Findings

To date, there have been 121 completed surveys submitted from 17 different counties. The return rate
based on 440 surveys sent out is 28%.

The following are the key questions from the survey:

Where do you currently live?
83 said a house
38 stated in an apartment/condo

If you live in a house or apartment/condo, who do you live with?
52 said they lived alone
39 indicated they lived with family
12 said that they lived with a roommate
 8 stated that they lived with a care provider

At this time, is this the best housing arrangement for you?
61 said YES
34 said NO
 1 said DON‘T KNOW




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                                  Statewide TBI Housing Needs Assessment June 2011
                                                                                  Survey Results (continued)


In the next 3-5 years, do you think this person might benefit from a different housing arrangement?
48 said YES
19 stated NO
28 said DON‘T KNOW

To date, we have conducted 78 phone interviews with Individuals.

The following are responses to key questions from the phone interviews:

Do you own your home or do you rent?
23 said OWN
46 said RENT
 5 reported OTHER (free, nursing home, assisted living)

How long have you lived there?
12 said LESS THAN 1 YEAR
22 said FROM 1-3 YEARS
 8 said MORE THAN 3 TO 6 YEARS
26 said MORE THAN 6 YEARS

Who do you live with?
54 said ALONE
 4 said ROOMATE
17 said FAMILY
 2 said Caregiver

How much is your mortgage or rent?
LESS THAN $601/MONTH
 5 said MORTGAGE
23 said RENT

MORE THAN $600 TO $800/MONTH
 2 said MORTGAGE
 2 said RENT

MORE THAN $800 TO $1,200/MONTH
 6 said MORTGAGE
 6 said RENT

MORE THAN $1,200/MONTH
 5 said MORTGAGE
 3 said RENT




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                               Statewide TBI Housing Needs Assessment June 2011
                                                                                  Survey Results (continued)


Do you receive any assistance in paying your (rent/mortgage payment) like a Section 8 voucher?
11 said RECEIVE SUBSIDIZED HOUSING (Section 8, rent a housing authority unit)

How much is your monthly income?
25 said LESS THAN $701
14 said MORE THAN $700 TO $1,000
 8 said MORE THAN $1,000 TO $1,500
25 said MORE THAN $1,500

What is your source of income?
52 said SSI/SSA/SSDI
 5 said L&I
 5 said PENSION
 6 said WORK
10 said OTHER (disability policy, unemployment, settlement, leave pay)

Are there changes that would make your current housing situation better for you?
13 said THEY NEED SOME ACCESSIBILITY MODIFICATIONS
13 said THEY WANT/NEED TO LIVE IN A DIFFERENT LOCATION
14 said THEY NEED MONEY TO MOVE
23 said THEY NEED SOME SUPPORT WITH MANAGING THEIR HOME
 8 said THEY NEED HELP TO FIND WORK
 2said THEY NEED MORE HOURS OF SUPPORT THAN THEY ARE CURRENTLY
        RECEIVING

Are you a veteran?
11 said THEY WERE VETERANS

Recommendations

   1. With so many extremely low-income individuals with a traumatic brain injury paying much of
      their income towards housing costs, there should be an organized plan to increase the number of
      subsidized accessible housing units using public and private funding.

   2. As a complementary part of increasing housing units, working with housing authorities to increase
      the allocation of Section 8 vouchers to people with a traumatic brain injury.




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                               Statewide TBI Housing Needs Assessment June 2011
Attachment #1
 Survey for Individuals with a Traumatic Brian Injury
 The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned
 Terry Home to complete a statewide housing needs assessment for people with a traumatic brain injury.
 This survey is part of a larger effort to collect housing related information. This survey should only take a
 couple of minutes to complete and your input is very important to people with a traumatic brain injury.
 Thank you
        You can complete this survey online by typing this link into your internet address bar:
                             https://www.surveymonkey.com/s/tbi_individuals

    1. What city do you live in? ______________________________

    2. Where do you currently live?

        House ___ Apartment/Condo ___ Other (please specify) _____________________

        2a. If you live in a house or an apartment/condo, do you live:

        Alone ___ With a family member(s) ___ With a roommate(s) ___

       With a care provider ___ Other (please specify) _______________________
    3. At this time, is this the best housing arrangement for you?

        Yes ___ No ___

        If no, what do you need (i.e. support services, more affordable rent, accessibility features in
        your home)? Use the back of the survey if you need more space.
        _______________________________________________________________________________

        In the next 3-5 years, do you think you might benefit from a different housing arrangement?

        Yes ___ No ___ Don’t know ___

        If yes, what might you need? Use the back of the survey if you need more space.
        _______________________________________________________________________________

    4. If we wanted to ask you some follow-up questions, could we contact you? Yes ___ No ___

        If yes, please provide us with an email address and/or a phone number.

        ________________________________________________________________

    5. Your name (optional)        _____________________________________

                                    Thank you for your participation!!!
                Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155 or
                      use the SurveyMonkey link above to complete the survey online.


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                                   Statewide TBI Housing Needs Assessment June 2011
Attachment #2
 Generic Interview for In Person/Phone Contacts for Individuals

 Date________ Interviewer_________________ Start Time____ End Time____

 Type of Contact: ___In person ___Phone

 Name of person being interviewed: ____________________________________

 INTRODUCTION
 My name is _______________________. I am following up on a housing survey you filled out where you
 said we could contact you if we had more questions about housing and traumatic brain injury. Is this a
 good time for us to talk?

 (Before the interview, review the person‘s survey responses and modify the questions accordingly.)

     1. In the survey you said that you live in an (apartment/condo/house) (with a roommate/family/alone)
        in (city).

        Do you rent or own the place you are living in?
        How long have you lived in your home?
        If they live with a roommate, how long have they lived together?
        If they live with a care provider, how long has this care provider lived with them? Issues/concerns with
         live-in care providers?
        Did you need to make any changes at your home to make it safer or easier to live in?
        What is your (portion) of the monthly (rent/mortgage payment)?
        Do you receive any assistance in paying your (rent/mortgage payment) like a Section 8 voucher?
        Can you take a guess at what your average cost for utilities are each month?
        This is confidential but really important to our work; would you share with us your monthly income? (If no,
         let‘s try two ranges: Is it more than $1,300/month? Is it more than $2,000/month?)
        Would you rather be living someplace else? If so, where? What is preventing you from moving?
        Are there changes that would make your current housing situation better for you?
        If you could describe the perfect housing situation, what would that be?
        Have you ever been without a home, either living at a friend‘s house or a shelter?
        Have you ever needed help finding a place to live? If so, who helped you?
        Did you own your own home at the time of your injury or were you renting or living with family members?
        Did you return home after your injury (identify: self, roommates, family)? If not, where did you go?

     2. Are there any (support) services that you need that you are not receiving or that you need more of?
     3. How were you injured? What year was that? How old are you now? Gender?
     4. Were you in school at the time of your injury? If so, K-12 or college? Did you return, if so how long
        after your injury?
     5. Were you (also) working at the time of your injury? If so, what type of work were you doing? Were
        you able to go back to that job after your injury? Are they currently working? If so, how many hours
        each week? Do you need any support while you are on the job? If yes, what type of support(s)?
     6. Were you married at the time of your injury? Do you have any children? Are you still married or did
        you re-marry?
     7. Do you receive any assistance from the government such as medical coupons, Medicaid/Medicare,
        SSI/SSA/SSDI, COPES, Medicaid Personal Care? Do you have health ins.? Is this through work,
        family, yourself, from the government?
     8. Are you in the military or a veteran?
                                                     25 | P a g e
                                    Statewide TBI Housing Needs Assessment June 2011
        SECTION 6
   Surveys and Interviews
          Families, Care Providers
                and Friends

Attachments

  1. Survey for Families, Care Providers and Friends
  2. Generic Interview for In Person/Phone Contact
  3. Family, Care Provider and Friends Thoughts on Improving Housing
     Opportunities for People with Traumatic Brain Injury




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                     Statewide TBI Housing Needs Assessment June 2011
                              Family, Care Providers, and Friends
                                        Survey Results
                                         Methodology
Surveys (see attachment #1) were mailed and emailed out to 377 people. They could be completed and
mailed back or there was a link for SurveyMonkey.com provided for on line completion.

The following key questions were asked on the survey:

       1.   Are you a family member, care provider or friend?
       2.   Where does your family member/the person you provide care to/friend currently live?
       3.   If they live in a house or apartment/condo, who do they live with?
       4.   In your opinion is this the best housing arrangement at this time?
       5.   In the next 3-5 years, would this person benefit from a different housing arrangement?
       6.   Please share any thoughts you might have on improving the housing opportunities for
            people with a traumatic brain injury.

A follow-up phone interview was scheduled for Family, Care Providers, and Friends who:

       1. Responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions,
          could we contact you?‖
       2. They provided us with an email address and/or a phone number.

See attachment #2 for a copy of the phone interview script.

Findings
To date, there have been 68 completed surveys submitted from 13 different counties. The return rate
based on 377 surveys sent out is 18%.

The following are the key questions from the survey:

Are you a family member, care provider or friend?
48 stated they were family members
6 responded that they were care providers
8 indicated that they were friends

Where does your family member/the person you provide care to/friend currently live?
46 said a house
8 stated in an apartment/condo

If they live in a house or apartment/condo, do they live with?
15 said they lived alone
32 indicated they lived with family
2 said that they live with a roommate
4 stated that they live with a care provider


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                                 Statewide TBI Housing Needs Assessment June 2011
                                                                                       Survey Results (continued)


In your opinion is this the best housing arrangement at this time?
31 said YES
22 said NO
8 stated they DON‘T KNOW

In the next 3-5 years, do you think this person might benefit from a different housing arrangement?
34 said YES
18 stated NO
11 said DON‘T KNOW

Share thoughts you have on improving the housing opportunities for people with a traumatic brain injury.
(See attachment #3 are (6) pages for open-ended responses by family, care providers, and friends to
question.)

After reviewing the responses, we have grouped them as follows:
    9 stated more TBI specific homes
    8 indicated more support services
    7 listed affordable housing
    7 identified more accessibility in housing
    6 stated a central location near family or close to transportation and shopping
    5 wanted more homes but did not specify TBI specific
    5 listed apartments with staff to provide assistance
    3 mentioned cohousing

There were a number of comments about places in other states (i.e. MN, OR); small farm; Terry Home
place; kibbutz; transportation needs; the need for non-profit housing providers to develop projects to
support people with TBI; and a resource list of facilities and affordable housing statewide. To date, we
have conducted 16 phone interviews with Family, Care Providers, and Friends.

In the phone interviews, the following are the key responses to what people needed/their concerns:
      supervised care in homelike setting with access to a social group;
      TBI Adult Family Home with a trained person; living with other people under 30;
      local support groups; doesn't know what will happen next;
      doesn't know what options are out there;
      looking for apartment; nothing out there; needs a supported environment;
      needs 24-hour supervision; wants more social connection;
      does not know where she would go next; needs supervision; cannot live on his own;
      appropriate fulfilling work; appropriate housing with oversight;
      need a safer location; need an accessible, affordable apartment; wife would like to work
      but needs to stay with husband; someplace with younger people

Recommendations
   1. A plan to encourage non-profits statewide to develop affordable, accessible housing.
   2. A statewide resource guide of facilities and housing that is updated regularly.
   3. A plan to develop housing plus services specifically for people with a traumatic brain injury.
                                                  28 | P a g e
                                 Statewide TBI Housing Needs Assessment June 2011
Attachment #1

Survey for Family, Care Providers, and Friends of a Person with a Traumatic Brain Injury
The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned Terry
Home to complete a statewide housing needs assessment for people with a traumatic brain injury. This survey is
part of a larger effort to collect housing related information. This survey should only take a couple of minutes to
complete and your input is very important to people with a traumatic brain injury. Thank you.
You can complete this survey online by typing this link into your internet address bar:
https://www.surveymonkey.com/s/tbi_individuals

   1. Are you a Family member ___ Care provider ___ Friend ___ Other _______________________

   2. What city do you live in?__________________________________________________

   3. Where does your family member, the person you provide care to or your friend currently live?

       House ___ Apartment/Condo ___ Other (please specify) _____________________
       3a. If they live in a house or apartment/condo, do they live:

                Alone ___ With a family member(s) ___ With a roommate(s) ___

                With a care provider ___ Other (please specify) _______________________

   4. In your opinion is this the best housing arrangement at this time?

       Yes ___ No ___ Don‘t know ___

       If no, what is needed (i.e. support services, more affordable rent, accessibility features in the home, to live
       in a different area)? Use the back of the survey if you need more space.
       __________________________________________________________________________________

   5. In the next 3-5 years, do you think this person might benefit from a different housing arrangement?

       Yes ___ No ___ Don‘t know ___

       If yes, what might be needed? Use the back of the survey if you need more space.
       __________________________________________________________________________________

       Please share any thoughts you might have on improving the housing opportunities for people with a
       traumatic brain injury. Use the back of the survey if you need more space.
       __________________________________________________________________________________

   6. If we wanted to ask you some follow-up questions, could we contact you? Yes ___ No ___

      If yes, please provide us with an email address and/or phone number. ___________________________

   7. Your name (optional) __________________________________________

Thank you very much for your participation!!
Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
or use the SurveyMonkey link above to complete the survey online.


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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #2
                  Generic Interview for In Person/Phone Contacts for Families/Care Providers
  1. Date________ Interviewer_________________ Start Time____ End Time____

  2. Type of Contact: ___In person ___Phone

  3. Name of person being interviewed: ____________________________________

  4. INTRODUCTION

  5. My name is _______________________. I am following up on a housing survey you filled out where
     you said we could contact you if we had more questions about housing and traumatic brain injury. Is this
     a good time for us to talk?

             (Before the interview, review the person‘s survey responses and modify the questions accordingly.)
  1. In the survey you said that your (family member/friend/someone you provided care to) lived in an
     (apartment/condo/house/facility/homeless) (with a roommate/family/alone) in (city).
   Do they rent or own the place they are living in?
   How long have they lived in their home?
   If they live with a roommate, how long have they lived together?
   If they live with a care provider, how long has this care provider lived with them? Any issues/concerns      with
     the live-in care provider?
   Are there any changes needed at the home to make it safer or easier to live in?
   What is their (portion of the) monthly (rent/mortgage payment)?
   Do they receive any assistance in paying the (rent/mortgage payment) like a Section 8 voucher?
   This is confidential but really important to our work; would you share with us their monthly income? (If no, let‘s
     try two ranges: Is it more than $1,300/month? Is it more than $2,000/month?)
   Would they rather be living someplace else? If so, where? What is preventing them from moving?
   Are there changes that would make the current housing situation better for them?
   Have they ever been without a home, either living at a friend‘s house or a homeless shelter?
   Have they ever needed help finding a place to live? If so, who helped them?
   Did they own their own home at the time of their injury or were they renting or living with family members?
   Did they return home after their injury (identify: self, roommates, family)? If not, where did they go?

  6. Are there any (support) services that they need that they are not receiving or that they need more of?
  7. How were they injured? What year was that? How old are they now? Gender
  8. Were they in school at the time of their injury? If so, K-12 or college? Did they return, if so how long after
     their injury?
  9. Were they (also) working at the time of their injury? If so, what type of work were they doing? Were they
     able to go back to that job after the injury? Are they currently working? If so, how many hours each week?
     Do you need any support while they are on the job? If yes, what type of support(s)?
  10. Were they married at the time of the injury? Do they have any children? Are they still married or did they
      re-marry?
  11. Do they receive any assistance from the government such as medical coupons, Medicaid/Medicare,
      SSI/SSA/SSDI, COPES, Medicaid Personal Care? Do they have health ins.? Is this through work, family,
      individual, from the government?
  12. Are they in the military or a veteran?




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                                    Statewide TBI Housing Needs Assessment June 2011
Attachment #3
                    Family, Care Providers, and Friends Thoughts
      on Improving Housing Opportunities for People with a Traumatic Brain Injury
                             The following statement was presented to survey takers:
 ―In the space below, please share your thoughts on how we might improve the housing opportunities for people
                                         with a traumatic brain injury.‖

  1. Check out Uhlhorn and RiverKourt (Shelter Care) in Eugene Oregon.
  2. Central locations with more support It's hard to send your loved one out there in the community , when
      he looks good on the outside but has severe short term memory issues
  3. Grouping people in a group home setting would help integrate people with TBI socially to be able to
      learn how to get along with people i.e. make friends, etc.
  4. As stated above, it would be nice to have housing opportunities with other young adults with the same
      kind of issues. She would need someone to be there for the money and cleanliness issues. Someone to
      oversee her care. It would be nice, too, to know what is out there and available for those with TBI. I
      don't know of anything around here.
  5. Homes in the community
  6. Maybe a place (apartment complex) where a counselor or staff could help with bills, technology and job
      training/counseling.
  7. I will have to leave that to the experts.
  8. I have been a real estate broker in the Seattle area for 40 years. The needs are so varied. I viewed Terry
      Home today. Excellent for many. Great they have acquired another lot to build another home for those
      20 people on the wait list. Great Terry Home has been a step to independent living for many. Larry was
      TBI 47 years ago at the age of 18 (4/17/65). Wichita, Kansas developed Timbers & Larry was one of the
      first residents.(4-plex apartments)He also has lived in an apartment building & by himself in a private
      residence.
  9. Lower rents
  10. We are especially fortunate that soon this person will be healed and independent. In most cases however,
      having housing that provides places to "lock up" certain things that can be harmful such as cleaning
      products. In addition, single level homes are best. Having homes with showers that are open and easy to
      step into, having the toilet located in a place where there is a natural support, i.e. a counter or bar to grab
      onto to get up and down. Having houses with more open space is better, as closed, tight places get
      confusing and can cause frustration.
  11. Provide affordable safe housing that has supports to meet individual TBI needs to make them successful.
  12. I don't really know. In the case of my son and I, it would have been helpful to have help re-constructing
      his mobile home to be wheelchair accessible. There are so many small things that people in wheelchairs
      can't reach, access, open, see and etc. I do think it is better for people with a brain injury to be as close to
      loved ones as possible. Also, having grants or loans for brain injured people would help them get better
      housing.
  13. Provide more low-cost or subsidized housing, possibly group homes with on-site caregivers who can
      monitor medications and ADLs.
  14. First start with those who are not able to live alone. Get a Federal brain injury waiver to help provide
      long-term care in the community. COPES does not. States like Minnesota can do this why can't
      Washington? Use the TBI Bill funds to offer incentives to those wanting to provide homes for TBI
      survivors. Pass a law making it illegal to use TBI funds for anything BUT, TBI services. Tell the
      Governor about it. The Brain Injury Association could use some of the funds raised at their GALA to
      help get a home started. Housing for traumatic brain injury does not exist on the eastside of Washington.
      They need housing also.


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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                       Family, Care Providers, and Friends Thoughts (continued)

15. There is very little housing available or even accessible to TBI patients or anyone with disabilities and if
    there is housing the properties are in bad neighborhoods, rents and utilities are too high, housing units
    run down, landlords are slum lords even those who provide government funded housing. They deserve
    better than this, they deserve to be treated with dignity, respect, etc and not like some slum dog off the
    side of the road who milks the system and takes away from those who are in need.
16. It's hard to say, especially when the presence or extent of the TBI is not known. In the case of our friend,
    she has no outward signs of brain injury (as my wife does, having been through two strokes), nor does
    she demonstrate any behaviors we would associate with TBI; if our friend had not told us about it, we
    would not have known. For people whose TBI expresses itself through behavioral signs such as
    forgetfulness or problems with balance, I would suggest that some form of co-housing with a caretaker
    would be the ideal alternative form of housing.
17. More one-to-one support within the community
18. Provide more therapy to survivors on a more regular basis. Provide opportunities for people who want to
    enter the working world to not be penalized for working; i.e. take away their SSI, etc.
19. ....a way to check in with these individuals on a daily basis, but also a way to preserve their
    independence and dignity. I am still thinking on this here....
20. The layout of the house is not such that housekeeping is easy. My family member has a lot of art
    supplies and tools that she uses in her work as an artist. In my opinion, they are not organized and stored
    in a manner that insures safety. The entire house is her studio; that is OK as long as it is safe. The
    driveway is very steep. She parks her vehicle outside the garage in the driveway. The garage is also full
    of tools and art supplies. I am concerned that she could fall and suffer from broken bones. Perhaps your
    assistance with storage space and organizing her art materials would be helpful. In my view, the best
    possible solution for my family member would be relocation to a house on flat land. She is buying her
    current residence. Relocation is a huge consideration at this time of her life. Given the current economic
    trend, I am sure she would see the relocation challenge as even more daunting than usual. I support my
    family member's wishes as she moves through the many aspects of healing herself from traumatic brain
    injury. Please let me know if I can be of further assistance.
21. Co-housing or "villages" with small individual/family units and communal gathering/recreation areas
    Funding for accessibility modifications to existing housing options
22. Transportation to and from rural areas so they may retain their independence. Shopping assistance and
    help with paying bills.
23. I believe that the first step is to begin to ask people with TBI's what sort of help they need as well as
    their caregivers. I suffered injuries in my home from various deficits caused by my brain injury and
    eventually ended up homeless. Housing is improved as well when income is adequate, I believe that
    people with TBI"s experience disability discrimination at work which can result in job loss and housing
    loss Recognition that we can be gainfully employed will contribute much to stable housing, My own
    case of housing loss after a TBI had everything to do with being excluded from my tasks at work
    because I was "different" after the TBI. In fact, one of the people guilty of the exclusion was the person
    that had jurisdiction over the TBI work group for my division of DSHS. She did not have a TBI, did not
    have a family member with one and had far more work than she could manage. While I was requesting
    to be included in work groups, and was not, she was given every assignment that opened up including
    the TBI. The result, the person who actually had one, was not invited to participate in any way in any
    work group until there was no reason to go to work at all I was forced to move into my car and leave to
    find better medical follow up and rehab out of the State of Washington.




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                                 Statewide TBI Housing Needs Assessment June 2011
                                                                       Family, Care Providers, and Friends Thoughts (continued)

24. I think That the housing opportunities need to be safe, and in an area of the community that does not
    have safety issues. Ideally, with the number of TBI's increasing in this state, a community could be built
    that could operate somewhat like a kibbutz, and the TBI community could live side by side, and have a
    special product that they could produce to sell on the open market to help maintain the expenses of the
    community, and that would give the victims a feeling of accomplishment, accountability, and feelings of
    pride. It would be complicated to create, due to needs for staff, etc, but I feel it would be worth it.
25. Housing for TBI survivors would greatly benefit each survivor and their family. Separate housing units
    for TBI patients would give them greater opportunity to thrive in their recovery. It would also provide
    families with the opportunity to spend more time with their family member and participate more actively
    in the recovery process.
26. My husband lives at home with me and our kids. He is doing extremely well after years of therapy and
    now, school. I can't speak to any situation outside of mine.
27. Reduce cost full ingress and egress falls prevention in house counseling and support groups privacy
28. Read book this book: "Unanticipated Gains". To appreciate the value of an institution (in this case
    daycare facilities) as a astonishing broker of resources to it's members. Every victim of TBI is different,
    unfortunately. ―Individualized ―placement is a necessity. Frankly a group-home approach my not be
    ideal, living among the healthy may be a better all around. Just as housing a group of the deaf or blind
    together seems a poor idea . Primarily encourage the community as a whole to feel good about
    welcoming person with a brain injury into an apartment next door. This would involve education and an
    easy to grasp narrative for EACH of the injured. Thank you.
29. Non-profit housing providers must begin to service TBI and other people with disabilities. Currently this
    population is primarily served by these providers are seniors. Non-senior disabled people are not being
    targeted. And the TBI population is the least served of all of these groups. The State needs to provide
    better funding resources to encourage these non-profit developers to build housing with special needs
    care facilities and services for TBI residents.
30. You need more outreach programs. Right now, I have never received ANY information with regards to
    what is available.
31. Comprehensive surveys as to what is needed by the individual in helping meet their needs and a detailed
    description of what can be provided for housing. What is involved with applying for and securing such
    housing.
32. Individual counseling or assistance regarding a suitable place to live.
33. To make sure they have a place to live
34. Have options for people with brain injuries that are not adult family home residents who are severely
    impaired and totally dependent. Awareness of the many survivors who need help with their
    independence!
35. A small group home on Vashon would be very helpful. The community is already supportive.
36. There is only one place in our area that I know of for people with disabilities and that is for severly
    disabled people. My daughter has a TBI but is higher functioning but can't live on her own. I would love
    to see a place in our area that she could live at to learn how to live on her own but still knowing that
    there is someone there to make sure she is safe and supervised. If she lived on her own she would be
    victimized because she is so trusting. In the mason county district there is no help for brain injured
    people. I hope that someday we will see more help for families here because we have to travel to other
    areas to get any kind of help. My daughter will never move from here and most care facilities don't have
    a lot of experience with brain injuries so it can make the situation worse because they feel and work with
    people as if brain injuries are the same as any other disability.




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                                 Statewide TBI Housing Needs Assessment June 2011
                                                                       Family, Care Providers, and Friends Thoughts (continued)

37. Have a range of options for people, from group homes to individual apartments in buildings with other
    populations to smaller apartment buildings for people with TBI that include support services in the
    buildings. Have those housing options located near transportation (especially bus lines), shopping,
    medical and mental health providers. Have one or more housing specialists in each area of the state to
    help people get into housing that fits their needs and is affordable to them.
38. Let them live in a supervised group home that is affordable Less than $400/month
39. My son is 10 years out from his TBI and is very functional. He works at a part time job, but still requires
    care to manage finances, medications, transportation and provide activities. It would be wonderful for
    people like him to be able to live in semi-supervised housing with opportunities for meaningful
    activities. I believe the Developmentally Disabled community has housing like this. Perhaps this model
    could be studied. It seems like most housing is for TBI survivors is set up for the very physically
    disabled.
40. I am not sure this box is big enough for my thoughts. There are a lot of people like my son that have
    brain injuries but are very high functioning. Not good enough to get a job in our society but a ton of
    things and jobs he could do if we could find employers with a little empathy, patience and time. They
    would benefit with having employees that show up every day, happy to be there, happy to work and
    would give 110% every day and not play the crazy games a lot of employees do. Woops, I guess this
    isn't housing answers is it? So my thoughts on housing would be maybe a sustainable small farm
    situation with yard work and responsibilities. Maybe having several small houses on some acreage so
    they would have friends, maybe getting the community involved and them involved in the community. I
    think that is more important that where. If my son lived in an apartment - which he does - and could be
    involved in society, working, being active and having friend, living in an apartment would more be so
    confining. Living in an apartment also 99% of the time helps no one, especially the disabled.
41. We don't have to deal with that, so I haven't thought of what other kinds of accommodations we might
    need.
42. Can't speak in general, but our child needs much supervision and oversight to maintain good
    equilibrium. Shared housing opportunities, with separate space for each resident, together with 24 hour
    staff on site make expenses within reach. A tall order, we know.
43. Right now it seems that the state and health departments look at brain rehab as experimental, there
    doesn‘t' appear to be any good programs out there that the state and or medical insurance covers.
44. A centralized listing service for all types of living facilities for the disabled would be a great benefit and
    probably not be very expensive to build/maintain. Pursue and establish cooperative living facilities with
    other organizations that assist the disabled. Does the military have any programs for TBI injured
    soldiers? Those soldiers may benefit from interaction with civilians with similar disabilities and needs,
    and vice-versa for younger TBI injured civilians.




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                                 Statewide TBI Housing Needs Assessment June 2011
          SECTION 7
     Surveys and Interviews
    Professionals and Policy Makers

Attachments

  1. Survey for Professionals and Policy Makers
  2. Interview Script for Professionals and Policy Makers
  3. Comments from Professionals and Policy Makers




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                        Statewide TBI Housing Needs Assessment June 2011
                          Professionals and Policymakers Survey Results
Methodology

Surveys (see attachment #1) were mailed and emailed out to 257 people. They could be completed and mailed
back or there was a link for SurveyMonkey.com provided on the survey where the survey could be completed
online.

The key question on the survey was:

      Please share any thoughts you might have on improving the housing opportunities for people with a
       traumatic brain injury.

A follow-up phone interview was scheduled for (53) professionals and policymakers who:

   1. Responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could we contact
      you?‖

   2. They provided us with an email address and/or a phone number.

See attachment #2 for a copy of the phone interview script. The following were the key questions for the phone
interview:

      On your survey you shared (some of your specific thoughts) on how to improve housing opportunities.
       Could you elaborate a little more on your thoughts about this?

      Are there other ideas, concerns, experiences…that you would like to share about ways to improve
       housing opportunities?

Findings

To date, there have been 95 completed surveys submitted from 25 different counties. The
return rate based on 257 surveys sent out is 37%.

The key survey question was:

―In the space below, please share any thoughts you might have on improving the housing opportunities for
people with a traumatic brain injury.‖

In attachment #3 are (11) pages of open-ended responses by professionals and policymakers to this key survey
question.

After reviewing the responses, we have grouped them as follows:

      26 responded that there were no options or no appropriate options in their area. People were put in
       places with the elderly, people with dementia, or people with developmental disabilities.
      16 responded that housing that had staff trained specifically for people with a TBI and a home that
       specialized in TBI.
      13 responded about the need for affordable housing.

                                                    36 | P a g e
                                   Statewide TBI Housing Needs Assessment June 2011
                                                                          Professionals and Policymakers Survey Results (continued)

        (Groupings)
       6 responded about the need for accessible housing.
       5 responded about training for staff to work with people with a TBI.
       3 responded about rental history problems and the need to work with landlords.
       There were a number of comments about: supported living model like DD; homeless prevention;
        financing for accessibility modifications; reach out to housing coalitions; apartments with resident
        assistants; more Rehab Without Walls and Terry Homes; pay advocates and lobbyists to get more
        services.

To date, we have conducted 35 phone interviews with Professionals and Policymakers.

The following are responses to key questions from the phone interviews:

       More housing with on-site services or staff that come in
       A tiered approach towards housing that provides different levels of supervision
       More affordable housing
       On-going training and support for caregivers;
       Accessibility for homes
       Training for staff in TBI
       Incentives to AFHs to specialize in TBI
       The need for ―pooling‖ Medicaid funded hours and the Clustered Care model
       Respite care, planned and emergency
       Look outside the scope of AFHs and Boarding Homes for housing solutions
       On-site service coordinators at apartment sites
       Mockingbird Family Model adapted for TBI
       Care Assessment is not a good tool to measure or assign a score to complex
        cognitive challenges. People end up receiving far fewer support hours because
        they are physically able and come off well in answering questions. However,
        their verbal ability on how to complete complex tasks and their actual ability to
        initiate, remember, and complete those complex is often quite different. The
        net result of the test not being sensitive enough, is that some people end up in
        more restrictive setting who would not necessarily be there if they had more
        hours.

Recommendations

   1. The Care Assessment tool may need to be modified or an additional assessment tool might need to be
      included when measuring the complex cognitive challenges that a person might have. Given that the
      score then translates into hours of service, this would have a profound effect on the housing options that
      might be available to someone with more hours of support.

The Mockingbird Family Model is worthy of evaluating its potential benefits to people with a traumatic brain
injury and family members. It includes a level of peer and family support, planned and unplanned respite care,
shared activities, training and support from professionals, and some very positive outcomes based on the current
participants.



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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #1
                         Survey for Professionals & Policymakers
        In the Field or Who Have an Impact on People with Traumatic Brain Injury
The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned Terry
Home to complete a statewide housing needs assessment for people with a traumatic brain injury. This survey is
part of a larger effort to collect housing related information. This survey should only take a couple of minutes to
complete and your input is very important to people with a traumatic brain injury. Thank you in advance.

You can complete this survey online by typing this link into your internet address bar:
www.surveymonkey.com/s/tbi_professionals_policymakers

   1. What city do you work in?_____________________________________

   2. Who do you work for?_____________________________________________

   3. Briefly, what do you do that in some way interfaces with or has some impact on people with a
      traumatic brain injury?
      _______________________________________________________________________
      _______________________________________________________________________

   4. Please share any thoughts you might have on improving the housing opportunities for people with
      a traumatic brain injury (use the back if you need more
      space_______________________________________________________________________________
      _____________________________________________________________

   5. If we wanted to ask you some follow-up questions, could we contact you?

        Yes ___ No ___
       If yes, please provide us with an email address and/or phone number.
        ________________________________________________________________

   6. Your name (optional)_______________________________________

Thank you very much for your participation!!
Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
or type the SurveyMonkey link above to complete the survey online.




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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #2




                   Interview Script for Professionals and Policy Makers

Date________ Interviewer_________________ Start Time____ End Time____
Type of Contact: ___In person ___Phone
Name of person being interviewed:____________________________________

INTRODUCTION

My name is _______________________. I am following up on the TBI housing needs assessment survey you filled out
where you said we could contact you if we had more questions about housing and traumatic brain injury. Is this a good
time for us to talk?
(Before the interview, review the person‘s survey responses and modify the questions accordingly.)

   1. On your survey you said that you interface with people with a traumatic brain in your position as a
      ________________________________________________ Can you tell me a little more about what
      you do?


   2. On your survey you shared _____________________________________________________ on how to
      improve housing opportunities. Could you elaborate a little more on your thoughts about this?


   3. Are there other ideas, concerns, experiences…that you would like to share about ways to improve
      housing opportunities?




Thank you for your time!!




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                                      Statewide TBI Housing Needs Assessment June 2011
Attachment #3
                                   Professionals and Policy Makers
                               Open-Ended Responses to Survey Question
                                Other Comments on Housing for People with TBI

   1. There are no established housing opportunities in Whatcom County for people with head injuries. Needs:
       Transitional units designed to support people who have potential to re-integrate into community or live alone. 2)
       Housing for people with moderate to severe head injuries (presently the choices are to d/c to nursing home,
       dementia care units or to adult family homes with individuals with developmental disabilities. None of these
       housing opportunities specifically serve the needs of the TBI population.) Housing needs to be accessible, in areas
       that are safe (i.e. not on busy intersections), preferably with access to the outdoors, access to transportation, in a
       physical environment which supports recovery and optimal functioning, etc. Also, staff trained specifically to
       work with people head injuries as they need careful and specialized support to be successful and maximize
       function and outcomes.
   2. There is a lack of housing for pts that have had brain injury and need 24 hour supervision.
   3. Many brain injury sufferers are on DSHS and there are no adult family homes that will accept them with this low
       form of payment. They often end up in a nursing home and they don't need that level of care. They don't need to
       be institutionalized; they just need someone to keep them safe by supervising. We need more home-like settings
       specializing in brain injury.
   4. We need group homes with all the properly trained staff in place.
   5. Our patients need to continue their course of rehabilitation after they leave our unit, and many of them have
       difficulty finding housing that will accommodate their special needs even if only for a short while. I think a plan
       for short-term housing designed to allow patients freedom and time/space for therapies, while providing a safe,
       therapeutic environment is needed in our area. The space should provide ground level dwellings that are fully
       accessible and economical for patients that may have to be out of work for an extended period of rehabilitation.
   6. High level TBI‘s often do not have an intermediate place to stay after their acute and sub acute treatment is
       completed. Unless they have family willing to provide 24 hour assistance and work with them they unfortunately
       end up in an ECF or on their own. Neither of which provide an environment for recovery, ultimately costing more
       for long care of these individuals.
   7. Having a specialized home for people with TBI would improve the person‘s quality of life and the community
       quality of life.
   8. More spaces. Housing close to bus routes. Accessible housing as clients may be using wheelchair part of the day.
       Help provide structured environment and low stimulation--allow clients time to relearn daily living tasks w/
       tapered support.
   9. A successful example of providing residential support could be based around the ―Supported Living‖ services
       model, which is offered by DDD. Services and supports are built around the person‘s needs and may vary from a
       few hours per month up to 24 hours per day of one-on-one support. The supports could include areas of home and
       community living tasks such as maintaining the home, paying bills, preparing meals and personal tasks. Supports
       in the community may include going to public places and participating in recreational activities, shopping, and
       connecting with friends and relatives.
   10. Frequently we have pts that we have great difficulty finding placement for secondary to their TBI.
   11. Housing is needed! Currently, many of the TBI patients in the community, once discharged from the hospital
       and/or the Rehabilitation unit immediately becomes homeless. IF they have family or other supportive friends
       who take them in after the acute phase of injury, oftentimes, their 24/7 care and/or behavior not only changes their
       relationships - but often leads the family/friends to make the difficult choice of telling the person with a TBI they
       need to leave their residence. This again often leads to homelessness.
   12. There is a great need for adults with TBI who require 24/7 supervision for their ADLs, mobility and community
       reintegration. These patients may need temporary to permanent 24/7 supervision depending on the severity of
       their TBI.TBI patients need a place to live as well as accessibility to medical services. There are no places that
       specialize (in terms of housing) with this population to meet their needs for housing, community re-entry, or job
       opportunities.




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                                       Statewide TBI Housing Needs Assessment June 2011
                                                                             Professionals and Policy Makers Thoughts (continued)

13. In Whatcom County we have a real dearth of options when patients with TBI discharge from our unit. They are
    sometimes forced to go to a skilled nursing facility, and often an adult family home is not able to handle the care
    needs of a patient with TBI, or the ones which do are too distant or do not have space available. Generally
    speaking a SNF is not the best option for someone with TBI and so a specialized unit would be much more
    appropriate.
14. Financing for people to retrofit their houses post traumatic brain injury.
15. Increased education for community and professionals to better understand and develop skills to work with TBI
    behaviors. Ignorance hinders acceptance. Day programs and related services for people with TBI.
16. It would be great to have a facility that was similar to an ALF where there is staff accessible to assist this
    population at home.
17. People with traumatic brain injuries often have trouble being a participating member of society and so assistance
    with housing would decrease our homeless population.
18. Affordable, accessible housing is a great need since many individuals who have experienced severe TBI need to
    receive disability payments and have limited funds. Housing with structure and supervision would be an
    additional benefit.
19. Developing housing options such as Adult Family Homes, Assisted Living Facilities, and or apartments that will
    accept younger TBI people would be a wonderful addition to our community. Currently there a very few and
    limited housing options for the younger TBI person/
20. House which ignores prior evictions or crimes as TBI clients is typically very different people then they were.
    Congregate Care units would be nice. Client could have their own space monitored by caregiver a few minutes at
    a time as needed.
21. In general, need more housing! It generally needs to be handicap accessible.
22. A major issue is affordability. Second is creating a doable process for those who cannot manage the stress and
    paper work involved in getting access. I
23. Clients with traumatic brain injuries have specialized needs. Quite often they are highly functioning physically
    but require a higher level of supervision and cuing to participate in instrumental activities of daily living.
24. These patients frequently require 24 hour supervision, which working family members are not able to provide.
    Finding a place for them is very challenging. They may go to dementia units, nursing homes, or adult family
    homes (rarely). Rehab's goal is to foster independent living. For them to have a place to live that understands
    brain injury, and supports their recovery and long term quality of life would be most appropriate for this
    population. I think a group home specializing in brain injury is the setting of choice.
25. I think the following there are two systems that would work well with this population: 1) following the
    Development Disability model of Contracted Supported Living, where people have their own apartments in a
    complex and there is staff on site for help. 2) For people that need more hands on help 24/7, an Adult Family
    Home would be perfect. Since we have an in-pt. rehab unit at St. Joseph PeaceHealth, it would be great to be able
    to transition people to one or both of these types of sites.
26. There are very limited options for housing for these patients. They often need 24 hour supervision-level care
    because of cognitive impairments, but may not need the significant physical help available in a nursing home
    setting, and yet they end up in a nursing facility for lack of other options. These patients are often younger, more
    physically able, and do not fit well into a nursing home environment. An adult family home or group home
    specifically for brain-injured patients would improve options for care and safety of these patients in the
    community.
27. We need more adult family homes that specialize in TBI. We need more affordable housing for TBI/SSI
    recipients with very limited incomes.
28. I am unaware of any designated housing for people with traumatic brain injuries in our community. We see a lot
    of this diagnosis in our inpatient rehab program as well as outpatient therapies. Issues with accessibility,
    augmentative communication. Environmental controls etc. are always issues. As our community grows, and with
    our relative proximity to Seattle, but still being a more "isolated" area, it is important that the best housing options
    are available. It would be a great benefit to our community if the Opportunity Council is able to build a facility to
    meet these needs.Currently there are very few options for pts with TBI in our area for those who require
    supervision for ADL or have any acting out type behaviors.


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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                             Professionals and Policy Makers Thoughts (continued)

29. There is a need for housing that promotes the independence of persons with a TBI while providing necessary
    community supports at the same time.
30. The affordable housing situation is very tight in Whatcom County, and the waiting period for public housing
    (subsidized) can be as long as 6 years. The waiting list for Section 8
31. Housing Choice Vouchers has been closed since 2007. People with TBI may have extra problems if they ever
    have trouble with a landlord and are evicted- they are then excluded from most housing. Specialized housing
    services for people with TBI would prevent their becoming homeless in this way.
32. This is a very challenging population that requires special skills to provide care for. They don't seem to just fit in
    to our regular programs.
33. There are NO options currently in Bellingham or Whatcom County for TBI housing.
34. Unfortunately, sometimes individuals have to take residence in ECFs (more costly) or locked dementia units due
    to poor housing (this is in regarding to those with more severe TBI's)... For those with milder TBI, it is also
    difficult to find placement, sometimes out of area completely away from any social/family support.
35. All but one of my residents with TBI would qualify for lesser care settings such as an Adult Family Home or a
    high level care Assisted Living Facility. But, due to regulations such as age and lack of homes willing or able to
    take on TBI residents many of these individuals are "stuck" in a Skilled Nursing Facility. If there were more
    homes available for the under 60 or even 50-40 set then there would be less men and women stuck in Skilled
    Nursing Facilities and therefore, really save the state money due to smaller homes having less overhead costs.
36. Provide group homes specifically designated for people with TBI or ABI
37. Various housing coalitions already exist. Please reach out and share findings/needs with other coalitions Specific
    housing issues applicable to TBI folks would benefit an aging society.
38. Housing in general is very limited. When specialized needs are represented it becomes more limited. Many with
    TBI need closer supervision than those without that injury. If they do not have family or friends to assist, their
    circumstances can become very dire. I feel that appropriate housing would need to include case management and
    staff available to assist 24/7 to help keep this type of client safer than living in single person dwelling. Of course,
    building more housing would make more available for all populations.
39. People with TBI are often challenged by their rental history. It would be helpful to have some sort of program that
    assists them in developing a good rental history or that somehow vouches for them so that landlords will rent to
    them.
40. Honestly, I know fairly little about what is available although the report of caregivers is that there are generally
    limited opportunities and those that exist offer little specialization. For instance, I recently evaluated a stroke
    victim that remained fairly high functioning in many ways but whose motor deficits made it impossible for his
    aging wife to care for him at home. The locale where he was currently living was populated by individuals with
    severe developmental delays or such serious injuries that he shared little in common with them.
41. Despite attempts to provide intellectual stimulation for him it has been a difficult situation.
42. Section 8 housing vouchers
43. I think training needs to happen with community landlords-for profit and non-profit landlords because often
    landlords don't understand the complexity of those with TBI. It often leads to evictions when landlords get
    frustrated with those with TBI. Some assistance for those with more severe TBI with daily living skills and
    teaching those skills to live independently.
44. My ideal for those who could live independently but need cognitive and mild to moderate behavioral assistance:
    Apartments with life support specialist (salary paid in part by pooling funds from residents, in part from other
    source) who could meet with residents re schedule planning, task organization, etc. on a regular basis and be
    available for questions (almost like an RA in a college dorm but with more skills and some scheduling). In the
    same way, more community supports to maintain persons with TBI in their own apartments - the above idea in a
    mobile form. I think it would be important to have clients pay at least a nominal fee for these services. I would
    support housing pods in housing that does not completely separate persons with TBI into a separate community
    but allows for some peer support and interaction. However, this concept would not necessarily work as well for
    persons with moderate to severe behavioral challenges. There is a need for more structured support for persons
    with behavioral challenges and impulsivity.



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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                         Professionals and Policy Makers Thoughts (continued)

45. Need better training for caregivers specifically on how to deal with behaviors manifested in TBI clients. Need
    specialized facilities, as most that take Medicaid are for elderly or physically disabled. TBI clients tend to be
    younger and many have behaviors that make them not fit into these facilities.
46. Accessibility and safety are the two primary issues. I love the cottage type scenario where an individual can have
    their own apt or small home and share meals and vocational activities with others. I think an assisted living type
    set up is idea, but the peer group of seniors is not.
47. An AL for TBI would be great.
48. Coordinate with Rehab without walls. They are now CARF accredited.
49. Many clients have an inability to remember dates, events and have poor social skills due to TBI along with
    medications; it makes it difficult to find housing for these clients.
50. Flexibility in age requirements. Case management and communication with schools to improve
51. As there are NO housing opportunities specific to the TBI population in the Gig Harbor/Tacoma area,
    ANYTHING would be an improvement!
52. More low income housing recourses.
53. I don't have any knowledge of this issue upon which to base any thoughts or comments.
54. Adequate support services in place including housing case management, peer support and/or mentors. Activities
    and employment opportunities that allow people routine and self-sufficiency progress.
55. Funding!! These folks often are not able to pay market rate rents, so a housing subsidy is necessary, and, of
    course, funding for case management/mental health needs. To that end, the VASH program should be increased,
    and; we'd like to use Grant and Per Diem funding but the match requirements are onerous. If the state could help
    with the match, that would be awesome and would help draw in large federal dollars for acquisition or
    development of Vets housing.
56. These individuals need support in both personal hygiene and up keep of their housing environment. To put these
    individuals in to housing and expect them to maintain a neat clean environment is setting them up for failure, they
    must be supported
57. I have a dream that before I retire that Snohomish County will have a housing first program for individuals who
    are TBI, Mentally Ill, or Autistic (Aspesbergers). As long as I'm dreaming how about a boarding home system
    that allows for criminal offenders who are mentally ill, TBI individuals. Find ways to illuminate current barriers
    in the system.
58. Having more housing available and more awareness of current availabilities would be beneficial
59. Of course it is impossible to talk about people who have a TBI as a unitary group. There needs to be a range of
    housing supports. Perhaps the most difficult support to come by in that range is practical, daily support for people
    living in their own homes who need assistance in getting organized and carrying out the activities necessary to
    live independently. Along with that, some people will need rent subsidies if they or they their families have been
    unable to secure an adequate income. There are some who might need on-call staff 24 hours. Whatever else,
    housing supports need to be flexible and to be able to serve not just the person who has a TBI but in some cases
    the whole family. Supports need to be flexible also because some people will need very little assistance - perhaps
    help with budgeting and bills every two weeks. Please keep in mind that the people I have served are often those
    with greater than average needs so my perspective is definitely narrow.
60. Ensure Boarding Homes receive as much in daily rates as nursing/retirement homes.
61. Provide more housing for survivors of TBI in smaller setting so it feels more home-like instead of institutional.
62. Affordable housing for people with disabilities is very scarce. Close work needs to be done with the county‘s
    housing people and the Housing Authorities. These organizations need to prioritize housing for people with
    special needs such as brain injuries and mental illnesses.
63. More housing and services will be available for people with brain injuries when there are people paid to advocate
    for it and to develop it. There is no easy and cheap solution that I am aware of.
64. Identify, then locate a therapeutic community concept in scatter-sites in a city/county. Might possibly bring TBI
    clients and caregivers into a geographic center for mutual support and security. If housing options range from
    owning to renting to shared living and group homes; the concept could be inclusive of a larger number of
    individuals. Also, a critical need for routine assistance handling clutter and chaos in the home. Could reduce
    stress/anxiety and increase safety while safeguarding assets of the individual with TBI.


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                                   Statewide TBI Housing Needs Assessment June 2011
                                                                          Professionals and Policy Makers Thoughts (continued)

65. Most of the offenders we work with are not severely affected by their TBI but do need some type of support,
    either financial or ADL support. Those with severe TBI are very difficult to place in long term care facilities due
    to their criminal history as well. If there were more facilities that catered to specific populations that might help.
66. It has been documented through the Seattle Office of Housing that there are substantially fewer new rental
    housing opportunities for people with TBI (and for people with DD) than actually represents the growth of both
    issues in the community. There needs to be a strong focus on developing affordable housing opportunities that
    include a service component to adequately support people with TBI in the community. Not all housing is
    appropriate for people with special needs -- and while studio apartments are great, there are many people with
    TBI who need the ability to live with others so that their service needs can also be met. Until both ends of this
    question are answered, people with TBI will have fewer choices than non-disabled individuals in the community.
67. The Terry Home is one of the few housing opportunities for people with TBI in this area. They have quite a wait
    list, and there are many other individuals in the state that could benefit from housing such as the Terry Home.
    Individuals with TBI need a safe, caring place that is able to tailor their services to the survivor's needs.
68. Caregivers would benefit from specialized training in TBI, younger people living with TBI would benefit from
    housing opportunities with families their own age rather than in mostly senior housing, transportation is always an
    issue rurally, support groups and counseling provided locally would be beneficial
69. full ingress and egress for people with TBI and their visitor‘s computer software to increase communication, such
    as dragon naturally speaking, reading software, etc. ongoing training and support, in-house, for caregivers
70. For veterans, it may be beneficial to focus on VA facilities and get their recommendations. They may have the
    best experience and visibility of challenges. Service members on active duty have a unique route of addressing
    housing concerns. The transition from active duty to veteran status (ACAP) provides a time and place to identify
    and target those with the greatest needs. Aside from financial considerations, the cognitive ability of those with
    moderate and severe TBIs, may challenge them in obtaining safe housing. A tiered approach that provides a level
    of supervision such as a community home or assistive care as well as non-supervised low income housing will be
    needed by some. The idea of using the Soldier's home for those with the greatest challenges is ideal. A point of
    contact that can walk the veterans with TBIs through the resources and help them to make decisions would be
    wonderful. TBI is rarely a standalone concern. It is complicated with post traumatic stress and multiple other co-
    morbidities. To adequately address the housing concerns for veterans, the broader picture has to be taken into
    consideration. The stress of adjustment, employment, family support, and other environmental factors are but a
    few areas that need exploration. The work you are doing is very important.
71. More housing for TBI survivors (mild to severe) with access to in home rehab therapy.
72. not sure what is out there. I know that there are boarding houses and some adult family homes. how do teenagers
    transition into after they mature out of school system and all?
73. Increase the number of housing units and Adult Family Homes trained in the care of young adults and adults.
    Convert an apartment complex into a life skills training center where one can learn how to live a more
    independent and productive life. There would be living units on the complex but the life skills training would help
    individuals advance their skills and transition into regular housing.
74. This really depends upon the level of needs. One area of great need is for interim, structured care for those not
    ready to return to independent living. Often with a significant injury it can take months before one with the TBI
    has enough return of their executive function and brain energy to function well enough socially, physically and
    financially to be independent or semi independent. When survivors return home too early, their family is often
    overwhelmed and become burned out. Adult family homes set up for those working toward independence could
    be very helpful.
75. Better education for patients and their families. Better information/education to the places that care for TBI
    survivors. More PSA's on TV and radio?
76. In my area (central WA) there are NO housing opportunities for people with TBI. I constantly need to refer
    patients to a more structured living setting such as a group home, or a setting where there is a degree of assistance,
    such as with bill payment and medication compliance, that falls short of a full-on nursing home situation...but
    there is NO PLACE that even resembles this level of care or guidance. It seems like the only living situations
    even remotely approaching what we need are those set aside for drug and alcohol users in



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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                               Professionals and Policy Makers Thoughts (continued)

      recovery, or for people with severe chronic mental illness. However, mixing TBI survivors with these populations
       is a recipe for disaster. We are in desperate need out here in Central Washington. We have a very high number of
       individuals sustaining TBI's, primarily due to the agricultural and blue-collar work that forms our economic base
      in this part of the state, but it seems like all TBI funds and services are spent/directed to Seattle and the West side.
77.   Just like those who are disabled in other ways there is not enough affordable housing available. People with TBI
      have difficulty maintaining housing because of their specialized needs such as: Anger Management, low tolerance
      for noise or crowds and severe memory loss to negotiate and/or problem solve with family, caregivers, neighbors
      and landlords. Angry rages result in property damage or other tenants feeling threatened.
78.   It would be great to have more transitional housing available with basic support from someone who lives on site
      and checks in with residents on a daily basis to make sure they are doing alright.
79.   Much work needs to be done to help identify the housing needs/requirements/criteria of TBI patients which would
      include input from the TBI client, the care giver, the therapists, doctors and other professionals. State & Federal
      VA housing/homeless coordinators & county & state housing experts need to be involved to find multiple options.
      This survey is certainly a great first step in getting input and ideas.
80.   Housing needs to be affordable and accessible, without long waiting lists.
81.   I wish that the DSHS-provided housing options had ABI/TBI as a drop-down option.
82.   Presently there is only DD, Alzheimer's, Mental Illness for options. Brain injury is similar to none of these options
      yet there are SO many people with brain injuries requiring subsidized housing. It would be so great if they could
      live with others with similar challenges.
83.   A broader range of information would be helpful. I had a very difficult time placing one of my TBI clients. He
      almost died on the streets before I could get him the help he needed. I think that if there was more
      information/education about how to manage folks affected by TBI we would have a better understanding of what
      clients can tolerate and what other service providers can reasonably expect. Most housing available to low income
      individuals is not tolerable to folks with TBI. It would be lovely if there were more funding and housing available
      to focus specifically on TBI clients. I found that the AFH has been the most tolerable for my client. It has literally
      saved his life.
84.   Gather data on: --Current state of available housing --Trends over past 10 years --Funding issues --Demand
85.   Remember the people.
86.   So far, those we work with are active duty or National Guard and Reservists. I have not heard of any of them
      losing their homes but I have read of it happening in the news papers.
87.   Provide outside support and encouragement to individuals accessing low income housing service
88.   I see 3 distinct levels of need: -residential care: long term residences that are staffed 24hours, can provide care
      services, supervision and behavior management, specifically for younger people -group home options: boarding
      homes with supportive services, daily or several times weekly for people who manage their personal care needs
      with little or no assistance, who can come and go without supervision and who require intermittent supports for
      meals, financial management, etc. -independent housing options: advocates to help find, acquire and maintain
      subsidized apartments. including payee services when this is needed to ensure bills get paid and documentation is
      completed as needed.
89.   There is a severe shortage of housing available for homeless or mentally ill persons. There would also be a
      shortage for those persons with TBI, some of which are my clients. As many of these persons end up on the street,
      homeless, and in the hospitals or jails, funding for secure housing coupled with case management would do much
      to decrease the high costs of providing services to such high utilizes of services (ER, hospitals, and jails).
90.   Increased availability of supported housing and group housing.
91.   Brain Injury specific adult family homes, boarding homes, congregate care homes. BI victims need to be housed
      with younger folks, not just general AFH's. Also, an opportunity to have more age appropriate
      activities/interactions would be great.
92.   Housing resources in our area are generally very limited for people with limited resources. Even more so those
      who are in need to additional services to help with daily tasks.
93.   Have colleague in Tacoma who works for Housing Authority. Suggest involve him.
94.   Create more options for people with TBI so they can live independently.



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                                      Statewide TBI Housing Needs Assessment June 2011
          SECTION 8
     Surveys and Interviews
               Adult Family Homes

Attachments

  1. Survey for Adult Family Homes
  2. Generic Interview Form for Phone Contacts




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                       Statewide TBI Housing Needs Assessment June 2011
                                            Adult Family Homes
                                              Survey Results
                                              General Information

There are currently 2,867 licensed Adult Family Homes (AFH) identified on the DSHS website in WA. To
locate an AFH by county, city, zip code or by license number, you can go to the DSHS Adult Family Locater at:
fortress.wa.gov/dshs/adsaapps/lookup/AFHAdvLookup.aspx.
The Legislature has passed RCW Chapter 70.128 governing the formation, licensing, and operation of AFHs.
These can be viewed at apps.leg.wa.gov/rcw/default.aspx?cite=70.128.

The AFH is a residential home licensed to care for up to six non-related residents. They provide room, board,
laundry, necessary supervision, and necessary help with activities of daily living, personal care, and social
services. If you are considering care at an AFH or are interested in starting one, you can view detailed
information on a variety of related topics at the DSHS website at: www.aasa.dshs.wa.gov/professional/afh.htm.

Most AFHs accept payment for services from Medicaid through a contract with DSHS and from individuals or
family members paying privately. The AFHs are operated by both profit and non-profit corporations.

Methodology

A survey (see attachment #1) was mailed to all 2,867 AFHs that were listed on the DSHS Adult Family Locator
website. In addition, the Washington State Residential Care Council of Adult Family Homes (www.wsrcc.org)
also sent out the surveys to their members by mail and email with a cover letter encouraging them to participate
in the needs assessment. Surveys mailed out could be completed and mailed back or there was a link for
SurveyMonkey.com provided on the survey where the survey could be completed online.

The following were the key questions that were asked on the survey:
   6. Has a person with a brain injury ever lived in your home?
   7. If funding and training were available, would you consider a person with a brain injury?
   8. Do you accept people funded by Medicaid?

A follow-up phone interview was scheduled for AFH providers that submitted surveys back with the following
responses:

   1. They responded ―yes‖ to the question: ―Has a person with a brain injury ever lived in your
      home?‖
   2. They responded ―yes‖ or ―maybe‖ to the question: ―If funding and training were available, would
      you consider a person with a brain injury?‖
   3. They responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could
      we contact you?‖
   4. They provided us with an email address and/or a phone number.

       See attachment #2 for a copy of the phone interview script. The following were the key questions for the
       phone interview:




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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                                 Adult Family Home Survey Responses (continued)

   1. On the survey you indicated that you have supported a person with a brain injury at the home.
          Do you currently support a person with a brain injury?
          If so, how long have they lived there?
          Do you remember where they lived before moving in with you?
          If you do not currently support a person with a brain injury, when was the last time that you did?
          Do you remember how long they lived at the home?
          Do you remember where they lived before moving in with you?
          Do you remember where they moved to?
   2. Have you had any particular problems with supporting a person with a brain injury?
           If yes, what problems have you had?
           Did any of these problems cause the person to leave the home permanently?
   3. Do you currently have a vacancy?
           If yes, how many?

Findings

To date, there have been 252 completed surveys submitted from 23 different counties. The return rate based on
2,867 surveys sent out is 9%.

Key Survey Questions:

Has a person with a brain injury ever lived in your home?
95 said YES
111 said NO
15 were NOT SURE

If funding and training were available, would you consider a person with a brain injury?
163 said YES
14 said NO
43 said maybe

Do you accept people funded by Medicaid?
161 said YES
 29 said NO
31 said MAYBE

To date, we have conducted 43 phone interviews with AFH providers.

No one stated that they terminated anyone because of their behaviors although 14 reported continuing behavior
problems, some aggressive in nature.

26 indicated that they currently support a person with a TBI, with (2) supporting 2 people.
            14 people were there for up to 2 years.
            8 were there between 2 and 4 years.
            6 were there for more than 4 years. The (3) longest stays were 11, 13, and 15 years.



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                                   Statewide TBI Housing Needs Assessment June 2011
                                                                                  Adult Family Home Survey Responses (continued)

Almost all the people moved in from a hospital, a nursing home or another AFH. It was pretty evenly split
between the three.

There were 7 people that moved out: 2 each to independent living, family home, and another AFH. One person
went to a nursing home.

Recommendations

Given that 24 out of 26 AFHs were supporting just one person with a TBI, the question is whether it would
might make sense to pilot a few AFHs in different geographical areas that were age and disability appropriate,
especially for young adults with a traumatic brain injury.




                                                     49 | P a g e
                                    Statewide TBI Housing Needs Assessment June 2011
Attachment #1
                                 Survey for Adult Family Home Providers
                             Traumatic Brain Injury Housing Needs Assessment

The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned Terry
Home to complete a statewide housing needs assessment for people with a traumatic brain injury. This survey is
part of a larger effort to collect housing related information. This survey should only take a couple of minutes to
complete and your input is very important to people with a traumatic brain injury. Thank you in advance.


   1. Has a person with a brain injury ever lived in your home?
             □ Yes □ No □ Not Sure

   2. If funding and training were available, would you consider a person with a brain injury?
            □ Yes □ No □ Maybe

   3. Do you accept people funded by Medicaid?
           □ Yes □ No □ Maybe

   4. What city is your home located in?
      ______________________________________

   5. If we wanted to ask you some follow-up questions, could we contact you?
              □ Yes □ No
      If yes, please provide us with an email address and/or phone number.
       ________________________________________________________________

   6. Your name (optional)
      ___________________________________________

                             Thank you very much for your participation!!
               Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
                                                   or
          You can complete this survey online by typing this link into your internet address bar:
                         www.surveymonkey.com/s/tbi_adult_family_home_providers




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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #2



                    Phone Interview Questions for Adult Family Homes
     Date ________        Interviewer ______________                  Start Time_______   End Time________

                                    Type of Contact: ___In person ___Phone

               Name of person/organization being interviewed: _____________________________

                                              INTRODUCTION
My name is ______________. I am following up on a DSHS sponsored housing survey that you filled out. You
 indicated on the survey that we could contact you if we had more questions about housing and brain injury. I
just have a few follow-up questions that should just take a few minutes of your time. Is this a good time for us
                                                    to talk?
      (Before the interview, review the person‘s survey responses and modify the questions accordingly.)

   4. On the survey you indicated that you have supported a person with a brain injury at the home.
          Do you currently support a person with a brain injury?
          If so, how long have they lived there?
          Do you remember where they lived before moving in with you?

               If you do not currently support a person with a brain injury, when was the last time that you did?
               Do you remember how long they lived at the home?
               Do you remember where they lived before moving in with you?
               Do you remember where they moved to?

   5. Have you had any particular problems with supporting a person with a brain injury?
          If yes, what problems have you had?


               Did any of these problems cause the person to leave the home permanently?


   6. Do you currently have a vacancy?
           If yes, how many?

                              Thank you for helping us out with your participation!




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                                     Statewide TBI Housing Needs Assessment June 2011
          SECTION 9
     Surveys and Interviews
                    Boarding Homes

Attachments

  1. Survey for Boarding Homes
  2. Generic Interview for Phone Contacts




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                       Statewide TBI Housing Needs Assessment June 2011
                                               Boarding Homes
                                                Survey Results
General Information

There are currently 504 licensed Boarding Homes (BH) identified on the DSHS website in WA. To locate a BH
by county, city or zip code, you can go to the DSHS Boarding Home Locater at:
fortress.wa.gov/dshs/adsaapps/lookup/BHPubLookup.aspx.
The Legislature has passed RCW Chapter 18.20 governing the formation, licensing, and operation of BHs.
These can be viewed at: apps.leg.wa.gov/rcw/default.aspx?cite=18.20.

According to the DSHS website (www.adsa.dshs.wa.gov/pubinfo/housing/other/#BH), ―Boarding Homes are
facilities in a community setting where staff assumes responsibility for the safety and well-being of the adult.
Many boarding homes call themselves "Assisted Living" facilities. Housing, meals, laundry, supervision, and
varying levels of assistance with care are provided. Some provide nursing care. Some offer specialized care for
people with mental health issues, developmental disabilities, or dementia. The home can have seven or more
residents and is licensed by the state.‖

Most BHs accept payment for services from Medicaid through a contract with DSHS and from individuals or a
family members paying privately. The BHs are operated by both profit and non-profit corporations.

Methodology

A survey (see attachment #1) was mailed out to all 504 BHs that were listed on the DSHS Boarding Home
Locator on their website. Surveys mailed out could be completed and mailed back or there was a link for
SurveyMonkey.com provided on the survey and could be completed online.

The following were the key questions that were asked on the survey:
   9. Has a person with a brain injury ever lived in your home?
   10. If funding and training were available, would you consider a person with a brain injury?
   11. Do you accept people funded by Medicaid?

A follow-up phone interview was scheduled for BH providers that submitted surveys back with the following
responses:

      They responded ―yes‖ to the question: ―Has a person with a brain injury ever lived in your
       home?‖
      They responded ―yes‖ or ―maybe‖ to the question: ―If funding and training were available, would
       you consider a person with a brain injury?‖
      They responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could
       we contact you?‖
      They provided us with an email address and/or a phone number.




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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                                       Boarding Home Survey Results (continued)

See attachment #2 for a copy of the phone interview script. The following were the key questions to the
interview:

   7. On the survey you indicated that you have supported a person with a brain injury at the home.

              Do you currently support a person with a brain injury?
              If so, how long have they lived there?
              Do you remember where they lived before moving in with you?
              If you do not currently support a person with a brain injury, when was the last time that you did?
              Do you remember how long they lived at the home?
              Do you remember where they lived before moving in with you?
              Do you remember where they moved to?

   8. Have you had any particular problems with supporting a person with a brain injury?
          If yes, what problems have you had?
          Did any of these problems cause the person to leave the home permanently?

   9. Do you currently have a vacancy?
           If yes, how many?
Findings

To date, there have been 95 completed surveys submitted from 25 different counties. The return rate
based on 504 surveys mailed out is 19%.

Has a person with a brain injury ever lived in your home?
54 answered YES
19 answered NO
13 answered NOT SURE

If funding and training were available, would you consider a person with a brain injury?
50 answered YES
7 answered NO
31 answered MAYBE

Do you accept people funded by Medicaid?
59 answered YES
19 answered NO
8 answered MAYBE

To date, we have conducted 12 phone interviews with BH providers.




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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                                        Boarding Home Survey Results (continue)

Do you currently support a person with a brain injury?
5 answered NO
5 supporting 1 person
2 supporting 2 people

If so, how long have they lived there?
1yr; 4yrs; 3yrs; 11yrs; 1yr; 3yrs; 2yrs; 2yrs; month

Do you remember where they lived before moving in with you?
3 came from a hospital
1 from a nursing home
3 from home
1 from rehab
1 from an AFH

If you do not currently support a person with a brain injury, when was the last time that you did?
3 just left
2 never have

Do you remember how long they lived at the home?
2yrs; 4 mos.; 1yr

Do you remember where they lived before moving in with you?
3 from home

Do you remember where they moved to?
1 to a nursing home
2 to an apartment

Have you had any particular problems with supporting a person with a brain injury?
8 had no problems
4 had behavior problems
1 had a drug problem
1 was too young

Did any of these problems cause the person to leave the home permanently?
1 person with a drug problem

Do you currently have a vacancy?
All had a vacancy ranging from 1 to 21

Recommendations
No recommendations at this time.




                                                      55 | P a g e
                                     Statewide TBI Housing Needs Assessment June 2011
 Attachment #1
                               Survey for Licensed Boarding Home Providers
                             Traumatic Brain Injury Housing Needs Assessment

The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned Terry
Home to complete a statewide housing needs assessment for people with a traumatic brain injury. This survey is
part of a larger effort to collect housing related information. This survey should only take a couple of minutes to
complete and your input is very important to people with a traumatic brain injury. Thank you in advance.


   1. Has a person with a brain injury ever lived in your home?
             □ Yes □ No □ Not Sure

   2. If funding and training were available, would you consider a person with a brain injury?
            □ Yes □ No □ Maybe

   3. Do you accept people funded by Medicaid?
           □ Yes □ No □ Maybe

   4. What city is your home located in?
      ______________________________________

   5. If we wanted to ask you some follow-up questions, could we contact you?
              □ Yes □ No
      If yes, please provide us with an email address and/or phone number.
       ________________________________________________________________

   6. Your name (optional)
      ___________________________________________

                                Thank you very much for your participation!!
               Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
                                                   or
          You can complete this survey online by typing this link into your internet address bar:
                                www.surveymonkey.com/s/tbi_boarding_homes




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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #2



                Phone Interview Questions for Licensed Boarding Homes

Date_____           Interviewer_________________            Start Time________          End Time __________

Type of Contact: ___In person ___Phone

Name of person/organization being interviewed:

INTRODUCTION

My name is ______________. I am following up on a DSHS sponsored housing survey that you filled out. You
indicated on the survey that we could contact you if we had more questions about housing and brain injury. I
just have a few follow-up questions that should just take a few minutes of your time. Is this a good time for us
to talk?
(Before the interview, review the person‘s survey responses and modify the questions accordingly.)


   1. On the survey you indicated that you have supported a person with a brain injury at the home.
          Do you currently support a person with a brain injury?
          If so, how long have they lived there?
          Do you remember where they lived before moving in with you?

               If you do not currently support a person with a brain injury, when was the last time that you did?
               Do you remember how long they lived at the home?
               Do you remember where they lived before moving in with you?
               Do you remember where they moved to?

   2. Have you had any particular problems with supporting a person with a brain injury?
          If yes, what problems have you had?


               Did any of these problems cause the person to leave the home permanently?


   3. Do you currently have a vacancy?
           If yes, how many?

Thank you for helping us out with your participation!




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                                     Statewide TBI Housing Needs Assessment June 2011
          SECTION 10
     Surveys and Interviews
                     Nursing Homes

Attachments

  1. Survey for Nursing Home Providers
  2. Generic Interview for Phone Contact




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                       Statewide TBI Housing Needs Assessment June 2011
                                     Nursing Homes Survey Responses
General Information

There are currently 239 licensed Nursing Homes (NH) identified on the DSHS website in WA. To locate a NH by county,
city or zip code, you can go to the DSHS Nursing Home Locater at:
fortress.wa.gov/dshs/adsaapps/lookup/NHPubLookup.aspx. The Legislature has passed RCW Chapter 18.51 governing
the formation, licensing, and operation of NHs. These can be viewed at:
apps.leg.wa.gov/RCW/default.aspx?cite=18.51&full=true.

According to the DSHS website (www.adsa.dshs.wa.gov/pubinfo/housing/other/#nursing), ―Nursing homes provide 24-
hour supervised nursing care, personal care, therapy, nutrition management, organized activities, social services, room,
board and laundry.‖

A NH accepts a variety of payment options for their services including Medicare, Medicaid, private insurance, and paying
privately. The NHs are operated by both profit and non-profit corporations, and in some cases by the state (i.e. Western
State Hospital).

Methodology
A survey (see attachment #1) was mailed out to all 239 NHs that were listed on the DSHS Nursing Home Locator on their
website. Surveys mailed out could be completed and mailed back or there was a link for SurveyMonkey.com provided on
the survey where the survey could be completed online.

The following were the key questions that were asked on the survey:

    12. Has a person with a brain injury ever lived in your home?
    13. Do you accept people funded by Medicaid?

See attachment #2 for a copy of the phone interview script. A follow-up phone interview was scheduled for NH providers
that submitted surveys back with the following responses:

       Responded ―yes‖ to the question: ―Has a person with a brain injury received services at your nursing
        home?
    Responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could we contact
        you?‖
    And they provided us with an email address and/or a phone number.
The following were the key questions to the interview:

    4. On the survey you indicated that you have supported a person with a brain injury at the nursing home.
           Do you currently support people with a brain injury?
           If so, about how many people do you currently support?
           In the last 5 years, what % pass away or go to a hospital or hospice?
           What % leaves your nursing home to go back home?
              Boarding Home or Adult Family Home?
              Other (please describe)

    5. Have you had any particular problems with supporting people with a brain injury?
           If yes, what problems have you had?

    6. When people need to leave do you have a problem helping to find them a place to live?
           If so, what sort of problems do you encounter?
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                                      Statewide TBI Housing Needs Assessment June 2011
                                                                                    Nursing Home Survey Responses (continued)

Findings

To date, there have been 38 completed surveys submitted from 15 different counties. The return rate based on 240 surveys
mailed out is 16%.

Key Survey Questions:

Has a person with a brain injury ever lived at the NH?
33 said YES
6 said NO

Do you accept people funded by Medicaid?
35 said YES
2 said NO
2 said MAYBE

To date, we have conducted 6 phone interviews with NH providers.

Do you currently support people with a brain injury?
3 answered YES; 3 answered NO

If so, about how many people do you currently support?
3 or 4; 2 or 3; 3

In the last 5 years, what % pass away or go to a hospital or hospice?
10%; 100% (1/1); 0%; 2%; 1%; 5%

What % leaves your nursing home to go back home?
1%; NA; NA; not sure; 84%; 3%

Boarding Home or Adult Family Home?
1%; NA; 2%; not sure; not sure; 1%

Other (please describe)
NA; NA; hospital: not sure; NA; NA
Have you had any particular problems with supporting people with a brain injury?
Aggressive
Medically fragile, non-responsive
Behavior problems, too young
No
Behavior problems and Behavior Problems

When people need to leave do you have a problem helping to find them a place to live?
No
Yes, tried Delta but was turned down.
Challenging
No
Not enough options

Recommendations
No recommendations to make.


                                                       60 | P a g e
                                      Statewide TBI Housing Needs Assessment June 2011
 Attachment #1
                                   Survey for Nursing Home Providers
                             Traumatic Brain Injury Housing Needs Assessment

The Traumatic Brain Injury Council and the Dept. of Social and Health Services have commissioned Terry
Home to complete a statewide housing needs assessment for people with a traumatic brain injury. This survey is
part of a larger effort to collect housing related information. This survey should only take a couple of minutes to
complete and your input is very important to people with a traumatic brain injury. Thank you in advance.


   1. Has a person with a brain injury received services at your nursing home?
             □ Yes □ No □ Not Sure

   2. Do you accept people funded by Medicaid?
           □ Yes □ No □ Maybe

   3. What city is your nursing home located in?
      ______________________________________

   4. If we wanted to ask you some follow-up questions, could we contact you?
              □ Yes □ No
      If yes, please provide us with an email address and/or phone number.
       ________________________________________________________________

   5. Your name (optional)
      ___________________________________________

                                Thank you very much for your participation!!
               Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
                                                   or
          You can complete this survey online by typing this link into your internet address bar:
                                 www.surveymonkey.com/s/tbi_nursing_homes




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                                     Statewide TBI Housing Needs Assessment June 2011
Attachment #2

                       Phone Interview Questions for Nursing Homes

Date_____          Interviewer_________________            Start Time________          End Time __________

Type of Contact: ___In person ___Phone

Name of person/organization being interviewed:

INTRODUCTION

My name is ______________. I am following up on a DSHS sponsored housing survey that you filled out. You
indicated on the survey that we could contact you if we had more questions about housing and brain injury. I
just have a few follow-up questions that should just take a few minutes of your time. Is this a good time for us
to talk?
(Before the interview, review the person‘s survey responses and modify the questions accordingly.)

   1. On the survey you indicated that you have supported a person with a brain injury at the nursing home.
          Do you currently support people with a brain injury?
          If so, about how many people do you currently support?
          Over the past 5 years, what would be your guess of the % of people with a brain injury that stay
             at your nursing home until they passed away or went to a hospital or hospice? _________
          What % leave your nursing home to go back Home_______
             Boarding Home or Adult Family Home______
             Other (please describe) ___________________________________________


   2. Have you had any particular problems with supporting people with a brain injury?
          If yes, what problems have you had?



   3. When people do need to leave by choice or because of funding, do you have a problem helping to find
      them a place to live because of the lack of housing and support options?
           If so, what sort of problems do you encounter?


                Thank you for your participation!




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                                    Statewide TBI Housing Needs Assessment June 2011
          SECTION 11
     Surveys and Interviews
      Affordable Housing Programs

Attachments

  1. Survey for Affordable Housing Program Providers
  2. Generic Phone Interview for Phone Contact




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                       Statewide TBI Housing Needs Assessment June 2011
                                 Affordable Housing Provider (AHP)
                                         Survey Responses
General Information

The Washington Housing Policy Act (Chapter 43.185B RCW) definition of ―Affordable Housing‖
(43.185B.010) states: ―Affordable housing means residential housing that is rented or owned by a person or
household whose monthly housing costs, including utilities other than telephone, do not exceed thirty percent of
the household's monthly income.‖ This is the generally accepted definition of affordable housing both in-state
and at the federal level including Housing and Urban Development (HUD). For publicly funded housing, there
are some exceptions to when a landlord can charge more than 30% of a tenant‘s income for rent and utilities.
This includes tenants using HUD Section 8 vouchers, as well as housing built with some state-only public
funding. Some exceptions aside, most tenants pay 30% of their income towards rent and utilities.

Providers of affordable housing in Washington State fall into three major groupings:

   1. Non-profits that own housing that was donated, purchased privately, or developed using public funding
      that usually has a combination of some private funding and/or financing.


   2. For-profits that use government financing programs that are not restricted to just non-profits, private
      financing, and rent subsidy programs. Two of the larger programs available to for-profits are the Low-
      Income Housing Tax Credit (LIHTC) program for financing development and the HUD Section 8 rental
      voucher program that provides tenant rental subsidies.


   3. Private landlords that accept HUD Section 8 rental vouchers for individual units in apartment buildings
      or for renting houses. For qualified housing, HUD pays the difference between ―fair market rent‖ and
      30% of a tenant‘s income including utilities.


In-state Affordable Housing Coalitions and Consortiums

The following (5) organizations, one statewide and the other four city/county specific, are affordable housing
coalitions and consortiums that include the full range of housing stakeholders including public, profit, non-
profit, and individuals working together on affordable housing development, preservation, and public policy.

The Washington Low Income Housing Alliance (WLIHA)
Founded in 1985, WLIHA is a statewide coalition of housing and service providers, advocates, funders, and
other housing experts. They work closely with elected officials to turn good ideas into sound policy. ―The
Washington Low Income Housing Alliance leads the movement to ensure that all our residents thrive in safe,
healthy, affordable homes. We do this through advocacy, education and organizing.‖ http://www.wliha.org/.

Tacoma/Pierce County Affordable Housing Consortium
―Formed in 2001, is a nonprofit organization of 62 housing providers, lenders, and other stakeholders who work
in Pierce County to provide a unified voice for affordable housing in our community.‖
www.affordablehousingconsortium.org/



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                                    Statewide TBI Housing Needs Assessment June 2011
                                                                         Affordable Housing Providers Survey Responses (continued)


Housing Consortium of Everett and Snohomish County (HCESC)
―Incorporated in 2002, HCESC is a collaborative partnership between nonprofit housing developers and service
providers with local business, government, and for-profit organizations focusing on issues and needs for
affordable housing in Snohomish County and throughout the State of Washington.‖
www.housingsnohomish.org/resources.html

Housing Development Consortium (HDC)
―HDC is the professional association for the local nonprofit affordable housing development and operating
sector for King County. Since its beginnings in 1988, HDC and its members have been dedicated to the vision
that everyone in the county will someday soon have access to a safe, decent and affordable place to call home.‖
www.housingconsortium.org

Spokane Low Income Housing Consortium (SLIHC)
SLIHC is a nonprofit that started in 1990. Today, the Consortium has 29 nonprofit and public members and
associate members that develop and promote affordable housing, and 13 supportive members that include
lenders, private sector firms, contractors, attorneys, and others that support affordable housing. The mission: to
improve the environment for efficient and substantial nonprofit initiatives which promote the long-term
availability of housing that is appropriate and affordable for low income and very low income persons.
www.slihc.org/

Affordable housing development for non-profits is a challenging financial endeavor, both to develop in the
short-term and to operate over the long-term. It often requires that some or most of the development funding
used to build or buy & remodel be provided by:

   1. public funders (i.e. federal, state, county, city) provide development loans with a range of terms and
      conditions from loans that convert to grants after a specified period of time, loans with no payments, and
      loans with payments plus interest. Each project is evaluated individually based on an operating pro
      forma that includes rental income, operating subsidies, building expenses (expenses related to providing
      services are not included), and necessary reserves for future repairs and replacements.


   2. private donations or other fundraising activities (i.e. capital campaign); and


   3. for projects that still need additional development funding, some of the other options are loans from
      banks, proceeds from bond financing (i.e. WSHFC), and investment partners (i.e. LIHTC program).


The long-term financial viability of operating affordable housing often requires some rental subsidy (i.e. HUD
Section 8 program, State Housing Trust Fund Operating & Maintenance Subsidy) or income from an unrelated
source (i.e. fundraising) to fill the gap between rental income and operating expenses. A rental subsidy is
necessary when all or most of the tenants have income that is at or below 30% of the area median. For example,
the standard Federal Supplemental Security Income (SSI) monthly payment amounts for 2011 are $674 for an
eligible individual (http://www.ssa.gov/oact/cola/SSI.html). This means that a tenant receiving just the standard
SSI would pay $202/month for rent and utilities.



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                                                                        Affordable Housing Providers Survey Responses (continued)



Methodology

A survey (see attachment #1) was mailed out to all 216 AHPs that were on the Department of Commerce
Housing Trust Fund (HTF) list of agencies that were previously funded to develop affordable rental housing or
to provide homeownership opportunities. Surveys could be filled-out online at SurveyMonkey.com or a hard
copy could be filled-out and mailed back in. The goal was to find out who had existing housing units that were
being rented to people with a TBI and who might be interested in developing affordable, accessible housing for
people with a TBI.

AHPs that did not receive this particular survey from this mailing were:

   1. for-profit corporations, as they are not eligible without a non-profit partner to receive HTF funding; If
      they operate one of the licensed facilities (i.e. nursing home, Adult Family Home), they would receive
      the survey for that particular type of facility and be covered elsewhere in this needs assessment report.


   2. non-profit organizations that developed housing without HTF funding, which might include private or
      other public funding or a combination of both; As with for-profits, if they operate one of the licensed
      facilities, then they would receive a survey that would be covered elsewhere in this report.


The number of affordable housing projects that these two groups might develop, which didn‘t include HTF
funding or was not a licensed facility covered elsewhere is this report, is probably relatively very small.


Among the survey questions asked, the following are (2) key questions:

   1. To your knowledge, have you ever provided housing to someone with a brain injury?


   2. If funding were available, would you be interested in developing a housing project that included
      people with a brain injury?



A follow-up phone interview was scheduled for AHPs that submitted surveys back with the following responses
by 5/13/11:

   1. They responded ―yes‖ to the question: ―If funding were available, would you be interested in
      developing a housing project that included people with a brain injury?‖

   2. They responded ―yes‖ to the question: ―If we wanted to ask you some follow-up questions, could
      we contact you?‖

   3. They provided us with an email address and/or a phone number.


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                                                                        Affordable Housing Providers Survey Responses (continued)

Among the questions asked, the following were (3) key questions for the phone interview:

   1. Do you currently provide housing to someone with a brain injury, if not when did you?

   2. Can you recall any particular problems in providing housing to someone with a brain injury?

   3. Do you have any ideas on what a housing project might look like that could include people with a
      brain injury?

See attachment #2 for a copy of the phone interview script.

Findings

To date, there have been 57 completed surveys submitted by Affordable Housing Providers out of 216 that were
sent out, which is a 26% return rate.

The following are responses to key questions from the surveys:

Had they provided housing to a person with a brain injury
 29 indicated ―yes‖
10 said ―no‖
16 were ―not sure‖.

For those responding ―yes‖ to providing housing:
19 stated that they rented to between 1-5 tenants
1 rented to between 6-10
3 rented to over 21 people
The remaining respondents were ―not sure‖

For the question about developing housing for people with a TBI if funding were available:
39 said ―yes‖
15 said ―no‖.

To date, we have conducted 21 phone interviews with Affordable Housing Providers.

The following are responses to key questions from the phone interviews:

   1. Only one provider reported any problems providing housing to a person with a brain injury and that was
      related to behavior problems.

   2. Most of the respondents did not know how long a person rented for. For those that did, 1 person was for
      less than a year and the other 5 were 1 ½, 2, 2, 3, and 3 ½ respectively.

   3. Of those interested in possibly developing a project, 9 indicated that they would need to partner with a
      service agency.

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                                                                       Affordable Housing Providers Survey Responses (continued)

Overall, between the surveys and the phone interviews, there was not a lot a familiarity by AHPs about their
rental involvement with people with a brain injury. Consequently there were a lot of ―not sure‖ responses.
AHPs do not ―officially‖ track tenants by type of disability, including brain injury. However, anecdotally many
knew of people that had a brain injury through their interactions with the tenants themselves.

Recommendations

   1. Given that so many AHPs have expressed an interest in developing housing that would include people
      with a TBI, there should be an initial organized effort to bring AHPs, service providers, and individuals
      with a TBI together. This should be done on a local level, possibly through the local housing coalitions
      and consortiums. Another unique and efficient opportunity would be to attend and participate at the
      annual Housing Washington Conference, which is from September 26-28 in Spokane. There is typically
      over 700 housing stakeholders that attend. There is exhibit space where a booth containing information
      with an emphasis in recruiting interested housing partners could be set-up. There may be an opportunity
      to provide or participate in a breakout session that included housing for persons with a TBI. Lastly, there
      could be a planned effort to network informally with key housing stakeholders to set-up post-conference
      discussions around developing housing. To see more about the conference go to
      http://www.wshfc.org/conf/.


   2. Given the responses by Affordable Housing Providers that they really knew very little about TBI,
      informational materials should be sent out and regional training opportunities should be provided to
      familiarize providers with TBI and the resources available out there to help.




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                                   Statewide TBI Housing Needs Assessment June 2011
Attachment #1
                                 Survey for Affordable Housing Providers
                             Traumatic Brain Injury Housing Needs Assessment

Through a contract with the Dept. of Commerce supported by the Traumatic Brain Injury Council and DSHS,
Terry Home has been funded to complete a statewide housing needs assessment for people with a traumatic
brain injury. This survey is part of a larger effort to collect housing related information. This survey should only
take a couple of minutes to complete and your input is very important to people with a traumatic brain injury.

You can complete this survey online by typing this link into your internet address bar:
                                www.surveymonkey.com/s/tbi_housing_providers
   1. To your knowledge, have you ever provided housing to someone with a brain injury?


       □ Yes □ No □ Not Sure

       1A. If yes, how many people have you provided housing to in the last 5 years?

                □ 1-5 □ 6-10      □ 11-15      □ 16-20       □ over 21       □ Not Sure

   2. If funding were available, would you be interested in developing a housing project that included people
      with a brain injury?


       □ Yes     □ No

   3. If we wanted to ask you some follow-up questions, could we contact you?

        □ Yes □ No
       If yes, please provide us with an email address and/or phone number.
        ________________________________________________________________

   4. Your name (optional)
      ___________________________________________

                                  Thank you very much for your participation!!
                 Mail the completed survey to: N+P, P.O. Box 65206, Shoreline, WA 98155
                                                      or
             You can complete this survey online by typing this link into your internet address bar:
                                www.surveymonkey.com/s/tbi_housing_providers




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Attachment #2

            Phone Interview Questions for Affordable Housing Providers

Date_____          Interviewer_________________            Start Time________          End Time __________

Type of Contact: ___In person ___Phone

Name of person/organization being interviewed:

INTRODUCTION

My name is ______________. I am following up on a DSHS sponsored housing survey that you filled out. You
indicated on the survey that we could contact you if we had more questions about housing and brain injury. I
just have a few follow-up questions that should just take a few minutes of your time. Is this a good time for us
to talk?
(Before the interview, review the person‘s survey responses and modify the questions accordingly.)

   1. On the survey you indicated that you have supported a person with a brain injury at the nursing home.
          Do you currently support people with a brain injury?
          If so, about how many people do you currently support?
          Over the past 5 years, what would be your guess of the % of people with a brain injury that stay
             at your nursing home until they passed away or went to a hospital or hospice? _________
          What % leave your nursing home to go back Home_______
             Boarding Home or Adult Family Home______
             Other (please describe) ___________________________________________


   2. Have you had any particular problems with supporting people with a brain injury?
          If yes, what problems have you had?



   3. When people do need to leave by choice or because of funding, do you have a problem helping to find
      them a place to live because of the lack of housing and support options?
           If so, what sort of problems do you encounter?



Thank you for helping us out with your participation!




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                                    Statewide TBI Housing Needs Assessment June 2011
             SECTION 12
        Surveys and Interviews
                   Housing Authorities

Attachments

  1.   Creation of Housing Authorities in Washington State
  2.   2010 AMI
  3.   Fair Market Rents
  4.   2011 Fair Market Rents in Washington State
  5.   Home Rent Levels 2010
  6.   Housing Choice Voucher Fact Sheet
  7.   Public Housing Authority Matrix
  8.   King County HASP Program




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                                             Housing Authorities (HA)

General Information

Currently there are 38 housing authorities in the state. Most counties have just one HA. However, there are several
cities that have formed a housing authority in addition to their county‘s HA (i.e. City of Everett/Snohomish County,
Cities of Seattle and Renton/King County, City of Tacoma/Pierce County). The legislature with RCW 35.82.030 (see
attachment #1) provided both cities and counties the opportunity to create a housing authority.

To find a specific HA, there is an excellent locator map by county on the Association of Washington Housing
Authorities (AWHA) website: www.awha.org/contact.html. You can also get information on Washington State HAs
on the U.S. Department of Housing and Urban Development (HUD) website at:
www.hud.gov/offices/pih/pha/contacts/states/wa.cfm.

Renee Rooker, Executive Director of the Walla Walla Housing Authority and current President of AWHA, shared
the following: ―Housing Authorities in Washington address a continuum of community housing needs. They
provide emergency shelters for homeless people and solutions to help them obtain permanent housing. Local
Housing Authorities own and manage safe, well-maintained housing and provide a variety of rental assistance
programs that assist in making the private market rental units affordable. They revitalize neighborhoods with mixed-
income housing, and they help people buy their first home.

Unlike local governments, Housing Authorities cannot levy taxes. Instead, they use entrepreneurial solutions to help
communities meet the housing needs of their most vulnerable citizens.

Developing mixed-income rental housing financed through tax-exempt mortgage revenue bonds, tax credits, and
other sources allows Housing Authorities to offer affordable housing for working families with limited incomes.
Not only do these properties fill immediate housing needs, they also provide a long term investment to support more
deeply subsidized special needs housing for seniors, disabled people and homeless families.‖

Each HA creates their own ―menu‖ of housing and related services based on their local needs, financial viability, and
the collaboration of partners. The following are (2) of the larger programs that are offered by HAs. There are other
programs and related services that HAs can offer such as homeless shelters, home repair, weatherization, tax-exempt
financing, and job training. You will need to check with each PHA on the services that they offer because each is
different.

    1. Housing Choice Vouchers (commonly called Section 8)

The Housing Choice Voucher program assists very low-income individuals and families, the elderly, and people
with disabilities to rent decent, safe, accessible, affordable housing in the private market place. The tenant typically
pays 30% of their income, but there are circumstances when they can pay up to 40% of their monthly income for rent
and utilities. To be eligible, household income must be at or below 80% of the area median income (AMI). See
attachment #2 for the AMI numbers for WA counties and some cities. Voucher holders are responsible for finding a
housing unit of their choice where the owner agrees to rent under the program. Units must meet minimum housing
quality standards of health and safety. A housing subsidy is paid to the owner directly by the HA. The voucher
holder pays the difference between the actual rent set by the owner and the amount subsidized by the Section 8
voucher program.




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                                                                                                Housing Authorities (continued)

The rent set by an owner must be approved by the HA and is often in-line with HUD‘s determination of Fair Market
Rents (FMR). For a detailed description about FMR, see attachment #3. To review FMR amounts in WA see
attachment #4. HAs also use the HOME Rent Limits by counties and some cities, as well as the size of the unit to
establish rents. See attachment #5 for HUD‘s HOME Rent Limits for WA areas. For more detailed information on
the Housing Choice Program, see attachment #6 and you can also visit the HUD website at:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/programs/hcv/about.

Some HAs have a Homeownership Voucher Program that allows a Housing Choice Voucher to be used to help pay
the mortgage on a qualifying home. See the section in this report titled ―Affordable Homeownership‖ for more
information about this program and which HAs participate.

    2. Housing Owned and Managed by HAs

HAs also own and manage apartments, townhouses and single-family homes reserved for low to moderate income
households and people with disabilities. Depending on the HA and the tenants living in the building, this housing
might include on-site social services that are funded under a variety of federal, state and local assistance programs.
These services might be provided directly by a HA staff person (i.e. Support Services Coordinator) and/or be
contracted to an agency through DSHS or another public or private funder.

Methodology

All of the HAs in the geographical areas of the needs assessment, a total of 17, were contacted by phone at least once
and some were additionally contacted by email. The following were the key questions that were asked:
     1. Did they provide any Section 8 vouchers, rental housing units or homeownership opportunities to people
         with a brain injury?
     2. Was their waiting list for Section 8 vouchers open or close?
          If their waiting list was closed, when might they expect it to re-open?
     3. Regardless of whether their waiting list was open or closed, how long would they estimate that the last
         person on their current list might move up and receive a Section 8 voucher?

Findings
(See attachment #7 with the spreadsheet matrix of HAs, their contact information, the questions asked, and their
individual HA responses).
Given a tenant‘s right to privacy, a HA cannot ask if or about a tenant‘s disability unless it is related to a specific
eligibility requirement for a particular housing unit. Clearly HAs support many people who have a traumatic brain
injury, but they have no way of knowing who or how many or where people might live. None of the HAs could
identify any individuals with a traumatic brain injury.

It is certainly possible that a HA could develop a stand-alone housing project and/or set units aside in a larger project
specifically for tenants with a traumatic brain injury. One example of a HA project that supports a particular
disability group is the Kitsap Consolidated Housing Authority (KCHA). They developed a duplex specifically for
people with developmental disabilities where the daily support services were provided by an agency that was funded
and contracted through the Division of Developmental Disabilities (DDD). KCHA is just acting in the capacity of
the developer, owner, and property manager. They purchased and remodeled a duplex using public funding that
requires a 40-year commitment that the initial and future tenants have a developmental disability. When a vacancy
occurs, each prospective tenant must be client of DDD or provide a Letter of Determination from DDD verifying
that they have a developmental disability. Having and demonstrating that a person has a developmental disability is
part of the tenant eligibility criteria for occupancy.

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                                                                                             Housing Authorities (continued)



It is also possible for a HA to allocate Section 8 vouchers to be distributed to people with disabilities that meet
certain programmatic guidelines. No such program was identified by any of the HAs specifically for people with a
traumatic brain injury. However, one example of a particular Section 8 program for people with disabilities is
offered by the King County Housing Authority called the Housing Access and Services Program (HASP). Details of
the HASP can be found in attachment #8. Also, the Roads to Community Living program in some areas have Section
8 vouchers for people living in a nursing home, on Medicaid, and clients of Home & Community Services. See
attachment #9 for a brochure of the program.

Eleven of the HAs stated that their waiting list was closed. The range of responses on how long it might take for the
last person on the current waiting list to receive a Section 8 voucher ranged from less than a year to 6 years. Most
HA staff said that they really didn‘t have an idea on how long it might take. In these more difficult times, HAs are
not seeing the level of turnover that they have historically seen with voucher recipients. A couple of HA staff
mentioned that their senior housing tenants were moving in at younger eligible ages and that in general the seniors
were living longer.

Recommendations

   1. HAs should be approached to develop stand-alone housing specifically for people with a traumatic brain
      injury. This could be in a range of smaller licensed facilities up to 6 people and larger programs up to 12
      people. Agencies would contract with and be funded by DSHS or another service-related funder so they
      could provide the 24/7 support services. The HA would just be the developer, owner, and property manager.

   2. In larger projects that HAs might be developing or currently operating, working with them to set-aside some
      units for people with a traumatic brain injury. Tenants in a project of this nature would probably need to be
      independent or require a level of support that could be provided by a program such as Medicaid Personnel
      Care (MPC) to ensure their health and safety.

   3. For HAs that do not provide an approved HUD Homeownership Voucher Program, to work towards
      establishing a program in areas where there is an identified need for individuals with a traumatic brain injury
      or families that have member living with them. The Section 8 voucher, which helps pay the mortgage, can be
      used in conjunction with down payment assistance programs to substantially reduce the monthly mortgage
      payments. In the Homeownership section of this report is an example in attachment where an individual with
      a traumatic brain injury was able to bring several down payment assistance funding sources together totaling
      over $100,000 that required no monthly payments.

   4. From time to time HUD announces a special allocation of Section 8 vouchers that HAs can apply for.
      Sometimes a portion of these special allocations of Section 8 vouchers can be provided directly to social
      service agencies to distribute to eligible clients. Often social service agencies will need to provide some case
      management and follow-up services to these clients as part of the HA set-aside criteria. It would be
      beneficial to work with a HA ahead of time to see if a HASP-type program might be developed in the event
      that an appropriate special allocation became available.




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Attachment #1

                       Creation of Housing Authorities in Washington State
                                                  RCW 35.82.030

In each city (as herein defined) and in each county of the state there is hereby created a public body corporate
and politic to be known as the "Housing Authority" of the city or county: PROVIDED, HOWEVER, That such
authority shall not transact any business or exercise its powers hereunder until or unless the governing body of
the city or the county, as the case may be, by proper resolution shall declare at any time hereafter that there is
need for an authority to function in such city or county. The determination as to whether or not there is such
need for an authority to function (1) may be made by the governing body on its own motion or (2) shall be made
by the governing body upon the filing of a petition signed by twenty-five residents of the city or county, as the
case may be, asserting that there is need for an authority to function in such city or county and requesting that
the governing body so declare.

    The governing body shall adopt a resolution declaring that there is need for a housing authority in the city or
county, as the case may be, if it shall find (1) that insanitary or unsafe inhabited dwelling accommodations exist
in such city or county; (2) that there is a shortage of safe or sanitary dwelling accommodations in such city or
county available to persons of low income at rentals they can afford; or (3) that there is a shortage of safe or
sanitary dwellings, apartments, mobile home parks, or other living accommodations available for senior
citizens. In determining whether dwelling accommodations are unsafe or insanitary said governing body may
take into consideration the degree of overcrowding, the percentage of land coverage, the light, air, space and
access available to the inhabitants of such dwelling accommodations, the size and arrangement of the rooms, the
sanitary facilities, and the extent to which conditions exist in such buildings which endanger life or property by
fire or other causes.

   In any suit, action or proceeding involving the validity or enforcement of or relating to any contract of the
authority, the authority shall be conclusively deemed to have become established and authorized to transact
business and exercise its powers hereunder upon proof of the adoption of a resolution by the governing body
declaring the need for the authority. Such resolution or resolutions shall be deemed sufficient if it declares that
there is such need for an authority and finds in substantially the foregoing terms (no further detail being
necessary) that either or both of the above enumerated conditions exist in the city or county, as the case may be.
A copy of such resolution duly certified by the clerk shall be admissible in evidence in any suit, action or
proceeding.




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Attachment #2




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Attachment #3


                                           Fair Market Rents
  Since 1974 the U.S. Department of Housing and Urban Development (HUD) has helped low-income
  households obtain better rental housing and reduce the share of their income that goes toward rent through
  a program that relies on the private rental market. As of 1997, 1.4 million households held Section 8
  certificates or vouchers, which allow them to rent eligible units in the private market and receive rental
  subsidies from the Federal Government. A key parameter in operating the certificate and voucher
  programs is the Fair Market Rent (FMR). This article explains what FMRs are, how they function in these
  programs, and how HUD calculates them.

  The Role of FMRs

  FMRs play different roles in the certificate and voucher programs. In both programs, FMRs set limits. In
  the certificate program, FMRs set limits on what units can be rented; in the voucher program, FMRs set
  limits on the subsidy provided to the household. Certificate program households cannot rent units with
  gross rents exceeding the FMR; the recipients receive a subsidy equal to the difference between the gross
  rent and 30 percent of their incomes.1 Voucher program households receive a subsidy equal to the
  difference between the FMR and 30 percent of their monthly incomes. Participants in the voucher
  program can choose units to live in with gross rents higher than the FMR, but they must pay the full cost
  of the difference between the gross rent and the FMR, plus 30 percent of their income.

  FMRs function primarily to control costs. Research has shown that program recipients act rationally and
  choose units with gross rents close to the FMRs, that is, the best units available under program rules.2 On
  average, higher FMRs would mean higher costs per household served and, within a fixed budget, fewer
  households would be assisted. FMRs also help ensure reasonableness in the Section 8 assisted housing
  program. The taxpaying public would probably be unwilling to support an assisted housing program that
  put low-income families in housing units that were substantially better than typical rental units.

  While budget realities and sensitivities to public acceptance exert pressures to set FMRs at low levels,
  other concerns create countervailing incentives to raise FMRs. For the Section 8 program to work
  properly, certificate and voucher holders must have an adequate supply of decent, safe, and sanitary rental
  units to choose from. Higher quality units command higher rents, so FMRs must be sufficiently high to
  provide acceptable choices for participants. In addition, the certificate and voucher programs were
  designed to allow assisted households to choose among different neighborhoods. The FMRs must also be
  high enough to provide acceptable choices among neighborhoods.




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                                                                                       Fair Market Rents (continued)


The FMR Standard

Since Congress established the Section 8 program in 1974, there have been three definitions of FMRs.
The current definition, which became effective in 1995, contains several elements:

The FMR is the 40th percentile of gross rents for typical, non-substandard rental units occupied by recent
movers in a local housing market.3

40th percentile: The 40th percentile is that point in a distribution of numbers at which 40 percent of the
numbers are less than or equal to it and 60 percent of the numbers are greater than or equal to it. In the set
of numbers {$395, $458, $486, $517, $675}, $458 would be the 40th percentile.4 The 40th percentile is
similar in concept to a median; the median is the 50th percentile.

Gross rents: Gross rent is the sum of the rent paid to the owner plus any utility costs incurred by the
tenant. Utilities include electricity, gas, water and sewer, and trash removal services but not telephone
service. If the owner pays for all utilities, then gross rent equals the rent paid to the owner.

Typical, non-substandard rental units: In developing the FMR, the following units are excluded: public
housing units, rental units built in the last 2 years, rental units considered substandard in quality, seasonal
rentals, and rental units on 10 or more acres. The definition excludes public housing units to prevent
subsidized rents from skewing the distribution. Similarly, rental units built in the last 2 years are excluded
to eliminate units at the higher end of the market from the distribution. Since Section 8 seeks to improve
the quality of housing occupied by lower-income families, substandard units are eliminated from the
distribution. Finally, seasonal units and units on large plots are not part of the market intended for Section
8 recipients.

Occupied by recent movers: The definition of FMRs recognizes that owners often charge new tenants
more than current tenants with leases. For this reason, the definition limits the distribution used to
calculate the FMR to units occupied by recent movers. HUD has found that recent mover units typically
rent for approximately 6 percent more than other units. However, this relationship can vary widely. In
markets where demand is bidding up the price of rental housing, the spread between recent mover rents
and other rents can be much higher. HUD has also observed markets where recent movers pay less than
current tenants with leases because the demand for rental units has failed to keep up with supply.

In a local housing market: To achieve cost control and workability objectives, FMRs should be calculated
in the context of the housing market in which certificate and voucher recipients shop. HUD generally uses
Federal Office of Management and Budget (OMB) metropolitan area definitions to define local housing
markets in urban contexts. Since OMB defines metropolitan areas on the basis of commuting patterns,
they represent the housing market available to households working within the area. As commuting
patterns have broadened, HUD has had to construct narrower local housing markets in a few metropolitan
areas.




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                                                                                        Fair Market Rents (continued)


For example, when OMB redefined the Washington, D.C., metropolitan area after the 1990 census, it
added two counties in West Virginia and some distant, primarily rural counties in Virginia. HUD
subsequently deleted these counties from the Washington, D.C., fair market rent area. In nonmetropolitan
areas, HUD uses the county as the local housing market. Overall, HUD estimates FMRs for 354
metropolitan areas, 2,366 counties in nonmetropolitan areas, and 16 counties dropped by HUD from the
OMB definitions of 6 metropolitan areas.

FMRs are set for rental units of different bedroom sizes, and Section 8 rules based on household size and
the age and sex of children determine what size unit a household can choose.

How HUD Estimates FMRs

Failure to distinguish between the definition of FMRs and how HUD estimates them has been the source
of considerable confusion. For example, the definition does not specify who is a recent mover; depending
on the available data, HUD will count households who moved in within the past 15 to 22 months as recent
movers. More fundamentally, the policy tradeoff between lower costs per family served, public
acceptability of the housing provided, and the ability to provide an adequate range of choice among units
and neighborhoods occurs at the definition level, not at the measurement level. Once the definition is
chosen, HUD strives to provide the most current and accurate measurement of the definition in each FMR
area. If in a particular market the FMR definition results in high per-unit costs or severe difficulties on the
part of certificate and voucher recipients in finding suitable units, HUD has only limited ability to respond
to these problems if it has measured the FMR correctly.5 (See discussion of exceptions below.)

HUD faces three problems in setting FMRs annually for 2,736 areas. First, the Department must obtain
sufficient data on gross rents to calculate a 40th percentile. Second, it has to adjust the data for the various
elements in the definition, such as recent movers and non-substandard housing. Third, if the data are not
current, HUD has to adjust the calculated 40th percentiles to reflect current rental prices and then project
them into the fiscal year for which it is estimating FMRs.

By law, HUD follows a formalized process in setting FMRs. In late April or early May of each year,
HUD publishes in the Federal Register proposed FMRs for every FMR area for the forthcoming fiscal
year (October 1 through September 30). The Federal Register notice invites comments from the public on
the appropriateness of the proposed FMRs. Comments are generally due around July 1.6 After HUD
reviews the comments, the Department publishes final FMRs in late September to take effect on October
1.

HUD uses four types of data for setting FMRs. From the U.S. Census Bureau, HUD has obtained a
special extract of the 1990 census with data on gross rents for every metropolitan area and every
nonmetropolitan county in the Nation. From its American Housing Survey (AHS), HUD has data on gross
rents for 47 metropolitan areas for 1 or more years since 1990.




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                                  Statewide TBI Housing Needs Assessment June 2011
                                                                                    Fair Market Rents (continued)


HUD also gathers data every year on gross rents for 50 to 60 metropolitan areas or counties using
Random Digit Dialing (RDD) telephone surveys. Finally, from the public comment process, HUD has
information provided by local housing authorities and others for specific FMR areas.

Of these four sources, the census extract contains the largest samples and provides consistent data for all
FMR areas. However, the census extract is the least current of the data sources. The AHS provides
consistent data 1 to 7 years prior to the fiscal year for which FMRs are being estimated. Moreover, sample
sizes among recent movers can be small in AHS samples for some areas. RDD surveys provide data on
gross rents for January through July of the year in which the FMRs become effective on October 1.
Publicly provided data are generally current but are idiosyncratic and often unusable.7

In all cases HUD uses these data to estimate the FMR for two-bedroom units only. Nationally, two-
bedroom units account for 43 percent of the rental stock. Being the most common unit, they are the easiest
units for which to obtain data. HUD estimates FMRs for efficiencies, one-bedroom units, three-bedroom
units, and units of other sizes using the two-bedroom estimate as a base.8

Table 1 explains how HUD adjusts the various data sources to fit all the elements in the FMR definition.
In general, HUD's own data sources -- the 1990 census extract, the AHS, and RDDs -- allow direct
adaptation to attain the FMR definition. With data obtained through public comments, HUD frequently
has to make adjustments based on 1990 census data or AHS data.

Table 1. How HUD Matches the FMR Definition With Different Data Sources




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                                                                                    Fair Market Rents (continued)


The final step in estimating two-bedroom FMR is to update and project the measured FMR from the date
of measurement to the middle of the forthcoming fiscal year, that is, to April 1 of the following year.
HUD uses a combination of sources and techniques to update and project. The approach used depends on
the particular FMR area and the date of the data used to establish the 40th percentile.

The Bureau of Labor Statistics publishes annual rent price index data from the consumer price index
(CPI) for 95 FMR areas. HUD uses the CPI data to update FMRs for these areas and then projects the
FMRs forward using approximately a 3-percent annual rate of increase. In estimating proposed FMRs for
fiscal year 2000, HUD will have available CPI data for these metropolitan areas through December 1998.
HUD will then inflate the end-of-1998 FMRs 15 months forward to April 1, 2000, using the assumed 3-
percent annual rate.

For other areas that have FMRs based on data from 1993 or later, HUD uses special RDD surveys to
update to the end of 1998 and then projects forward to April 1, 2000, again using the assumed 3-percent
annual rate. Prior to 1993 HUD used CPI rental price indices, which measure rent changes for 4 large
regions: the Northeast, the Midwest, the South, and the West. Experience during the 1980s with such
broad-based indices was not satisfactory, so beginning in 1993, HUD funded RDD surveys to measure
rent changes for 20 smaller areas. The 20 areas are derived from the metropolitan and nonmetropolitan
parts of each of the 10 Federal regions with one modification: The metropolitan part of each Federal
region omits all the metropolitan areas for which HUD has CPI data.9

For areas without local CPIs that have FMRs based on data from 1990, 1991, or 1992, HUD uses the
regional CPI rental indices to update these areas to the end of 1993 and then uses RDD surveys to finish
the updating to the end of 1998. Again HUD projects these FMRs forward to April 1, 2000, using the
assumed 3-percent annual rate.

Example

Table 2 shows how HUD has computed the two-bedroom FMR for Nashville throughout the decade. The
starting point was the 1990 census. Because the FMR definition used the 45th percentile prior to 1995,
HUD used the extract from the 1990 census to calculate a 45th percentile of $455 as of April 1990, the
date of the census. HUD then adjusted this estimate upward by 1 percent to account for the requirement in
the definition to exclude substandard units. (This 1-percent adjustment used both national AHS data and
census data for the Nashville area.) HUD then used CPI regional data to update the adjusted census
estimate to the end of 1993. Then HUD used its RDD survey for the metropolitan portion of the Southeast
region to obtain an end-of-1994 estimate of $521.10 When the FMR definition was changed to the 40th
percentile in 1995, the end-of-1994 estimate decreased by 2.1 percent to $509. An RDD survey for the
metropolitan portion of the Southeast region raised this estimate to $525 at the end of 1995.




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                                                                                   Fair Market Rents (continued)


Table 2. Example of FMR Calculation, Nashville Tennessee




In 1996 HUD conducted an RDD survey to update its baseline for Nashville. The survey found that the
40th percentile had increased to $578. The new baseline replaced all previous estimates and became the
starting point for the 1996 and subsequent FMRs. The current (fiscal year 1999) estimate of $626 was
obtained by updating the $578 to the end of 1997 using the RDD survey for the metropolitan portion of
the Southeast region and then projecting forward to April 1, 1999, using the assumed 3-percent annual
rate.

State Minimums, Exceptions, and Web Site

Sparsely populated, nonmetropolitan counties present special difficulties in setting accurate FMRs. These
counties typically have small Section 8 programs, making it cost-inefficient for HUD to conduct RDD
surveys to update their FMRs.11 Because the nonmetropolitan regional RDDs may miss small, hot real
estate markets, updating from the 1990 census can introduce errors over time. Generally, the public
comment process will identify these areas. Unfortunately, it is these small, nonmetropolitan areas that
have the most difficulty providing the information HUD needs to change an FMR. For these reasons,
HUD introduced State minimums in 1996. For fiscal year 1996 HUD set a minimum FMR for each State
that is the lesser of the average nonmetropolitan FMR for the State or $450. Since 1996 HUD has used
State minimums, updating the $450 limit for overall inflation in rents. In fiscal year 1999, 1,721 of the
2,382 county FMRs were State minimums.

By statute, HUD can increase the FMR by up to 20 percent for a portion of an FMR area. This provision
allows HUD to respond to situations where an areawide 40th percentile FMR does not provide the desired
range of choice among units or neighborhoods. There are three limitations on exceptions:




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                                                                                                   Fair Market Rents (continued)

       The exception area can contain no more than 50 percent of the population of the overall FMR area.
       The exception FMR must equal the 40th percentile rent within the exception area.
       The exception must respond to problems observed in operating the Section 8 program in the
        exception area or be part of an active effort to provide housing opportunities outside poverty
        areas.12

A complete list of FMRs can be obtained over the Internet.


Notes

   1.  Gross rent is the sum of the rent paid to the owner and an allowance for any utility costs incurred by the tenant.
   2.  The household does not actually "receive a subsidy"; payment goes directly to the owner. See pages 73 to 76 of Final
       Comprehensive Report of the Freestanding Housing Voucher Demonstration, Volume 1, U.S. Department of Housing
       and Urban Development, May 1990.
   3. See 24 CFR 888 for regulations governing FMRs.
   4. If one arranged the gross rents for 100 rental units in order from lowest gross rent to highest gross rent, then the 40th
       gross rent from the low end of the ordering would be the 40th percentile.
   5. The Quality Housing and Work Opportunity Act of 1998 gives local housing authorities that administer the certificate
       and voucher programs the ability to increase or decrease the FMR by up to 10 percent.
   6. To change a proposed FMR, HUD requires commenters to provide new data that it can use to estimate new FMRs.
       HUD keeps track of comments that do not contain new data to help the Department decide where to conduct its own
       surveys in the future.
   7. The most difficult problem faced by commenters in providing useable data is to obtain a sample representative of the
       entire rental market. Data from real estate organizations are typically representative only of large apartment
       complexes in the central city or nearby suburbs. Approximately one-quarter of the rental stock is in single-family
       homes. In recent years HUD has urged commenters to use RDD techniques to obtain representative samples. HUD
       provides two guides to help commenters conduct RDD surveys and, in the case of commenters with small Section 8
       programs, HUD permits a number of modifications to make RDD surveys simpler and less expensive. HUD has never
       rejected an RDD survey provided by a commenter.
   8. From the 1990 census extract, HUD calculates for each FMR area ratios between the 40th percentile of gross rents of
       various sized units and the 40th percentile gross rent of two-bedroom units. Using national data, HUD established
       boundaries between these ratios. For example, based on local data, HUD allows the ratio of one-bedroom to two-
       bedroom rents to range between 0.80 and 0.90. Using this information, HUD ratios the two-bedroom FMR down or up
       to estimate FMRs for units of other sizes.
   9. The Regional Activity section of each U.S. Housing Market Conditions contains maps that depict the make- up of
       each of the 10 Federal regions.
   10. The $521 amount was not the FMR for fiscal year 1995. The fiscal year 1995 FMR was the end-of-1993 estimate
       updated to April 1, 1995.
   11. HUD conducts approximately 10 RDDs of small, nonmetropolitan areas each year. The surveyed areas are selected
       based on the size of the Section 8 program and information about possible problems with the current FMR.
   12. See 24 CFR 982.504.




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 Attachment #4
                                          Fair Market Rents WA 2011
studio   1-bedroom   2-bedroom   3-bedroom   4-bedroom             county                       city and/or county
 434        518         664         891          919          Adams County                     Adams County, WA
 504        523         655         930          1133          Asotin County                  Lewiston, ID-WA MSA
 539        588         738         998          1182         Benton County          Kennewick-Pasco-Richland, WA MSA
 558        591         747        1008          1160         Chelan County          Wenatchee-East Wenatchee, WA MSA
 548        607         789        1153          1188         Clallam County                   Clallam County, WA
 675        783         905        1318          1583          Clark County       Portland-Vancouver-Hillsboro, OR-WA MSA
 448        523         690         932          1112        Columbia County                  Columbia County, WA
 480        603         700        1020          1163         Cowlitz County                   Longview, WA MSA
 558        591         747        1008          1160         Douglas County         Wenatchee-East Wenatchee, WA MSA
 434        514         664         891          919           Ferry County                     Ferry County, WA
 539        588         738         998          1182         Franklin County        Kennewick-Pasco-Richland, WA MSA
 448        523         690         932          1112         Garfield County                  Garfield County, WA
 443        526         681         920          945           Grant County                     Grant County, WA
 450        527         693         976          1003       Grays Harbor County              Grays Harbor County, WA
 805        807         974        1417          1710          Island County                    Island County, WA
 561        688         841        1223          1258         Jefferson County                Jefferson County, WA
 857        977        1176        1662          2030          King County         Seattle-Bellevue, WA HUD Metro FMR Area
 667        748         921        1318          1440          Kitsap County              Bremerton-Silverdale, WA MSA
 502        585         771        1033          1072         Kittitas County                  Kittitas County, WA
 581        589         700         983          1012         Klickitat County                 Klickitat County, WA
 485        620         745         995          1041          Lewis County                     Lewis County, WA
 434        514         664         891          919          Lincoln County                   Lincoln County, WA
 546        642         770        1052          1246          Mason County                    Mason County, WA
 486        585         688         941          1036        Okanogan County                  Okanogan County, WA
 476        513         672         953          991          Pacific County                   Pacific County, WA
 434        514         664         891          919        Pend Oreille County              Pend Oreille County, WA
 699        816        1018        1483          1669          Pierce County             Tacoma, WA HUD Metro FMR Area
 686        738         912        1311          1601         San Juan County                 San Juan County, WA
 614        760         943        1290          1610          Skagit County             Mount Vernon-Anacortes, WA MSA
 675        783         905        1318          1583        Skamania County      Portland-Vancouver-Hillsboro, OR-WA MSA
 857        977        1176        1662          2030        Snohomish County      Seattle-Bellevue, WA HUD Metro FMR Area
 474        555         731        1004          1138         Spokane County                   Spokane, WA MSA
 432        520         664         910          993          Stevens County                   Stevens County, WA
 628        705         901        1308          1582         Thurston County                  Olympia, WA MSA
 483        600         701        1021          1171       Wahkiakum County                 Wahkiakum County, WA
 448        523         690         992          1023       Walla Walla County               Walla Walla County, WA
 612        676         848        1237          1394        Whatcom County                   Bellingham, WA MSA
 485        534         693         978          1198         Whitman County                  Whitman County, WA
 515        604         782        1030          1086         Yakima County                     Yakima, WA MSA




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Attachment #5




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Attachment # 6                     Housing Choice Vouchers Fact Sheet

What are housing choice vouchers?
The housing choice voucher program is the federal government's major program for assisting very low-income
families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since
housing assistance is provided on behalf of the family or individual, participants are able to find their own
housing, including single-family homes, townhouses and apartments.

The participant is free to choose any housing that meets the requirements of the program and is not limited to
units located in subsidized housing projects.

Housing choice vouchers are administered locally by public housing agencies(PHAs). The PHAs receive
federal funds from the U.S. Department of Housing and Urban Development (HUD) to administer the voucher
program.

A family that is issued a housing voucher is responsible for finding a suitable housing unit of the family's
choice where the owner agrees to rent under the program. This unit may include the family's present residence.
Rental units must meet minimum standards of health and safety, as determined by the PHA.

A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family
then pays the difference between the actual rent charged by the landlord and the amount subsidized by the
program. Under certain circumstances, if authorized by the PHA, a family may use its voucher to purchase a
modest home.

Am I eligible?

Eligibility for a housing voucher is determined by the PHA based on the total annual gross income and family
size and is limited to US citizens and specified categories of non-citizens who have eligible immigration
status. In general, the family's income may not exceed 50% of the median income for the county or
metropolitan area in which the family chooses to live. By law, a PHA must provide 75 percent of its voucher
to applicants whose incomes do not exceed 30 percent of the area median income. Median income levels are
published by HUD and vary by location. The PHA serving your community can provide you with the income
limits for your area and family size.

During the application process, the PHA will collect information on family income, assets, and family
composition. The PHA will verify this information with other local agencies, your employer and bank, and
will use the information to determine program eligibility and the amount of the housing assistance payment

If the PHA determines that your family is eligible, the PHA will put your name on a waiting list, unless it is
able to assist you immediately. Once your name is reached on the waiting list, the PHA will contact you and
issue to you a housing voucher.

How do I apply?
If you are interested in applying for a voucher, contact the local PHA. For further assistance, please contact
the HUD Office nearest to you.

Local preferences and waiting list - what are they and how do they affect me?
Since the demand for housing assistance often exceeds the limited resources available to HUD and the local



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                                                                                       Housing Choice Vouchers (continued)

housing agencies, long waiting periods are common. In fact, a PHA may close its waiting list when it has more
families on the list than can be assisted in the near future.

PHAs may establish local preferences for selecting applicants from its waiting list. For example, PHAs may
give a preference to a family who is (1) homeless or living in substandard housing, (2) paying more than 50%
of its income for rent, or (3) involuntarily displaced. Families who qualify for any such local preferences move
ahead of other families on the list who do not qualify for any preference. Each PHA has the discretion to
establish local preferences to reflect the housing needs and priorities of its particular community.

Housing vouchers - how do they function?
The housing choice voucher program places the choice of housing in the hands of the individual family. A
very low-income family is selected by the PHA to participate is encouraged to consider several housing
choices to secure the best housing for the family needs. A housing voucher holder is advised of the unit size
for which it is eligible based on family size and composition.

The housing unit selected by the family must meet an acceptable level of health and safety before the PHA can
approve the unit. When the voucher holder finds a unit that it wishes to occupy and reaches an agreement with
the landlord over the lease terms, the PHA must inspect the dwelling and determine that the rent requested is
reasonable.

The PHA determines a payment standard that is the amount generally needed to rent a moderately-priced
dwelling unit in the local housing market and that is used to calculate the amount of housing assistance a
family will receive. However the payment standard does not limit and does not affect the amount of rent a
landlord may charge or the family may pay. A family which receives a housing voucher can select a unit with
a rent that is below or above the payment standard. The housing voucher family must pay 30% of its monthly
adjusted gross income for rent and utilities, and if the unit rent is greater than the payment standard the family
is required to pay the additional amount. By law, whenever a family moves to a new unit where the rent
exceeds the payment standard, the family may not pay more than 40 percent of its adjusted monthly income
for rent.

The rent subsidy
The PHA calculates the maximum amount of housing assistance allowable. The maximum housing assistance
is generally the lesser of the payment standard minus 30% of the family's monthly adjusted income or the
gross rent for the unit minus 30% of monthly adjusted income

Can I move and continue to receive housing choice voucher assistance?
A family's housing needs change over time with changes in family size, job locations, and for other reasons.
The housing choice voucher program is designed to allow families to move without the loss of housing
assistance. Moves are permissible as long as the family notifies the PHA ahead of time, terminates its existing
lease within the lease provisions, and finds acceptable alternate housing.

Under the voucher program, new voucher-holders may choose a unit anywhere in the United States if the
family lived in the jurisdiction of the PHA issuing the voucher when the family applied for assistance. Those
new voucher-holders not living in the jurisdiction of the PHA at the time the family applied for housing
assistance must initially lease a unit within that jurisdiction for the first twelve months of assistance. A family
that wishes to move to another PHA's jurisdiction must consult with the PHA that currently administers its
housing assistance to verify the procedures for moving.


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                                                                                      Housing Choice Vouchers (continued)


Roles - the tenant, the landlord, the housing agency and HUD
Once a PHA approves an eligible family's housing unit, the family and the landlord sign a lease and, at the
same time, the landlord and the PHA sign a housing assistance payments contract that runs for the same term
as the lease. This means that everyone -- tenant, landlord and PHA -- has obligations and responsibilities under
the voucher program.

Tenant's Obligations: When a family selects a housing unit, and the PHA approves the unit and lease, the
family signs a lease with the landlord for at least one year. The tenant may be required to pay a security
deposit to the landlord. After the first year the landlord may initiate a new lease or allow the family to remain
in the unit on a month-to-month lease.

When the family is settled in a new home, the family is expected to comply with the lease and the program
requirements, pay its share of rent on time, maintain the unit in good condition and notify the PHA of any
changes in income or family composition.

Landlord's Obligations: The role of the landlord in the voucher program is to provide decent, safe, and
sanitary housing to a tenant at a reasonable rent. The dwelling unit must pass the program's housing quality
standards and be maintained up to those standards as long as the owner receives housing assistance payments.
In addition, the landlord is expected to provide the services agreed to as part of the lease signed with the tenant
and the contract signed with the PHA.

Housing Authority's Obligations: The PHA administers the voucher program locally. The PHA provides a
family with the housing assistance that enables the family to seek out suitable housing and the PHA enters into
a contract with the landlord to provide housing assistance payments on behalf of the family. If the landlord
fails to meet the owner's obligations under the lease, the PHA has the right to terminate assistance payments.
The PHA must reexamine the family's income and composition at least annually and must inspect each unit at
least annually to ensure that it meets minimum housing quality standards.

HUD's Role: To cover the cost of the program, HUD provides funds to allow PHAs to make housing
assistance payments on behalf of the families. HUD also pays the PHA a fee for the costs of administering the
program. When additional funds become available to assist new families, HUD invites PHAs to submit
applications for funds for additional housing vouchers. Applications are then reviewed and funds awarded to
the selected PHAs on a competitive basis. HUD monitors PHA administration of the program to ensure
program rules are properly followed.

Additional Information and other subsidy programs
For additional information about the voucher program, contact either the
local PHA serving your community or the Office of Public Housing within your local HUD office. There may
be a long wait for assistance under the housing voucher program. If the PHA also administers the public
housing program,applicants for the housing choice voucher program may also ask to be placed on the waiting
list for the public housing program. HUD also administers other subsidized programs and you may obtain a list
of programs in your area from the Office of Housing at your local HUD office.

What regulations cover this program?
Regulations are found in 24 CFR Part 982.



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Attachment #7


                                                        PHA Matrix of Contact Information and Responses to Questions
                                                                                         Waiting List     When might the      If waiting list is
  Housing                                                                                                last person on the                                                               Additional
                 Executive Director           Email Address                Phone #        Open or                             closed, when it           The person contacted
  Authority                                                                                                waiting list be                                                                comments
                                                                                          Closed?                               might open?
                                                                                                               served?

                                                                                                                                                   Wendy Knight, Director of         subject to many variables (rent prices,
 Bellingham         John Harmon             jharmon@bwcha.org           360-676-6887        closed        at least 4 years            1+ year
                                                                                                                                                   Leased Housing                    funding, etc.)
                                                                                                                              It's been closed for
                                                                                                          Might be 5-6        18 months. Several                                     637 on list. They will likely place 100 by
 Bremerton           Kurt Wiest        Kwiest@bremertonhousing.org      360-479-3694        closed                                                 Cheryl Haws, 360-616-7121
                                                                                                             years.                years before                                      Sept. and then not again for another year.
                                                                                                                                     opening.
Chelan County
                                                                                                                                                   out until Tuesday, May 17; AB
  ,City of of       Alicia Mcrae             alicia@ccwha.com           509-663-7421        closed          Early 2012             Fall 2011
                                                                                                                                                   left messageLM 5/12/11
 Wenatchee

   Everett           Bud Alkire               Buda@evha.org             425-303-1102     Sect.8 Closed       ?                 After Sept. 2011    AB LM 5/12/11

                                                                         509-586-8576
 Kennewick       Karlene K Navarre       karlenen@kennewickha.org                            Open          up to 3 years          not closed       exchanged VM with Karlene
                                                                             X103
                                                                                                                                                 exchanged VM with Pam Taylor, based on funding; still have 300 on WL. Last
                                                                                                                              May 25, 2011 for 2
 King County        Mike Reilly               miker@kcha.org            206-574-1154        closed           3-4 years                           Section 8 Housing Manager 206- time WL was open was
                                                                                                                                   weeks
                                                                                                                                                 214-1306                        2007.
                                                                         360-423-0140,
  Longview         Christina Pegg          cpegg@longviewha.org                              Open                6 years          not closed
                                                                             x 15

Pasco/Franklin     F.J. Anderson           aanderson@hacpfc.org         509-547-3581         Open            6 Months             not closed       LM Adela, 5/13/11


Pierce County        Karen Hull              khull@pchawa.org           253-620-5400        closed               6 years         2 or 3 years

                                                                                                                                                   receptionist gave my # to Annette
                                                                         425-226-1850
   Renton          Mark Gropper           mrg@rentonhousing.org                             closed           6 months                              & Juanita, who were out of office still working on lis; closed since 2001
                                                                             x 227
                                                                                                                                                   on Thurs., 5/19. (x 226)
                                                                                                                                                                                     no way to estimate how long it will take to
                                                                                                                                                                                     get vouchers to those on
                 Karmin Hallbereg,
   Seattle                              khallberg@seattlehousing.org    (206) 239-1572      Closed           Unknown              Unknown          exchanged VM with Karmin.         WL; not offering vouchers at least through
                 Voucher Program
                                                                                                                                                                                     2011. No anticipated date for opening WL
                                                                                                                                                                                     again.
                                                                                                                               will open June 1-
  Spokane         Steve Cervantes      scervantes@spokanehousing.org    509-328-2953        closed        November, 2011                           Amanda, 509-252-7122, 5/12/11 600 on WL
                                                                                                                                    17,2011

                 Michael Mirra -
   Tacoma                               cwilson@tacomahousing.org       253-207-4400        Closed         March, 2011             1+ Years        LM Christine, 5/11/11
                  contact

 Thurstonm
                    Chris Lowell              chrisl@hatc.org           360-753-8292        ?                ?                    ?
  County
                                                                                                                                                                                     They closed the list in 2007. 3,400 on WL.
                                                                                                                                                   Steven Towell. He'll email or
 Vancouver         Steven Towell            stowell@vhausa.com          360-993-9563        Closed         August, 2014               3 years                                        Will open it again when
                                                                                                                                                   call with data.
                                                                                                                                                                                     there is about one year's worth of WL.

   Yakima          Lowel Krueger      lowel.krueger@yakimahousing.org   509-453-3106         Open          Within 4 years         not closed



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Attachment #8




                The Housing Access and Services Program in King County

The Housing Access and Services Program (HASP) is a King County Housing Authority program that
helps people with disabilities access Section 8 Vouchers. A Section 8 Voucher allows a person to pay 30
percent of his or her income towards rent and utilities. The King County Housing Authority pays the
difference between 30 percent of the tenant‘s income and a housing payment standard established by the
Department of Housing and Urban Development. To be referred into the HASP program, the applicant
must be prepared to be successful at independent or semi-independent living.

To be eligible for the HASP program, the applicant must:

    1. be eligible for services through DSHS/DDD or be a participant in The Arc of King
       County's Homeless Survival Services Program
    2. be an adult with a disability
    3. have a support system available. This support system may include case management, family,
       friends, or paid support providers.
    4. meet one of the following federal preference:
           o rent burdened: applicant pays more than 50 percent of his or her gross monthly income
               towards rent and utilities for at least 90 days
           o involuntarily displaced
           o living in substandard housing or homeless


For more information about King County Housing Authority‘s HASP program contact your DSHS/DDD
Case Manager or Interim, KCDDD Housing Coordinator, Katherine Festa at 206-263-9053.




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            SECTION 13
       Surveys and Interviews
        Affordable Housing Funders

Attachments

  1.   Washington State Housing Finance Commission (WSHFC)
  2.   HUD HOME Program
  3.   Housing Funder Matrix
  4.   City of Seattle Housing Levy
  5.   A Regional Coalition for Housing (ARCH)
  6.   King County Veterans and Human Services Levy
  7.   HUD Community Development Block Grant Program (CDBG)
  8.   HUD Section 811 Program




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                                    Affordable Housing Funders
                                            General Information

Affordable housing funders in Washington State come in all sizes and shapes. The two statewide public
funders established by the WA legislature are:

The WA State Housing Finance Commission (WSHFC) was created in 1983 and was given bond
authority to help finance housing. The WSHFC is financially involved in most of the large affordable
housing developments, as well as affordable homeownership mortgages and down payment assistance
opportunities. See attachment #1 for a list of the WSHFC programs and services. http://www.wshfc.org

The Department of Commerce offers three major programs related to housing:
(http://www.commerce.wa.gov/site/474/default.aspx)

   1. Affordable housing: There are two affordable housing programs of particular note.

      The first is the Housing Trust Fund (HTF) that was established by the legislature in 1987. Funding
       comes from the State Capital Budget from the sale of state bonds. The HTF provides funding
       through a competitive application process for affordable housing and homeownership
       opportunities for low-income individuals, households, and special needs populations. On May 25,
       2011 the legislature approved the Capital Budget that included $50 million for the 2011-2013
       biennium for the HTF to award. Included in that $50 million appropriation is almost $10 million in
       specific set-asides such as the $3 million Developmental Disabilities Set-Aside. Funding in this
       set-aside is restricted to supporting people with a developmental disability.
       (http://www.commerce.wa.gov/site/493/default.aspx)

      The second program to note is the HOME Investment Partnership Program (HOME) that is funded
       by federal dollars from Housing and Urban Development (HUD)
       (http://www.hud.gov/offices/cpd/affordablehousing/programs/home/). See attachment #2 for more
       information about the HOME program.

   2. Homeless programs

   3. Home repair and weatherization

The next level of in-state public funders is cities and counties. Their source and amount of funding is
quite varied. In attachment #3 is a list of 8 cities and 9 counties that includes information on their 2010
funding award amounts. A few interesting examples are:

      The City of Seattle has a voter-approved levy and awarded $23 million in 2010. For more
       information, see attachment #4. (www.cityofseattle.net/housing)


      On the eastside of King County, (15) cities have joined together to form A Regional Coalition for
       Housing (ARCH) to pool their funding. For more information, see attachment #5.
       (http://www.archhousing.org


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                                                                                      Affordable Housing Funders (continued)


        King County has a voter-approved levy, the Veterans & Human Services Levy that includes both
         housing and services. They awarded almost $10 million in 2010. For more information see
         attachment #6. (www.kingcounty.gov/operations/DCHS/Services/Levy)

A couple of noteworthy federal programs that fund housing are:

        The HUD Community Development Block Grant (CDBG) Program (see attachment #7) that
         provides funding directly to eligible cities and counties, as well as to the state. In these difficult
         financial times, many cities offer CDBG funding as their only means of financially supporting the
         development of affordable housing.
         (http://www.hud.gov/offices/cpd/communitydevelopment/programs)

         The HUD Section 811 Supportive Housing for Persons with Disabilities Program (HUD 811)
          provides funding to develop rental housing that must include the provision of support services to
          very low-income adults with disabilities. The major goal of the HUD 811 program is to provide
          housing opportunities to persons with disabilities to live as independently as possible in their
          community. A key component of the HUD 811 program is that it provides rent subsidies so the
          tenants only pay 30% of their income towards rent and utilities. See attachment #8 for information
          on the HUD 811 program.
       http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/mfh/progdesc/disab811

Methodology

There were (9) counties and (8) cities contacted about their funding of affordable housing programs, all
were located in the geographical areas of the needs assessment. In addition, the State Housing Trust Fund,
the Federal Home Loan Bank of Seattle, and the U.S. Department of Agriculture were also contacted.

The public housing funders were asked about:
    their prior funding of projects that supported people with a brain injury, and
    their total housing dollars awarded for all projects in 2010.

In attachment #3 is the spreadsheet matrix of the (20) funders contacted. The spreadsheet identifies each
funder, a contact person with a telephone number and email address, their response to any prior funding
for people with a brain injury, and how much funding they awarded to all housing projects in 2010.

Findings

In their combined history, there were only (3) projects that were identified statewide by public funders
that supported people with a traumatic brain injury:




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                                                                                     Affordable Housing Funders (continued)

   1. Terry Home opened a 10-bed facility in the City of Pacific in King County in 1996.


   2. Terry Home has a second facility in the works that was funded by the TBI Fund and King County
      in 2010 and is expecting a HTF award in 2011. They are planning to break ground in August to
      build a 12-bedroom facility in Auburn.
                                                                                     Affordable Housing Funders (continued)

   3. Accessible Spaces 21-unit Eagle Crest Apartments in Spokane that currently has 6 and possibly
      more tenants with a TBI.


In our discussion with several housing funders, no one had an idea about the type of housing or the
number of units that were needed for people with a TBI. This was particularly evident around tenants who
required some daily support services. A concern by one large funder was that the cost to develop housing
would be too expensive to support a smaller group of people who needed 24/7 support services such as
Terry Home‘s soon-to-be 12-bed facility.

In looking at the funding awards from 2010 for cities and counties, it is clear that some areas of the state
will be very challenged, but still with some possibility, to put together affordable, accessible housing with
just in-state funding. The HUD 811 program is becoming much more important as a source of funding,
particularly in rural areas where local funding is limited. The added benefit of the HUD 811 program is
that it also includes an operating subsidy that is built into the program to help pay for some of the
building‘s maintenance and repairs.

Recommendations

   1. Strong consideration should be made to having a dedicated TBI Set-Aside in the HTF. Twenty
      years ago, much like today for people with a traumatic brain injury, people with developmental
      disabilities were rarely considered for a stand-alone or to be part of a larger affordable, accessible
      housing project. The recently passed $3 million for the HTF DD Set-Aside for the 2011-2013
      biennium already has over $4.5 million in project requests for stand-alone projects. This does not
      include units that are part of larger projects or for down payment assistance for homeownership
      opportunities ($1.2 million already requested).


   2. Individuals with a TBI, family members, service providers, advocacy groups, and other
      stakeholders need to develop relationships with public funders, particularly local funders, to
      provide education on the housing and service needs of people with a TBI. All cities and counties
      are required to have a Comprehensive Plan, which sets the policy for land use including affordable
      housing. It is important to provide input into the Plan on the housing needs of people with TBI. It
      can be taken a step further, by establishing affordable, accessible housing as a priority for people
      with a TBI in a particular city or county.


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                                  Statewide TBI Housing Needs Assessment June 2011
Attachment #1
                 Washington State Housing Finance Commission (WSHFC)
                                     (http://www.wshfc.org/index.htm)

 Our Mission
 We are a publicly accountable, self-supporting team, dedicated to increasing housing access and
 affordability and to expanding the availability of quality community services for the people of
 Washington.

 Homeownership Programs
 Home Buyer Programs
  House Key 2009-C funds available fixed interest rate for 30 years
  House Key State Bond 5.00% (2 pts), 5.25% (1 pt), 5.50% (0 pts)
  New Home For You 4.75% (2 pts), 5.00% (1 pt), 5.25% (0 pts)

 Bond Financing Programs
 » Beginning Farmer & Rancher financing for land, improvements, equipment
 » Energy Efficiency financing for efficiency & renewable energy projects
 » Nonprofit Facilities financing for nonprofit 501(c)(3) organizations' capital facilities
 » Nonprofit & Multifamily Housing financing for developers of affordable rental housing
 » Senior Housing access to bond & tax credit financing for senior housing developers
 » Washington Works Housing Program a multifamily program for nonprofits

 Information for Low-Income Housing Tax Credit (LIHTC) Developers
 » Low-Income Housing Tax Credit for owners & investors who provide low-income housing
 » Land Acquisition for eligible organizations to purchase land for affordable housing
 » Rapid Response for eligible organizations to quickly respond to market conditions
 » American Recovery & Reinvestment Act for eligible projects

 Compliance & Preservation Programs
 » Compliance for owners & mgrs. of property financed with bonds, tax credits, & other sources
 » Preservation of affordable housing: funding sources, awards, training




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Attachment #2
                        HUD HOME Investment Partnerships Program


 HOME Program Summary
 HOME is authorized under Title II of the Cranston-Gonzalez National Affordable Housing Act, as
 amended. Program regulations are at 24 CFR Part 92. The HOME program final rule is available
 electronically. Additional information about the HOME program can be found by visiting the HOME
 program web pages.
 HOME provides formula grants to States and localities that communities use-often in partnership with
 local nonprofit groups-to fund a wide range of activities that build, buy, and/or rehabilitate affordable
 housing for rent or homeownership or provide direct rental assistance to low-income people.

 Purpose
 HOME is the largest Federal block grant to State and local governments designed exclusively to create
 affordable housing for low-income households. Each year it allocates approximately $2 billion among the
 States and hundreds of localities nationwide. The program was designed to reinforce several important
 values and principles of community development:

 HOME's flexibility empowers people and communities to design and implement strategies tailored to
 their own needs and priorities.

 HOME's emphasis on consolidated planning expands and strengthens partnerships among all levels of
 government and the private sector in the development of affordable housing.

 HOME's technical assistance activities and set-aside for qualified community-based nonprofit housing
 groups builds the capacity of these partners.

 HOME's requirement that participating jurisdictions (PJs) match 25 cents of every dollar in program
 funds mobilizes community resources in support of affordable housing.
 Types of Assistance
 HOME funds are awarded annually as formula grants to participating jurisdictions. HUD establishes
 HOME Investment Trust Funds for each grantee, providing a line of credit that the jurisdiction may draw
 upon as needed. The program's flexibility allows States and local governments to use HOME funds for
 grants, direct loans, loan guarantees or other forms of credit enhancement, or rental assistance or security
 deposits.

 Eligible Grantees
 States are automatically eligible for HOME funds and receive either their formula allocation or $3
 million, whichever is greater. Local jurisdictions eligible for at least $500,000 under the formula
 ($335,000 in years when Congress appropriates less than $1.5 billion for HOME) also can receive an
 allocation. Communities that do not qualify for an individual allocation under the formula can join with
 one or more neighboring localities in a legally binding consortium whose members' combined allocation
 would meet the threshold for direct funding. Other localities may participate in HOME by applying for
 program funds made available by their State. Congress sets aside a pool of funding, equivalent to the
 greater of $750,000 or 0.2 percent of appropriated funds, which HUD distributes among insular areas.



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                                                                                    Home Investment Partnerships (continued)


Eligible Customers

The eligibility of households for HOME assistance varies with the nature of the funded activity. For rental
housing and rental assistance, at least 90 percent of benefiting families must have incomes that are no
more than 60 percent of the HUD-adjusted median family income for the area. In rental projects with five
or more assisted units, at least 20% of the units must be occupied by families with incomes that do not
exceed 50% of the HUD-adjusted median. The incomes of households receiving HUD assistance must not
exceed 80 percent of the area median. HOME income limits are published each year by HUD.

Eligible Activities
Participating jurisdictions may choose among a broad range of eligible activities, using HOME funds to
provide home purchase or rehabilitation financing assistance to eligible homeowners and new
homebuyers; build or rehabilitate housing for rent or ownership; or for "other reasonable and necessary
expenses related to the development of non-luxury housing," including site acquisition or improvement,
demolition of dilapidated housing to make way for HOME-assisted development, and payment of
relocation expenses. PJs may use HOME funds to provide tenant-based rental assistance contracts of up to
2 years if such activity is consistent with their Consolidated Plan and justified under local market
conditions. This assistance may be renewed. Up to 10 percent of the PJ's annual allocation may be used
for program planning and administration.

HOME-assisted rental housing must comply with certain rent limitations. HOME rent limits are published
each year by HUD. The program also establishes maximum per unit subsidy limits and maximum
purchase-price limits.

Some special conditions apply to the use of HOME funds. PJs must match every dollar of HOME funds
used (except for administrative costs) with 25 cents from nonfederal sources, which may include donated
materials or labor, the value of donated property, proceeds from bond financing, and other resources. The
match requirement may be reduced if the PJ is distressed or has suffered a Presidentially declared disaster.
In addition, PJs must reserve at least 15 percent of their allocations to fund housing to be owned,
developed, or sponsored by experienced, community-driven nonprofit groups designated as Community
Housing Development Organizations (CHDOs). PJs must ensure that HOME-funded housing units
remain affordable in the long term (20 years for new construction of rental housing; 5-15 years for
construction of homeownership housing and housing rehabilitation, depending on the amount of HOME
subsidy). PJs have two years to commit funds (including reserving funds for CHDOs) and five years to
spend funds.

HUD Website on Program: http://www.hud.gov/offices/cpd/affordablehousing/programs/home/




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Attachment #3

                                                      HOUSING FUNDER MATRIX
                                                                                                                                   Total housing
     Housing Funder     City/       Contact Person              Phone                       Email               Prior TBI funding dollars awarded
                       County                                                                                    number or # /$        in 2010
                      Bellingham/
    Whatcom                          David Stalheim          360 778 8385             dbstalheim@c ob.org       none                  2,385,576
                       Whatcom
                        Seattle/      Tom Mack /             206 684 0339           tom.mack@se attle.gov       None / 21 units       23,000,000
    King
                         King        Eileen Bleeker          206 263 9080        eileen.bleeker@metrokc.gov     Terry Homes 1&2       9,784,381
                       Spokane/      Melora Sharts           509 625 325          msharts@spokanecity.org       21 units              1,189,000
    Spokane
                       Spokane       Tim Crowley             509 477 2521        cowley@spokanecounty.org       Eagle Crest Estates   2,000,000
                       Tacoma/      Richard Teasley          253 591 5238          cmorton@ci.ta coma.org                             2,000,000
    Pierce                                                                                                      None
                        Pierce        Gary Aden              253 798 6912           gaden@co.pie rce.wa.us                            4,790,345
                       Yakima/      Michael Morales          509 575 3533
    Yakima                                                                         bcobabaci.yaki ma.wa.us      None                  500,000
                       Yakima          Steve Hill            509 574 1520
                      Longview/
    Cowlitz                           Julie Hourcle          360 442 5081      julie.hourcle@ ci.longview.wa. us None                 637,320
                       Cowlitz
    Thurston                        Dwight Edwards           360 867 2532        dedwards@co. thurston.wa.us    none                  2,554,300
                      Vancouver/     Peggy Sheelan           360 487 7952    peggysheehan@city of vancouver.us None                   940,000
    Clark
                        Clark        Peter Munroe            360 397 2075        pete.munroe@ clark.wa.gov     None                   2,050,000
    Kitsap                            Bonnie Tufts           360 337 4606             btufts@kitsap. wa.us      None                  2,500,000
                      Wenatchee/     Monica Libbey           509 888 3252        mlibbey@wen atcheewa.gov       None                  718,603
    Chelan
                       Chelan         Steve Hill             509 667 6225        steve.hill@co.c helan.wa.us    None                  None
    Snohomish           County      Dean Weitenhagen         425 388 3267       dean.weitenha gen@snoco.or g    none                  5,500,000
    Federal Home                                                                                                                      No Funding
                       Statewide      Debra Davis            206 340 8663                                       None
    Loan Bank                                                                                                                         2010
                                                                                                                42 units
    Housing Trust                                                                                                                     no funding
                       Statewide       Dan Riebli            360 725 2660       dan.riebli@Co mmerce.wa.go v    Eagle Crest
    Fund                                                                                                                              2010
                                                                                                                Terry Home 1 & 2
    HUD/USDA                             Gayle                                          gayle.hoskison          21 units
                       Statewide                             360 704 7760                                                             $3,819,900
    811 projects                        Hoskison                                        @wa.usda.gov            Eagle Crest




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Attachment #4

                                    The City of Seattle Housing Levy
                                     www.cityofseattle.net/housing/

 Since 1981, Seattle voters have approved one bond and four levies to create affordable housing. Seattle
 has now funded over 10,000 affordable apartments for seniors, low- and moderate-wage workers, and
 formerly homeless individuals and families, plus provided down-payment loans to more than 600 first-
 time homebuyers and rental assistance to more than 4,000 households.

 The Office of Housing‘s Rental Housing Program funds the development of affordable rental housing in
 Seattle using the Housing Levy Rental Preservation and Production Program funds, federal funds, and
 other fund sources.

 At least once per year, OH publishes a Notice of Funds Available (NOFA)
 for the Rental Housing Program.

 The NOFA describes specific funding priorities and requirements for each available fund source.
 Project sponsors that are planning to apply for OH funds to develop affordable rental housing are required
 to prepare their project for application through the following stages. Before considering applying for
 funds, applicants should also review OH‘s funding notices and policy documents to become familiar
 with the priorities, processes and requirements associated with OH funds.

 Preparing Projects for Application
 Necessary steps prior to applying for funding.

 NOFA Announcements & Applications
 Funding announcements, application forms, City priorities and policies for developers seeking funding to
 develop affordable housing.

 Pre-closing
 Pre-requisites for OH loan closings.

 Projects Under Construction
 Wage rates, reporting and other requirements during the construction process.

 Project Closeout
 Wage rates documentation, closeout inspection with OH Asset Managers and other requirements for final
 disbursement at project construction completion and occupancy.

 Policies and Administrative Guidelines
 Policy documents governing the use of OH funding.

 Income and Rents
 Applicable income and rent limits for the OH Rental Housing Program.




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Attachment #5
                             A Regional Coalition for Housing (ARCH)
                            Working together to house East King County
                               http://www.archhousing.org/index.html

ARCH is comprised of 15 Eastside cities & King County.
Beaux Arts Village - Bellevue - Bothell - Clyde Hill Hunts Point
Issaquah - Kenmore - King County - Kirkland - Medina - Mercer Island
Newcastle - Redmond - Sammamish - Woodinville - Yarrow Point

The ARCH Housing Trust Fund

The primary means by which ARCH members assist in creating and preserving housing
opportunities for low- and moderate-income households. The Housing Trust Fund awards
loans and grants to Eastside developments that include below-market rate housing. Between
1993 and 2002, ARCH member jurisdictions committed over $20+ million to this fund,
including Community Development Block Grant (CDBG) and General Funds. Also included
in this amount is over $2 million in contributions of land, fee-waivers and other in-kind
donations.

Key program features:
    Funding is made available as loans or grants depending on affordability levels and
       other funding sources.

      Projects receiving local funds sign covenants ensuring affordability levels are
       maintained long term.

      Types of projects include: rental and ownership housing for lower income families;
       senior housing; homeless and transitional housing; and housing for persons with
       special needs.


See ARCH web site Housing Trust Fund page for a complete list of projects funded and
ARCH Sample Portfolio page for pictures and descriptions of funded projects.




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Attachment #6
                             King County Veterans and Human Services Levy
                            www.kingcounty.gov/operations/DCHS/Services/Levy

  The Veterans and Human Services Levy was passed by the voters of King County in November 2005 to
  generate much needed funding to help veterans, military personnel and their families and other
  individuals and families in need across the county through a variety of housing and supportive services.
  This levy allocates approximately $13.3 million per year for six years to implement housing and human
  services for these two broad groups. One half of these revenues are targeted for veterans and their
  families, and the remaining half is dedicated to other King County residents in need of human services.
  The levy will remain in effect until 2011.

  Citizen Boards

  Two citizen boards were created in February 2007. Both boards are responsible for reviewing the
  expenditure of levy proceeds, and for reporting annually to the King County Executive and the King
  County Council.

  Service Improvement Plan

  The levy implementation ordinance required a Service Improvement Plan to detail how the county will
  proceed to provide enhanced services and supports for veterans, military personnel and their families, and
  others in need.

  Procurement Plans and Requests For Proposals (RFPs)

  Stakeholder input is an important part of the process of implementing the Veterans and Human Services
  Levy. As part of the levy implementation ordinance, procurement plans for each of the activities
  described in the Service Improvement Plan are posted for review and comment before being finalized for
  implementation. In many cases, an RFP follows

  Background

  King County voters said yes to a ballot measure in November 2005 by a margin of nearly 58 percent
  support. Half of the revenue raised will fund services for veterans, military personnel and their families,
  including services specific to veterans' needs such as treatment for post-traumatic stress disorder. The
  other half will fund regional health and human services, including housing, homelessness prevention,
  mental health and substance abuse services and employment assistance.

  Goals

  The levy ordinance identified three goal areas for service enhancements and funding allocations. Levy
  dollars will seek to:
  Reduce homelessness and emergency medical costs
  Reduce criminal justice system involvement
  Increase self-sufficiency by means of employment




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 Attachment #6

                     Community Development Block Grant Program – CDBG

                      http://www.hud.gov/offices/cpd/communitydevelopment/programs/

   The Community Development Block Grant (CDBG) program is a flexible program that provides
   communities with resources to address a wide range of unique community development needs. Beginning
   in 1974, the CDBG program is one of the longest continuously run programs at HUD. The CDBG
   program provides annual grants on a formula basis to 1209 general units of local government and States.

   Program Areas

 Entitlement Communities
  The CDBG entitlement program allocates annual grants to larger cities and urban counties to develop
  viable communities by providing decent housing, a suitable living environment, and opportunities to
  expand economic opportunities, principally for low- and moderate-income persons.

 State Administered CDBG
  Also known as the Small Cities CDBG program, States award grants to smaller units of general local
  government that carry out community development activities. Annually, each State develops funding
  priorities and criteria for selecting projects.

 Section 108 Loan Guarantee Program
  CDBG entitlement communities are eligible to apply for assistance through the section 108 loan guarantee
  program. CDBG non-entitlement communities may also apply, provided their State agrees to pledge the
  CDBG funds necessary to secure the loan. Applicants may receive a loan guarantee directly or designate
  another public entity, such as an industrial development authority, to carry out their Section 108 assisted
  project.

 HUD Administered Small Cities
  The HUD Honolulu Office directly administers the CDBG program for non-entitlement communities in
  the State of Hawaii.

 Insular Areas
  The Insular Areas CDBG program provides grants to four designated insular areas: American Samoa;
  Guam; Northern Mariana Islands; and the Virgin Islands.

 Disaster Recovery Assistance
  HUD provides flexible grants to help cities, counties, and States recover from Presidentially declared
  disasters, especially in low-income areas, subject to availability of supplemental appropriations.

 Neighborhood Stabilization Program
  HUD provides grants to communities hardest hit by foreclosures and delinquencies to purchase,
  rehabilitate or redevelop homes and stabilize neighborhoods.


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                                                                                              CDBG (continued)

    Colonias
     Texas, Arizona, California, and New Mexico set aside up to 10 percent of their State CDBG funds
     for improving living conditions for colonias residents.


    Renewal Communities/ Empowerment Zones/ Enterprise Communities (RC/EZ/EC)
     This is a program that uses an innovative approach to revitalization, bringing communities
     together through public and private partnerships to attract the investment necessary for sustainable
     economic and community development.


    Brownfields Economic Development Initiative (BEDI). BEDI is a competitive grant program used
     to spur the return of Brownfield‘s to productive economic reuse. BEDI grants must be used in
     conjunction with a new Section 108 guaranteed loan. Both Section 108 loan proceeds and BEDI
     grant funds are initially made available by HUD to public entities approved for assistance.


About the Program
The CDBG program works to ensure decent affordable housing, to provide services to the most
vulnerable in our communities, and to create jobs through the expansion and retention of businesses.
CDBG is an important tool for helping local governments tackle serious challenges facing their
communities. The CDBG program has made a difference in the lives of millions of people and their
communities across the Nation.
The annual CDBG appropriation is allocated between States and local jurisdictions called "non-
entitlement" and "entitlement" communities respectively. Entitlement communities are comprised of
central cities of Metropolitan Statistical Areas (MSAs); metropolitan cities with populations of at least
50,000; and qualified urban counties with a population of 200,000 or more (excluding the populations of
entitlement cities). States distribute CDBG funds to non-entitlement localities not qualified as entitlement
communities.

HUD determines the amount of each grant by using a formula comprised of several measures of
community need, including the extent of poverty, population, housing overcrowding, age of housing, and
population growth lag in relationship to other metropolitan areas.

Citizen Participation
A grantee must develop and follow a detailed plan that provides for and encourages citizen participation.
This integral process emphasizes participation by persons of low or moderate income, particularly
residents of predominantly low- and moderate-income neighborhoods, slum or blighted areas, and areas in
which the grantee proposes to use CDBG funds. The plan must provide citizens with the following:
reasonable and timely access to local meetings; an opportunity to review proposed activities and program
performance; provide for timely written answers to written complaints and grievances; and identify how
the needs of non-English speaking residents will be met in the case of public hearings where a significant
number of non-English speaking residents can be reasonably expected to participate.



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Attachment #8
                 Section 811 Supportive Housing for Persons with Disabilities

           http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/mfh/progdesc/disab811

  Summary:
  HUD provides funding to nonprofit organizations to develop rental housing with the availability of
  supportive services for very low-income adults with disabilities, and provides rent subsidies for the
  projects to help make them affordable.

  Purpose:
  The Section 811 program allows persons with disabilities to live as independently as possible in the
  community by increasing the supply of rental housing with the availability of supportive services. The
  program also provides project rental assistance, which covers the difference between the HUD-approved
  operating costs of the project and the tenants' contribution toward rent. The program is similar to
  Supportive Housing for the Elderly (Section 202).

  Type of Assistance:
  HUD provides interest-free capital advances to nonprofit sponsors to help them finance the development
  of rental housing such as independent living projects, condominium units and small group homes with the
  availability of supportive services for persons with disabilities. The capital advance can finance the
  construction, rehabilitation, or acquisition with or without rehabilitation of supportive housing. The
  advance does not have to be repaid as long as the housing remains available for very low-income persons
  with disabilities for at least 40 years.

  HUD also provides project rental assistance; this covers the difference between the HUD-approved
  operating cost of the project and the amount the residents pay--usually 30 percent of adjusted income. The
  initial term of the project rental assistance contract is 3 years and can be renewed if funds are available.

  The available program funds for a fiscal year are allocated to HUD‘s local offices according to factors
  established by the Department.

  Each project must have a supportive services plan. The appropriate State or local agency reviews a
  potential sponsor's application to determine if the plan is well designed to meet the needs of persons with
  disabilities and must certify to the same. Services may vary with the target population but could include
  case management, training in independent living skills and assistance in obtaining employment. However,
  residents cannot be required to accept any supportive service as a condition of occupancy.

  Eligible Grantees:
  Nonprofit organizations with a Section 501(c)(3) tax exemption from the IRS. Must make an investment
  equal to 0.5 percent of the capital advance amount, up to a maximum of $10,000.

  Eligible Customers:
  In order to live in Section 811 housing, a household which may consist of a single qualified person must
  be very low-income (within 50 percent of the median income for the area) and at least one member must
  be 18 years old or older and have a disability, such as a physical or developmental disability or chronic
  mental illness.



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        SECTION 14
   Surveys and Interviews
              Homeless Programs

Attachments

  1. Homeless Housing and Assistance
  2. Washington Homeless Census and Count
  3. Homeless Shelter Matrix




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                                               Homeless Shelters
    General Information

    A historic piece of legislation was passed in Washington in 2005. The legislature enacted the
    Homelessness Housing and Assistance Act (RCW 43.185C see attachment #1) that generates
    approximately $20 million per year for shelters, housing and related services for people who are homeless
    or at risk for being homeless. The annual funding comes from a fee when documents are recorded. The
    Act requires counties to do the following:

   Develop a ten-year plan that will reduce homeless population by 50% by 2015
   Count the number homeless people annually
   Provide the Dept. of Commerce an annual progressive report
   The document recording fees established in the legislation for counties ($20.2 million per year) is to be
    used to reduce homelessness
   Implement a Homeless Management Information System (HMIS) to collect client data used to measure
    program, county and state performance.

    One of the Act‘s requirements (RCW 43.185C.030 see attachment #2) is to complete at least one point in
    time count of individuals who are homeless. On any given night in Washington, it is estimated that there
    are over 20,000 people who are homeless.

    Methodology

    Our goal was to contact at least (2) homeless shelters in each county that are included in the geographical
    areas of the needs assessment. We used the following website to identify homeless shelters to contact:
    http://endhomelessnesswa.org/resources/. The website has a map that you can click on by county that
    provides a list of agencies providing services to the homeless.

   We had two key questions to ask staff at the shelters:
1. Do they have a formal process for identifying and counting folks with a traumatic brain injury?
2. Do they know of any housing options for folks with a traumatic brain injury?

    In attachment #3 is a spreadsheet of the shelters that were contacted and the responses that they provided.

    Findings

    Five of the homeless shelters contacted reported that they ask people if they have a traumatic brain injury
    as part of an assessment process. This is a voluntary, self-disclosure by the individual. None of the
    homeless shelters keep track or count the number of people self-reporting as having a traumatic brain
    injury.

    A couple of homeless shelters each mentioned (1) housing option each for people with a traumatic brain
    injury, but the options mentioned were really quite inconsequential.




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                                                                                   Homeless Shelters (continued)
Recommendations

  1. Homeless shelters could offer resource materials related to traumatic brain injury services to those
     individuals that self-disclose, as well as displaying resource materials that might be easily viewed
     and taken for those who prefer some confidentiality.


  2. It would be beneficial if an unduplicated count is kept at all homeless shelters that ask a person to
     voluntarily self-disclose if they have a traumatic brain injury. For homeless shelters that do not
     ask, it would be helpful if they might time sample a request (i.e. during a two week period). Most
     jurisdictions now have ―one night‖ counts where volunteers and staff go around to different parts
     of the community to make counts of people who are homeless, including people on the street. This
     might also be an opportunity to count the number of voluntary self-disclosures.


  3. Homeless shelters would benefit from having an updated list of resources related to traumatic
     brain injury services (i.e. TBI Hotline number, support group contact information), including
     possible housing options that might be available in their area.




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Attachment #1
                              Homeless Housing and Assistance
                                 Chapter 43.185C RCW
 RCW Sections
 43.185C.005 Findings.
 43.185C.010 Definitions.
 43.185C.020 Homeless housing program.
 43.185C.030 Washington homeless census or count -- Confidentiality -- Online information and
             referral system -- Organizational quality management system.
 43.185C.040 Homeless housing strategic plan--Program outcomes and performance measures and
             goals--Statewide data gathering instrument--Reports.
 43.185C.050 Local homeless housing plans.
 43.185C.060 Home security fund account.
 43.185C.070 Grant applications.
 43.185C.080 Homeless housing grants--Participation.
 43.185C.090 Allocation of grant moneys--Issuance of criteria or guidelines.
 43.185C.100 Technical assistance.
 43.185C.110 Progress reports--Uniform process.
 43.185C.120 Rules.
 43.185C.130 Protection of state's interest in grant program projects.
 43.185C.140 Public assistance eligibility--Payments exempt.
 43.185C.150 Expenditures within authorized funds--Existing expenditures not reduced or
             supplanted.
 43.185C.160 County homeless housing task forces--Homeless housing plans--Reports by
             counties.
 43.185C.170 Interagency council on homelessness -- Duties -- Reports.
 43.185C.180 Washington homeless client management information system.
 43.185C.190 Affordable housing for all account.
 43.185C.200 Transitional housing assistance to offenders -- Pilot program.
 43.185C.210 Transitional housing operating and rent program.
 43.185C.215 Transitional housing operating and rent account.
 43.185C.900 Short title.
 43.185C.901 Conflict with federal requirements--2005 c 484.
 43.185C.902 Effective date--2005 c 484.




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Attachment #2
                              Washington Homeless Census or Count
 RCW 43.185C.030
 Washington homeless census or count — Confidentiality — Online information and referral system
 — Organizational quality management system.

 The department shall annually conduct a Washington homeless census or count consistent with the
 requirements of *RCW 43.63A.655. The census shall make every effort to count all homeless individuals
 living outdoors, in shelters, and in transitional housing, coordinated, when reasonably feasible, with
 already existing homeless census projects including those funded in part by the United States department
 of housing and urban development under the McKinney-Vento homeless assistance program. The
 department shall determine, in consultation with local governments, the data to be collected.

 All personal information collected in the census is confidential, and the department and each local
 government shall take all necessary steps to protect the identity and confidentiality of each person
 counted.

 The department and each local government are prohibited from disclosing any personally identifying
 information about any homeless individual when there is reason to believe or evidence indicating that the
 homeless individual is an adult or minor victim of domestic violence, dating violence, sexual assault, or
 stalking or is the parent or guardian of a child victim of domestic violence, dating violence, sexual assault,
 or stalking; or revealing other confidential information regarding HIV/AIDS status, as found in RCW
 70.24.105. The department and each local government shall not ask any homeless housing provider to
 disclose personally identifying information about any homeless individuals when the providers
 implementing those programs have reason to believe or evidence indicating that those clients are adult or
 minor victims of domestic violence, dating violence, sexual assault, or stalking or are the parents or
 guardians of child victims of domestic violence, dating violence, sexual assault, or stalking. Summary
 data for the provider's facility or program may be substituted.

 The Washington homeless census shall be conducted annually on a schedule created by the department.
 The department shall make summary data by county available to the public each year. This data, and its
 analysis, shall be included in the department's annual updated homeless housing program strategic plan.

 Based on the annual census and provider information from the local government plans, the department
 shall, by the end of year four, implement an online information and referral system to enable local
 governments and providers to identify available housing for a homeless person. The department shall
 work with local governments and their providers to develop a capacity for continuous case management
 to assist homeless persons.

 By the end of year four, the department shall implement an organizational quality management system.




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Attachment #3
 Attachment #3                                                 Homeless Shelter Matrix Page 2                                                                                         E = Email
  Page 1                                                              Homeless Shelter Matrix                                                                      E = Email
  City           County        Agency/Program                                                                    Executive                           E-Mail                               Phone
                                                                                                                 Director
  Seattle        King          Plymouth Housing Group                                                            Gretchen Reade                      greade@plymouthhousing.org           206-374-9409
                                                                                                                 Executive Director
  Pasco          Benton/       Tri-City Union Gospel Mission                                                     Michael Quinn                                                            206-728-5369
                 Franklin                                                                                        Clinical Supervisor
                               Martin Luther Ecumenical Center                                                   Felix Flanigan                      felix@mlkhda.org                     253-627-1099
                                                                                                                 Executive Director
  Pasco          Ben/Fran      Tri-City Union Gospel Mission                                                                                                                              509-547-2112
  Pasco          Benton/Fran   BF Community Action Center                                                        Judith A. Gidley                    igidley@bfcac.org                    209-545-4042
                                                                                                                 Executive Director
  Fed Way        King          Multi Service Center                                                                                                  info@multi-servicecenter.com         206-838-6810
  Seattle        King          Seattle Emergency Housing                                                         Al Poole                            emergencyservices@seattle.gov        206-684-0266
                                                                                                                 Staff
  Seattle        King          Downtown Emergency Services                                                                                           info@desc.org                        206-464-1570
  Olympia        Thurston      Bread and Roses Advocacy Center                                                                                       admin@breadandrosesolympia.org       360-754-4085
  Seattle        King          YMCA of Sea/King County                                                                                               info@ymcaworks.org                   206-461-4851
  Lacey          Thurston      Comm Action Council Of Lewis,                                                     John M. Walsh                       johnw@caclmt.org                     360-438-1100
                               Mason & Thurston Counties                                                         Chief Executive Officer
                 Pierce        Associated Ministries                                                             Chris Morton                        gregc@associatedministried.org       253-383-3056
                                                                                                                 Executive Director
  Seattle        King          Solid Ground                                                                                                          info@solid-ground.org                206-694-6700
                 Pierce        Exodus House                                                                      Joe O'Neil                          joeo@exodushouse.org                 253-862-6808
                                                                                                                 Executive Director
                 Pierce        Helping Hand House                                                                Nola Renz                           nolabr@helpinghandhouse.org          206-848-6069
                                                                                                                 Executive Director
                 King          Catholic Community Services                                                                                           info@ccsww.org                       206-328-5696
  Seattle        King          Friends of Youth                                                                  Joan Campbell                       joanc@friendsofyouth.org             425-869-6490
                                                                                                                 Pres & CEO
                 Thurston      Emergency Shelter Network                                                                                                                                  360-528-8999
  Yakima         Yakima        Triumph Treatment Services                                                                                                                                 509-248-1800
  Yakima         Yakima        Northwest Action Center                                                                                               avery2@ncactopp.org
                 Pierce        Nativity House                                                                    Nick Leider                         admin@nativityhouse.org              253-779-9248
                                                                                                                 Executive Director
                 Thurston      Emergency Shelter Network                                                                                                                                  360-528-8999
  Spokane        Spokane       Spokane Neighborhood Action Programs                                              Larry Stuckart & Ray Rieckers                                            509-456-7111
                                                                                                                 Director of Housing Opportunities
  Spokane        Spokane       Union Gospel Mission (Spokane)                                                                                                                             (509) 535-8510
  Wenatchee      Chelan        Chelan Douglas Community Action Council
                                                                                                                                                                                          509 662-6156
  Wenatchee      Chelan        Wenatchee Hospitality House                                                                                                                                509 663-4289
  Bellingham     Whatcom       Lighthouse Mission                                                                                                                                         360733-5120
  Bellingham     Whatcom       Whatcom Homeless Service Center                                                                                                                            360 255-2091
  Kelso          Cowlitz       Emergency Support Shelter                                                                                                                                  888 425-1176
  Longview       Cowlitz       Community House on Broadway                                                       Rich                                                                     360 425-8679
  Everett        Snohomish     Snohomish County Human Services Department                                                                                                                 425 388-7244
  Everett        Snohomish     Catholic Community Services Snohomish County                                                                                                               888 240-8572
                               Family Services

  Vancouver      Clark         Emergency Shelter Clearinghouse                                                                                                                            360-695-9677
  Vancouver      Clark         SHARE                                                                                                                                                      360 695-7658
  Bremerton?     Kitsap        Catholic Community Services
                               Kitsap Family Center
  Port Orchard   Kitsap        Retsil Veteran‘s Home / Transitional Housing for Homeless Vets & Service Center                                                                            360 895-4394


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Agency/Program                                              Formal process for counting folks with TBI?                   Do they know of any housing                      Contact Type
                                                                                                                          options for folks with TBI?
Plymouth Housing Group                                                                  No                                    Provides privately supported        Phone Message, EM, Phone Interview
                                                                                                                                   individual housing.
Tri-City Union Gospel Mission                                                                                               Ballard Care & Rehabilitation for            Phone Message, EM
                                                                                                                                      severe cases.
Martin Luther Ecumenical Center
Tri-City Union Gospel Mission
BF Community Action Center                                                                                                    No-housing subsidy provider                    None directly
Multi Service Center                                                                                                                                                     Phone Message, EM
Seattle Emergency Housing                                                               No                                   Try Seattle Housing Authority               Phone Message, EM
Downtown Emergency Services                                                                                                                                                 Phone Message
Bread and Roses Advocacy Center                                                                                                                                                  EM
YMCA of Sea/King County                                                                                                                                              EM - forwarded/case manager
Comm Action Council Of Lewis,
Mason & Thurston Counties
Associated Ministries                                                                                                                                                    Phone Message,   EM
Solid Ground                                                                                                                                                             Phone Message,   EM
Exodus House                                                                                                                                                                    EM
Helping Hand House                                                                                                                                                       Phone Message,   EM
Catholic Community Services                                                                                                                                              Phone Message,   EM
Friends of Youth
Emergency Shelter Network                                                                                                                                                     Check #
Triumph Treatment Services                                                              No                                                 no                              Phone Message
Northwest Action Center                                                                                                                                                     EM, bounced
Nativity House                                                                                                                                                           Phone Message, EM
Emergency Shelter Network
Spokane Neighborhood Action Programs                        No formal process. They ask if client has a disability and                     no                              Phone Interview
                                                                            if they want to talk about it.
Union Gospel Mission (Spokane)                               They ask if clients have a TBI as part of assessment, but    Just whatever agencies they work with            Phone Interview
                                                                              don't actually count the #.                                 offer.
Chelan Douglas Community Action Council
Wenatchee Hospitality House                                           They get lots of folks, but don't count.              referred me to Phoebe Nelson,                  Phone Interview
                                                                                                                          Bruce Hotel (she might be writing a
                                                                                                                                        grant)
Lighthouse Mission                                                                       No                                                                                Phone Message
Whatcom Homeless Service Center                                                          No                                                No                              Phone Message
Emergency Support Shelter                                   They ask if clients have a TBI as part of assessment, but                      no                              Phone Interview
                                                                            don't actually count the #.
Community House on Broadway                                                    not sure--don't count                                       no                              Phone Interview
Snohomish County Human Services Department
Catholic Community Services Snohomish County                                                                                                                                Phone Message
Family Services

Emergency Shelter Clearinghouse
SHARE
Catholic Community Services                                 They ask if clients have a TBI as part of assessment, but                      no                              Phone Interview
Kitsap Family Center                                                        don't actually count the #.
Retsil Veteran‘s Home / Transitional Housing for Homeless                                                                                  ?
Vets & Service Center




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SECTION 15
Focus Groups




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                                              Focus Groups Results
    Methodology

    We facilitated (8) focus groups, one each in the following cities: Yakima, Spokane, Bellingham, Everett,
    Seattle, Tacoma, Olympia, and Vancouver. These cities were representative of the geographical areas
    covered in the scope of the needs assessment. The invitation list for each focus group was compiled from
    survey responders and people that were known to the staff that were facilitating the focus groups. Where
    possible, we tried to have the focus group participants represented from each of the different survey
    groupings: individuals with a traumatic brain injury, family members, care providers, friends of a person
    with a traumatic brain injury, professionals, and policymakers.

    Each focus group meeting had two facilitators. One facilitator asked ―stock‖ questions and managed the flow
    of the meeting, while the other facilitator took notes. They often took turns between facilitating and note
    taking. Although there were some ―stock‖ questions, these were used to also facilitate an open discussion
    about housing and related service needs for people with a traumatic brain injury and their family members. A
    total of 74 people attended the focus groups.

    The following were questions used at the focus groups:
        What kind of housing for TBI is available?
        How do folks find out about housing for TBI?
          What is the first thing that comes into your mind when you hear ―housing for TBI‖?
          What type of housing would you like created for persons with TBI?
          How do folks find out about the Section 8 housing vouchers?
          What services should be included with housing?

    Findings

    If there was an overriding theme by focus group participants, it was that the current housing available was
    not age or disability appropriate for individuals with a traumatic brain injury. Also, there was a lack of
    training for caregivers, especially in AFHs, about the unique needs of individuals with a TBI. Finally, all
    groups listed out an array of needs including accessibility, cognitive therapy, OT/PT/Speech & Language,
    and transportation.

    The following statements are part of the comments that were made, in most cases, by several focus group
    participants and in many of the focus groups.

    The comments around existing housing were consistent:
   No housing in the area
   No age or disability appropriate housing
   AFHs are for the elderly
   Section 8 had long waits & difficult to keep track of
   Nursing homes were often the option regardless of need
    The comments about creating housing were pretty widespread:
   Studio and one bedroom units with supervision and case management
   Communal house of 4-5 people

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                                                                                            Focus Groups (continued)


          Creating housing for respite and temporary housing
          Using the HUD 811 program
          Developing homelike settings
          Focus on least restrictive environments, supporting inclusion, choice & community connections,
           and empowering the person

   Services in support of or in tandem with housing
       Training for case managers and discharge planners
       Transportation and a community that was accessibility
       Need to develop a clubhouse
       Activities that promote socialization
       Create day program activities
       Lead person or a clearinghouse to match people with housing

   Related needs
       Data gathering efforts to determine needs
       Public awareness campaigns for communities and public funders

   Recommendations

   Some additional recommendations that could easily have come out of the feedback from the focus groups
   are being covered in other sections of this report. In an effort not to duplicate recommendations, we have
   chosen two in particular that resonated strongly from the focus groups.

4. It was suggested in many different ways that there should be a designated person that would be the lead on
   all things related to housing. This person would be the resource for everyone including discharge planners,
   case managers, families, individuals, housing & service providers, and housing developers. This person
   could also provide training, encourage housing development, maintain an updated resource list, answer
   housing-related questions, and notify stakeholders on the opening of Section 8 waiting lists.

5. The fact that there are just a few age and disability appropriate housing and service options might be
   addressed with a pilot project that would be for a designated age range and for TBI specific individuals
   with similar support needs.




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                  SECTION 16
                 Homeownership

Attachments

  1.   HUD Definition of First Time Buyer
  2. Washington Homeownership Resource Center
  3. Washington State HomeChoice Second Mortgage
  4. Parkview Services Homeownership Program
  5.   Homeownership for TBI Survivor
  6.   HUD Homeownership Voucher Program Fact Sheet
  7. Pierce County Housing Authority
  8. Community Land Trust Fact Sheet
  9.   Homestead Community Land Trust
  10. Characteristics of Cohousing
  11. Jackson Cohousing
  12. Jackson Place Cohousing Vision Statement




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                                   Affordable Homeownership
The ―affordable‖ part of homeownership, much like affordable rental housing, is defined as housing that
is owned where the housing costs, including utilities, does not exceed 30% of an owner‘s or household‘s
income (Washington Housing Policy Act Chapter 43.185B.010 RCW).

There are many services and programs both in-state and nationally that assist first-time homebuyers and
homeowners. For the HUD definition of a first-time homebuyer, see attachment #1. These services and
programs include:
       teaching homebuyer education classes
       providing down payment assistance
       offering loan products
       providing counseling and mediation services on mortgage defaults

There are also several homeownership programs, down payment assistance opportunities, and loan
products that are exclusively offered to people with disabilities or families that have a family member
with a disability living with them.

The Washington Homeownership Resource Center (WHRC)

The WHRC is a statewide program that provides homebuyer and homeowner information and referral
services. The WHRC is a non-profit organization which serves as a clearinghouse for resources
available to first-time homebuyers and homeowners, particularly those with low to moderate incomes.
For additional information about the WHRC see attachment #2. You can also go to their website at
www.homeownership-wa.org or call their Information Hotline at 1- 877-984-4663.

The Washington State Housing Finance Commission (WSHFC)

The WSHFC provides a variety of housing-related services and products statewide, including a
Homeownership Program. Their mission is ―We are a publicly accountable, self-supporting team,
dedicated to increasing housing access and affordability and to expanding the availability of quality
community services for the people of Washington.‖ For more information on their Homeownership
Program, you can visit their website at www.wshfc.org.

The HomeChoice Program offered by the WSHFC is a down payment assistance program that is
exclusively provided to qualified borrowers who have a disability or who have a family member with a
disability living with them. WA led the nation several years back in the number of HomeChoice loan
products used by people with disabilities and families that had a member with a disability living with
them. This program provides, as of 5/31/11, up to $15,000 in down payment assistance. One of the key
benefits to the program is that you make no payments and it is at 1% interest loan. The loan becomes
due when the home is sold, or if the home is refinanced or after 30 years. To be eligible for a
HomeChoice loan you must not exceed the following income limits based on a family size of four:

Clark/Skamania Counties: $71,200
King/Snohomish Counties: $85,600
Kitsap/Thurston Counties: $71,900
All Other Counties: $70,400

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                                                                                          Affordable Homeownership (continued)

For more information about the HomeChoice Program, see attachment #3 and you can also go to the WSHFC
website listed above.

WA Homeownership Programs Exclusive to People with a Disability

Currently, there are (3) homeownership programs in WA that provide first-time homebuyer and homeowner
services exclusively to an individual with a disability or who have a family member with a disability living with
them:

    1. Parkview Services

Parkview Services is a non-profit organization that provides a variety of services, including homeownership opportunities
to people with disabilities and their families. Their Homeownership Program has assisted with 66 home purchases since
2006. The average down payment assistance per home to date is $82,386. For more information about Parkview‘s
Homeownership Program see the attachment #4 and you can go to their website at www.parkviewservices.org.

In attachment #5 is a real example of a person with a traumatic brain injury that purchased a condominium unit through
the Parkview Services Homeownership Program.

    2. Pierce County Coalition for People with Developmental Disabilities (PC2)

PC2 is a non-profit organization that supports people with developmental disabilities and their families in Pierce
County. For more information about the PC2 Homeownership Program you can go to their website at
www.pc2online.org.

    3. Arc of Spokane

The Arc of Spokane is a non-profit organization that supports people with developmental disabilities and their
families in Spokane. They have assisted with 72 home purchases since 2004. For more information about their
Homeownership Program you can go to their website at www.arc-spokane.org.

The Home of Your Own Program (HOYO)

HOYO was a program that was started in the early 1990‘s that offered home loans at below-market interest
rates to people with disabilities who wished to purchase their first home. WA was one of the national leaders in
the late 1990‘s in helping people with disabilities own homes using this program. In a HOYO sponsored by Sue
Closser and Sunrise Services in Everett, they assisted over 40 individuals with a disability to purchase their own
homes. Most of those purchases were condominium units. In a look-behind review of how people were doing in
2004, there were no loan defaults on any of these purchases. This is an example of how people with a disability
who were very low-income could purchase and manage their own homes.
Public Housing Authority (PHA)
PHAs have an option to offer a HUD approved Homeownership Voucher Program where a tenant‘s Section 8 rental
assistance voucher could be used to help pay a portion of a person‘s mortgage. There are income and other eligibility
requirements with the Homeownership Voucher Program. See attachment #6 for a HUD Homeownership
Voucher Program Fact Sheet and you can go to the HUD website for more information on housing vouchers:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/programs/hcv/homeownership



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                                                                                      Affordable Homeownership (continued)


There are (8) PHAs in WA currently offering a HUD approved Homeownership Voucher Program:

   1. Pierce
           In attachment #7 is a fact sheet about the Pierce County PHA Homeownership Voucher Program.
           You can go to their website at www.pchawa.org for more information about the program.
   2. Clallam Web Site: www.hacc-housing.org
   3. Kelso Web Site: www.kelsoha.org
   4. Longview Web Site: www.longviewha.org
   5. Spokane Web Site: www.spokanehousing.org
   6. Snohomish County Web Site: www.hasco.org
   7. Everett Web Site: www.evha.org
   8. Tacoma Web Site: www.tacomahousing.org
A Community Land Trust (CLT)

A CLT is a nonprofit corporation which acquires and manages land on behalf of the owners, while preserving
the affordability and preventing the foreclosure of the buildings/housing located on the land.

One important aspect of a CLT model of homeownership for a low-income homebuyer is that the CLT
purchases the land and thereby reduces, sometimes substantially, the cost of buying a home for the homebuyer.
For a fact sheet about CLTs, see attachment #8.

One example of a CLT that has been supporting low-income homebuyers since 1992 is the Homestead
Community Land Trust in Seattle. Homestead now offers homebuyers the option of purchasing either an
existing property that is owned by or where there has been an arrangement made with Homestead CLT or the
homebuyer can find an eligible home in the market place. In attachment #9 is a fact sheet about Homestead
CLT and their website contains more information at www.homesteadclt.org.

To learn more about CLT information and resources in the Pacific Northwest, you can go to the website of the
Northwest Community Land Trust Coalition at www.nwcltc.org. There are 16 CLT organizations from WA that
are members of the NWCLTC.

For an excellent resource about CLTs nationally, you can go to the National Community Land Trust Network
website at www.cltnetwork.org.

Cohousing (rental or homeownership)

Cohousing is often characterized as an intentional community where people live in separate housing or housing
units with common space for such things as meals, social and leisure activities, recreating, and shared outdoor
space. Members often participate in the day-to-day planning, activities, and maintenance of their own
communities. Cohousing members are ―intentionally‖ committed to living as a community.
The Cohousing Association of the United States is an excellent source on cohousing, including a directory of
cohousing communities. Their website is www.cohousing.org. In attachment #10 from their website is a short
informative piece entitled ―What are the 6 Defining Characteristics of Cohousing?‖




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                                                                                       Affordable Homeownership (continued)



Jackson Place Cohousing is a cohousing community located in Seattle. People started the process to come
together to build the 21-unit condominium project in 1997. Residents moved in 4 years later in 2001. Three of
the original residents, who are still occupying a three-bedroom unit, are young men with a disability that receive
some support through Medicaid Personal Care funding. In attachment #11 is their story about how their families
came together to make it all happen. In attachment #12 is the Jackson Place Co-Housing Vision Statement. You
can also find out more information about this intentional community at their website www.seattlecohousing.org.




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 Attachment #1

                                               HUD Definition of
                                            First-Time Homebuyers

        http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/sfh/ref/sfhp3-02

In order to help lenders properly identify first-time homebuyers, we are clarifying the definition of what
constitutes a first-time homebuyer. A first-time homebuyer is an individual who meets any one of the following
criteria:

  An individual who has had no ownership in a principal residence during the 3-year period ending on the date
  of purchase of the property. This includes a spouse (if either meets the above test, they are considered first-
  time homebuyers.
  A single parent who has only owned with a former spouse while married.
  An individual who is a displaced homemaker and has only owned with a spouse.
  An individual who has only owned a principal residence not permanently affixed to a permanent foundation
  in accordance with applicable regulations.
  An individual who has only owned a property that was not in compliance with State, local or model building
  codes and which cannot be brought into compliance for less than the cost of constructing a permanent
  structure.




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    Attachment #2
                                        Washington Homeownership

Resource Center Increasing and Preserving Homeownership for Washingtonians
The Washington Homeownership Resource Center (WHRC) is a non-profit organization which serves as a
clearinghouse for resources available to first-time homebuyers and homeowners, particularly those with low to
moderate incomes. Homeownership creates a sense of achievement and satisfaction for people and stabilizes
neighborhoods and communities. Homeownership‘s stabilizing effect on families extends beyond the individual
homeowner and creates healthier, safer neighborhoods. The Washington Homeownership Resource Center plays a
crucial role in building more vibrant communities by helping people who would otherwise find themselves
excluded from homeownership due to lack of information, credit problems, language issues, inadequate funds for
down payment, and discrimination. WHRC breaks down barriers by offering free education, information, referrals,
and support, in order to create informed, prepared homeowners who are less likely to default on mortgage loans and
by connecting distressed homeowners with the resources and support they need to preserve their homes.

Washington Homeownership Resource Center accomplishes its mission of "increasing and preserving
homeownership for lower and moderate income individuals and families" through several strategies. Our core
strategies are information and referral via the state homeownership information hotline information and the
Washington Homeownership Resource Center (WHRC) website.

Assistance for First-Time Homebuyers
Since 1996, WHRC has helped over 45,000 people who ―just don‘t know how to get started‖ on the path of
homeownership. In order to reduce the fear and uncertainty of home buying, WHRC is there to open doors for first-
time homebuyers by providing unbiased, confidential access to education, counseling and other services. WHRC
provides a neutral zone wherein a homebuyer can explore a multitude of options without experiencing a sales pitch.
The heart of our work is one-on-one education. First time buyers oftentimes don‘t know where to start and we help
demystify the home buying process and show people how to move forward on the path to homeownership.

When people call WHRC‘s Homeownership Information Hotline, a convenient toll-free number (877.984.HOME),
potential buyers receive information and referrals to the following resources:

•        Down payment assistance loans, grants and affordable mortgage products

•        Homebuyer education and counseling programs

•        Credit and debt counseling

•        Non-profit housing developer‘s self-help housing (Habitat for Humanity, etc.)

•        Fair Housing information

•        Special Housing Programs

•        Lenders who offer VA, FHA, Conventional, State Bond and Portfolio loans

All callers are encouraged to begin the path of homeownership by attending a homebuyer education class taught by
a Washington State Housing Finance Commission approved instructor or a non-profit organization. These classes
educate consumers and many down-payment programs require taking such a class prior to applying for funds.



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                                                                                        Washington Homeownership (continued)

Assistance for Homeowners



                                                                         Since March of 2009 the WHRC has
                                                                         assisted over 47,000 people who are
                                                                         having difficulty making their mortgage
                                                                         payments. Coincident with the onset of
                                                                         the housing crisis in early 2008 the
                                                                         overwhelming majority of callers are
                                                                         requesting assistance with mortgage
                                                                         default issues. Our call volume doubled
                                                                         from 600 to 1200 calls per month in
                                                                         June 2009 when Governor Gregoire
                                                                         announced the Housing Foreclosure
                                                                         Legal aid Project. The volume increased
    This map shows where hotline callers reported their distress
                                                                         again in July 2009 when senate bill
    properties were located between October 1 and December 31,
                                 2010.                                   5810 was enacted. That bill requires that
                                                                         servicers of distressed mortgage loans
                                                                         provide their borrowers with three
phone numbers – HUD, WA Civil Legal Aid Hotline, and The DFI Homeownership Information Hotline – that‘s
us. Since then we have been receiving about 1800 calls per month. To handle this we have 3 full time staff.

The calls are handled as follows:

1.      Information and referral specialists answer the calls and assess the caller‘s need.

2.      With the callers verbal authorization we record information about them, their property, and their loans.

3.       Callers are then referred to HUD approved housing counselors, the Housing Foreclosure Legal Aid Project,
or other free resources they may need.

4.    Callers assessed as high priority. For example, those that report a trustee sale within three weeks are
immediately transferred to an in house housing counselor.

All callers are encouraged to call us back if they are unable to connect with the resources that they need.

An example of how the WHRC preserves homeownership by assisting clients who are in danger of default or
foreclosure is as follows. "Ralph" called WHRC from Clallam County, a rural area of Washington. He spoke with
our Program Manager and was relieved to find a confidential source to talk with about the possibility of foreclosure
on his home. He remarked that because he lived in such a small community, he didn't feel comfortable talking about
personal issues with someone that he may run into at the grocery store. He was referred to the Parkview Services to
discuss remedies against foreclosure, and he called back later to say, "Thank you for taking the time to listen to my
problems. I felt like I could tell you everything that is going on and you helped me sort it all out, so that I could
begin to make steps to save my home."




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Attachment #3
                        Washington State's HomeChoice Second Mortgage

  HomeChoice is a down payment assistance, second mortgage loan program for qualified borrowers who
  have a disability or who have a family member with a disability living with them. Funds up to $15,000.
  One-on-one counseling is required.

  How do I get started?

  The first step is to meet with a House Key Lender in your area that has been trained on the HomeChoice
  program. The House Key Lender will determine if you are eligible for the HomeChoice second mortgage
  program and will then refer you to a free homebuyer education seminar and a HomeChoice trained
  Service Provider. For additional trained lenders or service providers, please email Karen Carlson at
  karen.carlson@wshfc.org or call 206-287-4413.

  How do I qualify?

  The HomeChoice Second Mortgage program is a Down Payment Assistance Program for low- to-
  moderate income people with a disability or who have a family member with a disability living with them
  and qualify for an FHA, Fannie Mae Conventional 30 year, House Key State Bond first mortgage.

  A 1.00% interest rate on the Down Payment Assistance loan program for first-time homebuyers
  (borrowers who haven't owned and occupied their primary residence in the past three years). If you buy
  in a targeted area you do not have to be a first-time homebuyer. Borrowers must meet the acquisition cost
  and income limits for the House Key program.

  To be eligible for a HomeChoice loan you must not exceed these income limits*:
  Clark/Skamania Counties: $71,200
  King/Snohomish Counties: $85,600
  Kitsap/Thurston Counties: $71,900
  All Other Counties: $70,400

  *Other requirements may apply. Please check with your lender or service provider to verify the limits.
  Manufactured homes only allowed with FHA financing. HomeChoice borrowers also must complete a
  Commission-sponsored homebuyer education seminar prior to reservation of funds.

  Benefits

  HomeChoice uses the interest rate advantage of the House Key conventional loan program.

  Down payment assistance - The Program offers up to $15,000 per household in a 1.00% interest, payment
  deferred second mortgage. Second mortgages are due when home is sold, or if home is refinanced or after
  30 years




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Attachment #4
                            Parkview Services Homeownership Program
 Parkview Services has been operating a Homeownership Program for first-time home buyers with household
 members who are persons with developmental disabilities since January 2006. In June of 2008 we expanded the
 program to include serving persons with permanent disabilities as defined by the Americans with Disabilities Act of
 1990.

 The Homeownership Program assisted 14 families realize the dream of homeownership in 2010. These individuals
 and families purchased homes in Snohomish, King & Pierce counties. The permanency of homeownership is
 essential for Parkview clients to achieve the security they so often lack while renting.

 Financial sources for down payment assistance came from the Washington State Housing Trust Fund, Snohomish
 County, King County, City of Everett, Everett Housing Authority, City of Seattle, the Washington State Housing
 Finance Commission and the Federal Home Loan Bank. Down payment assistance averaged $61,781 per
 household with an average of 3 sources of down payment assistance.

 Parkview‘s efforts to promote successful homeownership were supported by 6 first time homebuyer classes
 provided by Parkview Services in partnership with supportive realtors and lenders. In addition, each family
 receives personal counseling in the areas of budgeting and credit.

 A key component of the program is a layered financing package that leverages funds from several public and
 private sources, to make homeownership possible for low and moderate-income households. These layers include
 the WA State Housing Trust Fund, Snohomish County, City of Everett, King County Housing Finance Program,
 City of Seattle, Washington State Housing Finance Commission, The Federal Home Loan Bank, and Housing
 Authorities.

 We work with people with disabilities, their families, and their advocates to create and implement a plan for
 homeownership that is practical and sustainable.

 Essential services that we provide participants include individualized homebuyer education, pre and post purchase
 counseling, and post purchase maintenance support.

 The steps in Parkview Services Homeownership Program are as follows:

 1.      Interview with Parkview to determine eligibility (includes obtaining credit reports).
 2.      Meet with Parkview staff Housing Counselor to discuss our programs options and make a plan
 3.      Complete Homebuyer Education requirement with Parkview staff
 4.      Complete one-on-one Pre-Purchase/HomeChoice counseling session with Parkview staff
 5.      Select a lender and obtain a Pre-approval letter
 6.      Choose a Realtor (Parkview maintains a list of trusted Realtors)
 7.      Sign Readiness to Purchase Agreement (see attached)
 8.      Shop for a Home
 9.      Sign approved purchase and sale
 10.     With Parkview, arrange for Appraisal, Building and if necessary Haz/Mat Inspections


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                                                                                                        Parkview (continued)

11.         Close on the Home

12.         Post purchase counseling and follow-up service
Parkview Services Homeownership Program assisted 14 individuals and families to become homeowners in 2010.

      25

                                                    20
      20


      15                                                         14

                                        11
      10
                 8
                            7
                                                                              6
       5


       0
               2006        2007       2008         2009         2010        2011


                                   Homes Purchased by Year
           All households receive ongoing counseling support by Parkview Services staff.


Here are some facts about the Homeownership Program

•           Since January 2006 supported 66 households with disability to purchase their first homes.
•           Percentage of minority households that purchased: 35%
•           Percentage of households with incomes less than 50% of AMI: 49%
•           These households were made up of 83 minor children and 90 adults
•           Total Down Payment Assistance loaned and granted: $5,107,940
•           Average per home is $82,386
•           Total Mortgages taken out by Purchasers: $8,898,972
•           Average Mortgage: $142,367
•           Total Funds brought by the borrowers: $722,755
•           Average Borrower contribution per home: $11,657
•           Minimum Household income: $8,328 – 14% AMI
•           Maximum Household income: $72,372 – 80% AMI
•           Average Household income: $37,365 – 52.0% AMI
•           Average Mortgage payment (principle interest taxes and insurance): $1,095
•           Largest Household size: 9
•           Average Household size: 3
•           Number of Households transitioning from public housing or section-8 vouchers: 13



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Attachment #5
                            HOMEOWNERSHIP FOR TBI SURVIVOR
         Homeownership can be an affordable opportunity for persons with a traumatic brain injury. Henry
 is a 36 year old survivor living in Seattle. He rented a one bedroom apartment on Capital Hill for $795.00
 per month. His utilities were approximately $250 per month bringing his housing expenses to $1,045.00
 per month.
         One of the housing options for Henry was to participate with a local nonprofit to purchase a condo
 using a combination of available public subsidies. Henry‘s income from Social Security and Labor &
 Industries total $2,200 per month. Henry purchased a one bedroom condo on Capital Hill built in 1988
 with 830 square feet. The condo complex has only 14 units and provides a quiet oasis on the ground floor
 with an outdoor patio. The condo building has underground parking and an elevator and is on the bus
 line. The financing from public and government sources were as follows:

 Fannie Mae HomeChoice                                    $15,000.00

 City of Seattle housing levy                             $45,000.00

 House Key Plus                                           $10,000.00

 Parkview Services (HTF)                                  $40,500.00

 Federal Home Loan Bank                                   $14,714.00

                 TOTAL Public Subsidy            $125,214.00

 Gift subsidy from family                                 $67,223.00

 Mortgage Loan                                            $96,000.00

                 TOTAL PRICE                     $288,437.00

 Henry‘s condo expenses are:

 Mortgage loan: 30 yr @ 5.28%                             $560.00

 Real estate taxes (disabled discount )                   $100.00

 HOA includes all utilities except electric               $225.00

 Electric utilities                                       $ 40.00

                 TOTAL EXPENSES                  $925.00 per month



 Henry has an affordable quality living space suitable for his needs and providing him with long term
 stability.


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Attachment #6

                     HUD Homeownership Voucher Program Fact Sheet

 If I wish to purchase my first home but need help meeting the monthly mortgage and other
 homeownership expenses, is there a program that will help me?
 Yes, it is called the Homeownership Voucher Program.

 Who can I talk to obtain additional information about this program?
 You can call your local Public Housing Agency (PHA).

 Do all PHA's participate in this program?
 No. For a list of PHA's in WA that offer a Homeownership Program as of 5/31/11, see attachment #12.

 If I am currently a participant in the Housing Choice Voucher program and receive rental
 assistance, can I use my voucher to buy a home and receive monthly assistance in meeting
 homeownership expenses?
 Yes, if your local PHA participates in the homeownership voucher program, and you meet income and
 other eligibility requirements.

 If I don't have a rental voucher what do I do?
 You have to apply for a housing choice voucher at the local PHA.

 What if the waiting list at the housing agency in my area is closed and the PHA is not accepting
 applications?
 You can either wait until the waiting list opens up again, or you can apply in another jurisdiction where
 the waiting list is open. However, many PHA's give a preference to residents of the community over non-
 residents, and you may be required to reside in the jurisdiction of that PHA for at least one year. You
 should ask the PHA in the area where you are applying about their residency preferences.

 If I get on a waiting list, how long do I have to wait?
 The waiting time varies from PHA to PHA. You need to contact the PHA for an estimated wait time.
 Generally, waiting times can vary between several months and several years.

 If I am in Public Housing (but do not receive a voucher), what do I have to do to get into the
 homeownership voucher program?
 You have to apply for a housing choice voucher (the same as anyone else who does not have a voucher)
 and meet the eligibility requirements at the local PHA where you are applying.

 If I get on a waiting list for a voucher, is there any special preference for me because I want to
 purchase a home?
 No. There is no preference based on the fact that you desire to use your voucher for homeownership.

 Are there any standards for the home to be purchased under this program?
 The home must pass an initial housing quality standards inspection conducted by the PHA and an
 independent home inspection before the PHA may approve the purchase by the family.




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                                                                   Homeownership Voucher Program Fact Sheet (continued)

Are PHAs required to offer homeownership vouchers?
PHAs may choose to administer a homeownership program, but are not required to do so. The PHA may
impose limits on the size of this program, or limit use of the option to certain purposes. However, PHAs
must provide homeownership assistance when required as a reasonable accommodation to a family with a
disabled person.

What families are eligible to apply for homeownership vouchers?
Families must meet these requirements:

      First-time homeowner or cooperative member.
      No family member has owned or had ownership interest in their residence for at least three years.
      Except for cooperative members, no member of the family has any ownership interest in any
       residential property.
      Minimum income requirement. Except in the case of disabled families, the qualified annual
       income of the adult family members who will own the home must not be less than the Federal
       minimum hourly wage multiplied by 2,000 hours. For disabled families, the qualified annual
       income of the adult family members who will own the home must not be less than the monthly
       Federal Supplemental Security Income (SSI) benefit for an individual living alone multiplied by
       12. The PHA may also establish a higher minimum income requirement for either or both types of
       families. Except in the case of an elderly or disabled family, welfare assistance is not counted in
       determining whether the family meets the minimum income requirement.
      Employment requirement. Except in the case of elderly and disabled families, one or more adults
       in the family who will own the home is currently employed on a full-time basis and has been
       continuously employed on a full-time basis for at least one year before commencement of
       homeownership assistance.
      Additional PHA eligibility requirements. The family meets any other initial eligibility
       requirements set by the PHA.
      Homeownership counseling. The family must attend and satisfactorily complete the PHA's pre-
       assistance homeownership and housing counseling program.

What are monthly homeownership expenses?
Monthly homeownership expenses include:

1. Mortgage principal and interest,
2. Mortgage insurance premium,
3. Real estate taxes and homeowner insurance,
4. PHA allowance for utilities,
5. PHA allowance for routine maintenance costs,
6. PHA allowance for major repairs and replacements,
7. Principal and interest on debt to finance major repairs and replacements for the home, and
8. Principal and interest on debt to finance costs to make the home accessible for a family member with
disabilities if the PHA determines it is needed as a reasonable accommodations.



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                                                                   Homeownership Voucher Program Fact Sheet (continued)


How much financial assistance can PHAs provide in each voucher?
The PHA uses its normal voucher program payment standard schedule to determine the amount of
subsidy. The housing assistance payment (HAP) is the lesser of either the payment standard minus the
total tenant payment or the family's monthly homeownership expenses minus the total tenant payment.
The PHA may make the HAP payment directly to the family or to the lender.

What is the total monthly tenant payment?
For purposes of calculating the amount of financial assistance to be provided by the PHA, the monthly
tenant payment is generally 30% of the family's adjusted monthly income. For more information about
how to determine total tenant payment contact your local PHA.

What do I have to pay each month?
You have to pay at least the total tenant payment (approximately 30% of adjusted monthly income).
However, if you purchase a home that has monthly expenses higher than those covered by the total of the
financial assistance provided by the PHA together with the tenant payment (30% of income), any
additional amount will have to be paid by the family. To keep families from purchasing a home that will
result in a payment the family cannot afford, the PHA, may set affordability limits for their program.

Do families have to purchase a home in the jurisdiction where the PHA issued the voucher?
No. Families that are eligible for homeownership assistance may purchase a home outside the initial
jurisdiction if the PHA in the new jurisdiction administers the homeownership voucher program and
receives new families into the program. However, the family may only use the voucher to purchase a unit
in an area where the family is income eligible at admission to the program.

How long can a family receive assistance under this program?
There is no time limit for an elderly household or a disabled family. For all other families, there is a
mandatory term limit of 15 years if the initial mortgage incurred to finance purchase of the home has a
term that is 20 years or longer, and for all other cases the maximum term of homeownership assistance is
10 years.

What regulations cover this program?
The Regulations are found in 24 CFR Part 982 (particularly see sections 625-642).




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Attachment #7

                                  Pierce County Housing Authority
                                 Tacoma, Washington                (253) 620-5400

 PCHA Homeownership Program

 How can I purchase a home?

 There are basic preparations that anyone-regardless of income-should make if they want to own a home.
 Those preparations include:

        Making sure your credit record is good
        Attending a first-time homebuyer class
        Having some money for a down payment
        Working full time for at least a year (unless elderly or disabled)

 Is it possible for me to buy a home if my household receives Section 8 assistance?

 Yes, it is possible. If you have made the preparations described above, your Section 8 voucher may be
 used to subsidize your mortgage for a period of up to fifteen years. If you are elderly (62 and over) or
 disabled, this time limit may not apply.

 What kind of home would I qualify for?

 That depends on your income, the size of your household, and any debt you may have. Homes must be
 located in Pierce County, outside the city of Tacoma. They can be any type of housing (traditional,
 condominium, modular) - except manufactured homes, duplexes, owner-financed or lease-to-own.

 How can PCHA help?

 PCHA can help you pull your credit report so you know where you stand. Staff will direct you to financial
 literacy training; enroll you in first-time homebuyer class, and; facilitate consultation with trained lending
 professionals. As part of PCHA Section 8 responsibility, the agency will also inspect a home you are
 considering for purchase to make sure it meets Housing Quality Standards and provides your family with
 a safe and decent place to live.

 Where do I start?

  Contact PCHA's FSS/Homeownership Coordinator at 253-620-5474 for consultation.

 How do I apply?
 After renting with your Section 8 Voucher, you have the following options;

 Electronic Application (pdf)
 Mail in your Application to: PCHA P.O. Box 45410, Tacoma, WA 98448




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Attachment #8

                                Community Land Trust Fact Sheet

                   Taken From http://en.wikipedia.org/wiki/Community_Land_Trust

 Since 1992, the defining features of the CLT model in the United States have been enshrined in federal
 law (Section 212, Housing and Community Development Act of 1992). There is considerable variation
 among the hundreds of organizations that call themselves a community land trust, but ten key features are
 to be found in most of them.

 Nonprofit, tax-exempt corporation A community land trust is an independent, not-for-profit corporation
 that is legally chartered in the state in which it is located. Most CLTs are started from scratch, but some
 are grafted onto existing nonprofit corporations. Most CLTs target their activities and resources toward
 charitable activities like providing housing for low-income people and redeveloping blighted
 neighborhoods, making them eligible to receive 501(c)(3) designation from the IRS.

 Dual ownership A nonprofit corporation (the CLT) acquires multiple parcels of land throughout a
 targeted geographic area with the intention of retaining ownership of these parcels forever. Any building
 already located on the land or later constructed on the land is sold off to an individual homeowner, a
 cooperative housing corporation, a nonprofit developer of rental housing, or some other nonprofit,
 governmental, or for-profit entity.

 Leased land Although CLTs intend never to resell their land, they provide for the exclusive use of their
 land by the owners of any buildings located thereon. Parcels of land are conveyed to individual
 homeowners (or to the owners of other types of residential or commercial structures) through long-term
 ground leases. This two-party contract between the landowner (the CLT) and a building‘s owner protects
 the latter‘s interests in security, privacy, legacy, and equity, while enforcing the CLT‘s interests in
 preserving the appropriate use, the structural integrity, and the continuing affordability of any buildings
 located upon its land.

 Perpetual affordability The CLT retains an option to repurchase any residential (or commercial)
 structures located upon its land, should their owners ever choose to sell. The resale price is set by a
 formula contained in the ground lease that is designed to give present homeowners a fair return on their
 investment, while giving future homebuyers fair access to housing at an affordable price. By design and
 by intent, the CLT is committed to preserving the affordability of housing (and other structures) – one
 owner after another, one generation after another, in perpetuity.

 Perpetual responsibility The CLT does not disappear once a building is sold. As owner of the underlying
 land and as owner of an option to re-purchase any buildings located on its land, the CLT has an abiding
 interest in what happens to these structures and to the people who occupy them. The ground lease requires
 owner-occupancy and responsible use of the premises. Should buildings become a hazard, the ground
 lease gives the CLT the right to step in and force repairs. Should property owners default on their
 mortgages, the ground lease gives the CLT the right to step in and cure the default, forestalling
 foreclosure. The CLT remains a party to the deal, safeguarding the structural integrity of the buildings and
 the residential security of the occupants.




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                                                                              Community Land Trust Fact Sheet (continued)


Community base The CLT operates within the physical boundaries of a targeted locality. It is guided by
– and accountable to – the people who call this locale their home. Any adult who resides on the CLT‘s
land and any adult who resides within the area deemed by the CLT to be its ―community‖ can be-come a
voting member of the CLT. This ―community‖ may encompass a single neighborhood, multiple
neighborhoods, or, in some cases, an entire town, city, or county.

Resident control Two-thirds of a CLT‘s board of directors are nominated by, elected by, and composed
of people who either live on the CLT‘s land or people who re-side within the CLT‘s targeted
―community‖ but do not live on the CLT‘s land.

Tripartite governance The board of directors of the "classic" CLT is composed of three parts, each
containing an equal number of seats. One third of the board represents the interests of people who lease
land from the CLT (―leaseholder representatives‖). One third represents the interests of residents from the
surrounding ―community‖ who do not lease CLT land (―general representatives‖). One third is made up of
public officials, local funders, nonprofit providers of housing or social services, and other individuals
presumed to speak for the public interest ("public representatives"). Control of the CLT‘s board is
diffused and balanced to ensure that all interests are heard but no interest is predominant.

Expansionist acquisition CLTs are not focused on a single project located on a single parcel of land.
They are committed to an active acquisition and development program, aimed at expanding the CLT‘s
holdings of land and increasing the supply of affordable housing (and other types of buildings) under the
CLT‘s stewardship. A CLT‘s holdings are seldom concentrated in one corner of a community. They tend,
instead, to be scattered throughout the CLT‘s service area, indistinguishable from other owner occupied
housing in the same neighborhood.

Flexible development There is enormous variability in the types of projects that CLTs pursue and in the
roles they play in developing them. Many CLTs do development with their own staff. Others delegate
development to nonprofit or for-profit partners, confining their own efforts to assembling land and
preserving the affordability of any structures located upon it. Some CLTs focus on a single type and
tenure of housing, like detached, owner-occupied houses. Other CLTs take full advantage of the model‘s
unique flexibility. They develop housing of many types and tenures or they focus more broadly on
comprehensive community development, undertaking a diverse array of residential and commercial
projects. CLTs around the country have constructed (or acquired, rehabilitated, and resold) single-family
homes, duplexes, condos, co-ops, SROs, multi-unit apartment buildings, and mobile home parks. CLTs
have created facilities for neighborhood businesses, nonprofit organizations, and social service agencies.
CLTs have provided sites for community gardens and vest-pocket parks. Land is the common ingredient,
linking them all. The CLT is the social thread, connecting them all.




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Attachment #9

                                Homestead Community Land Trust
 Homestead Community Land Trust is a membership-based nonprofit organization dedicated to expanding
 opportunity, strengthening community, and investing in the future by creating permanently affordable
 homes in Seattle and King County. Our members include people from all walks of life - from displaced
 persons to government employees, community activists, business people, homeowners, and renters – who
 share a commitment to housing equity. Homestead provides both a smart and low-risk vehicle for
 achieving home ownership, and an innovative and effective way to address our region's affordable
 housing needs.

 Homestead was incorporated in 1992 primarily by low-income residents of the Central District and South
 Seattle who were concerned about the pattern of disinvestment and the potential for gentrification in the
 Central District. Witnessing the success of community land trusts at stabilizing communities and securing
 quality affordable home ownership for low-income residents in other parts of the country, Homestead's
 founding members decided to create a community land trust in Seattle.

 In 2002, Homestead completed its pilot project, the Delridge House. Two years later, we launched our
 ongoing Home Ownership Program. Since then, we have assisted 111 modest income households in
 achieving the dream of home ownership. We have gained the trust of real estate professionals, housing
 developers, and nonprofit organizations, and have proven ourselves a valuable partner in creating new
 homes and home ownership opportunities in Seattle and King County. Homestead has also built a track
 record of successful policy advocacy, working to eliminate the structural barriers to housing equity in our
 region.

 In 2010, Homestead launched its first large scale development project as the lead developer with Wolcott
 Homes. We saw an opportunity to transform a foreclosed, partially finished and vacant housing
 development into a thriving green neighborhood. It was a 5x win, for our buyers this year who get
 outstanding homes at an amazing price, for the community that gets occupied homes instead of empty,
 half-finished ones, for the local economy that gets construction jobs and increased tax base, for future
 generations of modest income buyers who will have the chance to buy, and for the environment via homes
 with lower carbon footprint to build, operate and travel from.




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                                  Statewide TBI Housing Needs Assessment June 2011
Attachment #10

                      From the Co-Housing Association of the United States website

                     What are the 6 Defining Characteristics of Cohousing?

  While these characteristics aren't always true of every cohousing community, together they serve to
  distinguish cohousing from other types of collaborative housing:

  1. Participatory process. Future residents participate in the design of the community so that it meets
  their needs. Some cohousing communities are initiated or driven by a developer. In those cases, if the
  developer brings the future resident group into the process late in the planning, the residents will have less
  input into the design. A well-designed, pedestrian-oriented community without significant resident
  participation in the planning may be ―cohousing-inspired,‖ but it is not a cohousing community.

  2. Neighborhood design. The physical layout and orientation of the buildings (the site plan) encourage a
  sense of community. For example, the private residences are clustered on the site, leaving more shared
  open space. The dwellings typically face each other across a pedestrian street or courtyard, with cars
  parked on the periphery. Often, the front doorway of every home affords a view of the common house.
  What far outweighs any specifics, however, is the intention to create a strong sense of community, with
  design as one of the facilitators.

  3. Common facilities. Common facilities are designed for daily use, are an integral part of the
  community, and are always supplemental to the private residences. The common house typically includes
  a common kitchen, dining area, sitting area, children's playroom and laundry, and also may contain a
  workshop, library, exercise room, crafts room and/or one or two guest rooms. Except on very tight urban
  sites, cohousing communities often have playground equipment, lawns and gardens as well. Since the
  buildings are clustered, larger sites may retain several or many acres of undeveloped shared open space.

  4. Resident management. Residents manage their own cohousing communities, and also perform much
  of the work required to maintain the property. They participate in the preparation of common meals, and
  meet regularly to solve problems and develop policies for the community.

  5. Non-hierarchical structure and decision-making. Leadership roles naturally exist in cohousing
  communities, however no one person (or persons) has authority over others. Most groups start with one or
  two ―burning souls.‖ As people join the group, each person takes on one or more roles consistent with his
  or her skills, abilities or interests. Most cohousing groups make all of their decisions by consensus, and,
  although many groups have a policy for voting if the group cannot reach consensus after a number of
  attempts, it is rarely or never necessary to resort to voting.

  6. No shared community economy. The community is not a source of income for its members.
  Occasionally, a cohousing community will pay one of its residents to do a specific (usually time-limited)
  task, but more typically the work will be considered that member's contribution to the shared
  responsibilities.




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Attachment #11

                             Jackson Cohousing – Living as a Community
Three young men share a home in a unique neighborhood where residents are committed to living as a community.
They live at Jackson Place Cohousing which was designed to encourage both social contact and individual space. A
cohousing community is planned, owned and managed by the residents; groups of people who want more social
interactions with their neighbors. Like other cohousing communities developed throughout the United States, Canada,
Europe and Australia, cohousing residents live in private homes, but have access to extensive shared spaces and
facilities which makes it easy to interact with neighbors and build mutually beneficial relationships over time.

Matt, Nate, and Patrick‘s three bedroom home faces a common courtyard with the other 27 attached units. Sitting
outside their front door, they greet neighbors walking by. In the evening, they often share supper with other residents
in the common dining room and talk over the activities of their day. Opportunities to bump into neighbors on a regular
basis help Matt, Nate, and Patrick‘s achieve their goal of getting to know people in their community.

Cohousing involves a group of families and individuals who collaborate in the design and operation of their own
neighborhood. Typically, cohousing groups hire an architect and builder who agree to accommodate individual needs
of households while designing a place that reflects the desires of the entire group. In 1999, when the City of Seattle
offered unused land for housing development, a group of interested individuals who desired to live in a cohousing
community worked with an architectural firm to develop Jackson Place Cohousing. With a central location at the
intersection of Seattle‘s International District and Central Area, they planned a unique concept and design in this dense
urban neighborhood. Row houses face a shared landscaped walkway. A parking garage is located underneath the
houses. A shared common building includes a large kitchen, dining and meeting area, guest room, and laundry
facilities. The design creates a place where people live in small units and share common spaces to optimize social
interactions. The design also allows for and encourages many types of households to be part of the community; single
people, single-parent families, two-parent families, unrelated individuals, and seniors whose children have left home.
As opposed to typical housing developments, cohousing offers natural social interaction among people of different
ages, incomes, abilities, and cultures.

Kathy and Bill Sellers, legendary King County disability activists, were two founding members of Jackson Place
Cohousing. Along with other founding members, they developed a vision for living in a diverse community. Bill and
Kathy encouraged people with disabilities to join this diverse mix of cohousing members. When planning began,
Kathy contacted Parkview Services, a nonprofit organization that develops housing for people with disabilities. The
executive director at the time attended cohousing meetings and discovered the unique opportunity to develop housing
units from the ground up with a design that promoted social interaction. He understood how this would benefit
individuals with disabilities who are often socially isolated from their neighbors and community.

Initially, Jackson Place Cohousing members were uncertain about Parkview, a nonprofit organization, purchasing a
unit. Typically, cohousing developments are planned and owned by individuals and families, not community
organizations. Questions were raised about how a nonprofit organization could be a participating member. Jackson
Place Cohousing, located in a historically ethnic and racially diverse neighborhood, was unable to attract a
membership that reflected this diversity. Members understood that including a housing unit for people with disabilities
could help achieve their vision of a diverse community. Following the extension of cohousing membership to
Parkview Services, Parkview wrote and received grants from the City of Seattle, the Washington State Department of
Community, Trade, and Economic Development, and the Federal Home Loan Bank to purchase a three bedroom home
at Jackson Place for approximately $266,000.

The next step was to find people who wanted to live in the Jackson Place Cohousing community. Parkview
approached Matt‘s father, who was on Parkview‘s Board, to find out if Matt would be interested. If interested, he
would need to find two other families with sons who wanted to live together. Parkview does not provide support for
individuals to live in their home, so the parents also had to agree on finding and coordinating ongoing supports for
their sons.

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                                                                                                Jackson Cohousing (continued)

Matt‘s parents immediately thought of Nate as a possible housemate, since they had been friends since childhood.
Matt and Nate‘s families had known each other from various activities and organizations, and their mothers played
tennis together. Nate and Matt‘s parents spread the word to other families about this shared housing opportunity and
interviewed several people. For one reason or another, the match was never right. One day, Patrick‘s mother Virjean
called and said they were interested. It was an instant match. From the start, all three families worked together to
create a household that fit their sons‘ needs.

Nate, Patrick, and Matt, all in their twenties, moved into the three story cohousing home seven years ago along with
many of the original residents. Opportunities have been abundant for the housemates to meet and get to know
neighbors. They step out their front door to a small garden that flows into a common walkway with numerous sitting
areas. They join their neighbors for dinner every night in the common dining room where a group of residents prepare
a meal for the community. Residents who work or are busy during the day can join their neighbors for a home cooked
meal and conversation. A sign up schedule allows people to choose their day to cook a meal or help clean up. Like
their neighbors, Nate, Patrick, and Matt can purchase a good meal for $4.00. They also help cook meals for the
community and they regularly volunteer to clean up after dinner. This daily opportunity to get together with neighbors
creates social interaction and, in some cases, friendships. Nate, Patrick, and Matt join in other community activities
including celebrations, work parties, and barbeques. Often they are asked to offer assistance to their neighbors, such as
moving someone‘s furniture or doing yard work.

After living together for seven years, and with the help of their families and personal care providers, Nate, Patrick, and
Matt have developed both individual and shared living routines. For the first two years, the families were frequently at
the house helping their sons adjust and pitching in where necessary. As Virjean honestly reflects, ―It hasn‘t always
been easy. It took Patrick a long time to settle into his new home. It would have been easier to keep him at home with
us‖. But seven years later she can see the individual growth from those first few years and feels Patrick has outgrown
living with his parents. Everything is easier and more relaxed with their established routines.

All three men are employed. Nate takes the bus to Swedish Hospital everyday where, for the last twelve years, he has
delivered mail to various departments. He is a valued member of the workforce and makes a good income. Matt used
to work at the Sheraton Hotel, but was laid off after 9/11. It‘s been difficult finding a community job ever since. Matt
now works at Northwest Center, a specialized job site for people with developmental disabilities. Trina, a care
provider, drives Matt to work every day and an Access van brings him home. Taking the Access van makes his family
feel confident Matt will get to work on time. Patrick takes the bus to his job in Fremont two days a week. For the last
six years, he has packaged materials and done recycling for Minerallac, a company that produces metal fasteners for
commercial projects. During the rest of the week, Patrick has a steady routine. He spends one day at home watching
TV, drawing, writing in his notebook, and doing puzzles. He also takes walks in the neighborhood, and often goes to
the local Goodwill store. He spends Wednesdays with his mother, usually going out to lunch and for walks.

All three young men receive Medicaid Personal Care hours that are used to hire providers for personal care needs.
Throughout the years, it‘s been a struggle to find qualified care providers who stay for long periods of time. Part time
work and inadequate pay can make it difficult to retain care providers. Getting to know the styles and personalities of
care providers who come and go has been both an opportunity and a challenge. The men and their parents have met
many good providers but they have also dealt with some that were problematic. Recently, they had to let someone go.
The families all agreed with the decision but it was still uncomfortable. Currently they are pleased with the three
motivated and caring providers who support the men throughout the week.

The three care providers are employed by two different agencies. The agencies send qualified people to be interviewed
by the families, who then decide if the match is right for the household. Alex was hired a year ago and instantly knew
he wanted to work with the three men.




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                                                                                               Jackson Cohousing (continued)

Alex has grown to appreciate their unique personalities. He typically works weekday evenings, helping the young men
with the specific personal care needs that they have been assessed for individually. Matt in particular needs support
with personal hygiene tasks such as showering and shaving. Alex enjoys their company and often joins the men and
their neighbors for dinner at the common house. After dinner the men typically go their own way to watch TV, listen
to music, or to participate in sports and other activities. Like many others after a day of work, the men appreciate their
time alone. They also often go to the park, to stores, or listen to music, and occasionally they watch movies together.

Trina supports each person during weekday mornings to help them with specific things they need to get ready for the
day. On Saturdays the men like to spend time together going to movies or community events like festivals, fairs, or
concerts. Leone, the third care provider, will provide support for their personal care needs on Saturday and Sundays
when the men are not visiting their families for the day.

The families communicate regularly with the care providers. For the care providers, communication can sometimes be
confusing when parents and agency staff all provide advice and direction. To help facilitate communication and keep
everyone informed, daily activities and notes about special circumstances are entered in a log. Typically the care
providers respect the opinions and advise of the parents since they understand the needs and desires of their sons better
than anyone. In turn, the parents listen to the care providers and show their appreciation by giving holiday bonuses,
money for gas, and other methods of compensation. Communication is considered the key to working well together.
After seven years, the families are more accustomed to the inevitable issues that arise and ways to work through them.

The families are very involved with their sons and provide on-going support to them and to the overall household..
Linda and Virjean regularly stock the kitchen with food staples. On Wednesday and Sunday when Virjean visits
Patrick, she checks to make sure Patrick‘s bedroom and bathroom are clean and that he is taking care of his personal
needs. Patrick‘s father manages the monthly household finances. Nate‘s father involves the men in sports activities on
the weekends, including skiing trips in the winter. Family members help out if care providers miss work. Matt‘s
brother has been a care provider and Linda, who lives only 25 minutes away, drops by or covers hours when needed.

The parents work hard to make this housing situation work for their sons. They pitch in and support each other when
needed. They meet every three or four months to discuss anticipated problems and solutions. Throughout the years
they have argued, apologized, and generally found ways to resolve their concerns and differences. They have become
good friends, enjoying shared values and senses of humor.

The men‘s cohousing community makes this housing arrangement particularly unique. The community provides an
extra layer of support that makes it easy for Nate, Patrick, and Matt to live on their own. These community qualities
give their families a sense of comfort that their sons are safe, especially since they have no one with them overnight
and are often home alone. Matt‘s mother Linda would prefer to have someone available throughout the night, but she
recognizes that the household‘s financial arrangement would not work if one bedroom was occupied by a care provider
who didn‘t pay rent. For now, she‘s comfortable and thankful that the cohousing experience promotes safety,
community connections, and mutual support. Linda is confident someone in the community would provide help in an
emergency.

Virjean is pleased that Patrick has opportunities to interact with so many people, which would not happen if he lived in
a typical apartment building. She believes Patrick has been forced to socialize and become more aware of the world
around him. The adjustments Patrick has been required to make in order to associate with so many different people
has helped him change some of his more difficult behaviors. Virjean acknowledges Patrick was protected and
―coddled‖ at home. Over the past seven years she has observed some significant and positive change.




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                                                                                              Jackson Cohousing (continued)

Patrick initiates situations, communicates what he wants to do, and even reads the paper to find out what is going on in
his community. Linda praises Matt‘s cohousing living arrangement. As she says, ―Matt is not anonymous. He is
known, cared for, and part of the community, like one big family‖. Matt, Patrick, and Nate have personally thrived in
this setting and established a balanced life -- living on their own and living as a community at Jackson Place
Cohousing.

Words of Advice:
• Try not to do it alone. Find other families to join you. It‘s great to have a support group, people you can call if
something comes up, even if there are occasional difficulties.
• What helps this household run smoothly are like minded parents who share priorities and senses of humor to help
make this arrangement work.
• Because there is so much to do and to advocate for it is important to avoid internal conflict among the men and
their families.
• Think about what you are creating for the future. Think about what you want when parents are no longer there for
support. We need to think about how to build our communities to support each other. Linking with other families
means there are more people who understand our children if something happens to their parents.

Housing:
• Three men share a well maintained three bedroom three bathroom attached house in the Jackson Park Cohousing
community in central Seattle. Jackson Park Cohousing is located near bus lines, restaurants and stores.
• The home‘s first floor includes a kitchen and a common living space. Patrick lives in his own bedroom with bath
on the lower floor. Matt and Nate have their own bedrooms with a shared bathroom on the second floor.
• Parkview Services owns the condominium unit at Jackson Place Cohousing. Each of the men have separate rental
leases with Parkview.
• Rents vary from person to person. Patrick and Matt each qualify for Section 8 housing vouchers that they use to
subsidize their rent. Nate pays Parkview 30% of his income for rent,.
• The rent the men pay in this setting is manageable. Patrick and Matt need to budget more carefully to cover
monthly expenses.
• Rental rates are reviewed every year, by Seattle Housing Authority and Parkview Services.
• Parkview pays all of the associated fees for the cohousing unit. This includes contributing to the cohousing funding
pool for any maintenance or upgrades, insurance, and membership dues. As a 501(c)(3) non profit, Parkview pays
reduced property taxes. Parkview sets aside funds from the rental income every year for property maintenance. The
rental income covers these fees.
• There aren‘t any reasonable accommodations required for the young men to use their vouchers in this housing
arrangement.

Support:
• The men hire MPC providers to receive support for their personal care needs. Two care providers are each
employed by separate agencies and the third individual provider is paid by the parents using MPC hours.
• Care providers are available at various times throughout the weekdays and weekends when personal support is
needed for each person. They are home alone during the night and other times during the day.
• The families provide ongoing support including overseeing the care providers, providing additional individual
support to their sons, and filling in for care providers as needed.
• The young men go to their family homes every Sunday.
• The cohousing community provides informal support, including evening meals and safety. The community feels
safe knowing that neighbors watch out for each other and provide help in emergencies. Cohousing provides social
interactions and opportunities to get involved in the community.




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Attachment #12

                        Jackson Place Cohousing Vision Statement
                                           as approved by consensus 11/12/00

Our vision is to create and sustain an urban community for 27 households in the Jackson Place neighborhood of Seattle. Our goal
is to create an environment that nourishes a vibrant, meaningful life for every member, ―providing individuals and families with
what they need from a private point of view while allowing them to get what they want from a community point of view.‖

The physical design of our community is intended to maximize our open, green space and to provide desirable, efficient and
economical living spaces for all our residents. Dense building clusters consisting of townhouses and flats surround a central
commons, with a Common House and underground parking at one end. Our Common House includes community kitchen and
dining hall, laundry and storage facilities, child play areas, office, and meeting space, and we will include other spaces and
amenities as we are able.

Individual units are condominiums, owned and occupied by residents, with the land held in common. We consider ourselves
stewards of our land and use our common areas and possessions with care and consideration for each other. We are committed to
reducing consumption and conserving natural resources, using ecologically sound maintenance practices and building materials
where possible. We share goods and resources, such as tools, transportation, child care, community-supported agriculture, and
common meals.

As the residents, we are the designers, developers, and caretakers of our community. Community work is shared by all residents,
and we gather in regular meetings to shape our direction and growth. We are committed to a consensus decision-making process.
We strive to create an atmosphere of cooperation and goodwill where everyone is willing to lend a helping hand. We choose to
develop relationships with each other based on mutual respect, trust, and honest communication. We agree to explore and to
resolve, to the best of our ability, the inevitable conflicts and misunderstandings that occur between people living in community.

We accept each person as a unique individual and value the strength of diverse perspectives, backgrounds, and experience. We
treat every person in the community with courtesy and respect. Children are valued as full members and are included in the daily
life of the community. We encourage gatherings to celebrate events such as birthdays, anniversaries, holidays, and the life of the
community. We support and are sensitive to members' individual needs and preferences for connection and relationship, and for
privacy and solitude. We try to accommodate dietary considerations of our members at our common meals. Our members manage
their pets' activities so they are good neighbors too.




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                   SECTION 17
                            Hospitals

Attachments

  1. Number of TBI Hospitalizations in Washington State
  2. Demographic Map of Washington with TBI Hospitalizations by County




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                                                  Hospitals
According to the Department of Health (DOH) there is an estimated 5,500 TBI related hospitalizations
each year. See attachment #1 for the DOH fact sheet. In attachment #2 is a map of the state broken out by
counties with the number of TBI hospitalizations under each county name. These numbers are also from
the DOH.

Methodology

We contacted several hospitals to find out where they might place a person with a traumatic brain injury
who wasn‘t returning home or to a family member‘s home. We thought that this would yield housing and
service-related community options that we would not find otherwise in our housing search.

Findings

Unfortunately when we talked to discharge planners at the hospitals, they didn‘t have any housing and
service-related resources that we didn‘t already have on our list. Their concern and to some extent their
frustration was that the choices for individuals with a traumatic brain injury were very few. They often
found themselves looking for a place that had a vacancy that matched up with the person‘s funding source
and daily rate. The existing available options were typically nursing homes, boarding homes, and AFHs
that were not age or disability appropriate.

We didn‘t continue with our original plan to contact most of the hospitals in the geographic areas of the
needs assessment. The discharge planners provided valuable input on their process for making placements
and the resources that they felt were needed. However, we felt that further time expended contacting
additional hospitals and talking to more discharge planners would not be of value.

Western State Hospital

Our discussion with staff at Western State Hospital was somewhat unique. At Western State Hospital they
have a unit that has about 27 males with a traumatic brain injury. About half of them are just waiting for
housing, preferably a small group home or a Terry Home type facility that supports about 10 people. The
biggest problem reported to us in successfully placing someone out of Western was behavior problems or
in some cases having a history of behavior problems. Many community programs will turn a person down
just on having a history of behaviors and the fact that they are at Western. Although there might be
intervention strategies in place that are working, the history of behaviors such as violence, sexual
inappropriateness, and aggression often shut the door to most community placement opportunities. Even
when there might be a provider interested in taking someone that has some challenging behaviors, the
daily reimbursement rate is often prohibitive low given the extra support that is needed to support the
person. Providers often choose people who require less support and are a better ―fit‖ with their other
residents. The other critical piece to complement a community residential placement is the need for out-
of-home activities such as a day treatment program, employment, pre-vocational training, or volunteer
opportunities. Having people sit at home without some supported structure is likely to initiate or increase
an individual‘s challenging behaviors. This in turn, without adequately trained staff and individual
supports in place, will likely jeopardize an individual‘s placement. The question is what might we do to
minimize this?



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                                                                                           Hospitals (continued)


Recommendations

   1. Develop a State Operated Living Alternatives (SOLA) type program much like the State Division
      of Developmental Disabilities (DDD) where the programs are operated by DDD with state
      employees providing the 24/7 support and training services. By setting up a state operated
      community-based residential program for difficult to place people with a traumatic brain injury,
      many of the reasons that community providers turn a person down would be minimized or
      eliminated (i.e. adequate daily rate, discretion to choose others, inadequately trained staff).

The second idea is to develop a more intensive and extensive support system for community placements
that includes an out-of-home day program, pre-placement and on-going staff training, support around
behaviors and intervention strategies, and planned respite and crisis bed opportunities. In addition, there
would be a daily rate that includes an adequate staffing level that includes specialized training. A program
of this type should increase the placements of harder-to-place individuals, as well as increase the amount
of time they can successfully stay in a community placement.




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Attachment #1




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Attachment #2


                Demographic Map of Washington with
                  TBI Hospitalizations by County




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                 SECTION 18
 Innovative Housing and Services


Attachments

  1. Sunrise Services
  2. Terry Home
  3. Starbird Farm
  4. Companion Homes RCW
  5. Karistad
  6. Life Enrichment Opportunities
  7. Cluster Care Implementation Procedures
  8. Washington Initiative for Supported Employment
  9. LifSPAN
  10. Rehab Without Walls
  11. The Mockingbird Family Model Brochure
  12. The Mockingbird Family Model




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                                    Innovative Housing and Services

General Information

William Plomer wrote ―Creativity is the power to connect the seemingly unconnected.‖ This quote about
creativity could just as well be about the efforts by people with a traumatic brain injury to connect with
services and resources.

We are including stories and information about people, ideas, journeys, and resources; some of which
were creative in their time, others are new and unique, and still others are self-proclaimed works in
progress. This is by no means a comprehensive list, but in our efforts over the last 5 months these are
some of the things that were shared with us.

Housing for People with a Traumatic Brain Injury

We could only identify (5) existing housing opportunities, with or without services, that were exclusively
or mostly for people with a traumatic brain injury. The pioneers in this state, all doing something a little
different than the other, are:

   1. The Delta Rehabilitation Center (www.deltafoundation.com)
       Delta, also known as the Chalet, started in 1975 and is located in Snohomish
       Their facility has 120 beds and they support about 90 people with a traumatic brain injury.
       They are primarily funded by Medicaid and currently have 3 openings.

   2. Sunrise Services (www.sunrisecommunityliving.com)
       Sue Closser started Sunrise Services in 1977 to support people with developmental disabilities.
       In the middle 1990‘s Sunrise help start the state‘s first Home of Your Own program that
         assisted people with disabilities buy their first home.
       In 2000, they put together a pilot program to support (3) young adults with a traumatic brain
         injury in a house.
       Sunrise provides the only Clustered Care model of services in the state where Medicaid clients
         who live near each other can benefit from a coordinated effort by personal care workers.
       See attachment #1 for an interview with Sue Closser, the founder of Sunrise Services.
   3. Terry Home (www.terryhomeinc.org)
       Terry home incorporated as a non-profit in 1986.
       They built 10-bed licensed boarding home for people with TBI with funding assistance from
         King County and State Housing Trust Fund (HTF). They opened in 1996 in the City of Pacific
         in King County.
       They have a waiting list and the next person in line has been waiting since 2005.
       Terry Home has recently purchased a property in Auburn funded by the TBI Fund, King
         County, and the HTF to build a 12-bed facility for people with a traumatic brain injury.
       See attachment #2 for an interview with Mary Norman (mother) & Tim Norman (son), and
         Myla Montgomery, the founders.

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                                                                                Innovative Housing and Services (continued)

   4. Starbird Farm
       Starbird was started about 14 years ago in Woodinville as an Adult Family Home (AFH)
       About 10 years ago Starbird started another AFH up in Mt. Vernon on 80 acres of land
       They don‘t keep a waiting list and decide on a case-by-case basis who to take.
       See attachment #3 for an interview with Richard Hanika, the founder

   5. Accessible Spaces, Inc., (www.accessiblespace.org)
       Was founded in Minnesota in 1978 and is a non-profit organization.
       Today they own 101 buildings in 27 states supporting people with disabilities including
         individuals with a traumatic brain.
       They have (1) apartment building, Eagle Crest Apartments, that is located in Spokane and has
         21 accessible units that rents only to people with disabilities. Currently there are at least 6
         people living there that have TBI.
       See attachment #4 for a brochure on Eagle Crest Apartments.

Housing Models for People with a Disability

Many innovative housing models have come from the developmental disabilities field and from families
that have a son or daughter with a developmental disability.

A Companion Home provides support from a foster care model approach to (1) person with a
developmental disability who lives in a traditional family home and receives services. The Home is
approved by DDD to help ensure the individual‘s well-being, health, and safety. DDD pays the Home for
the support and services. Companion homes offer 24-hour accessible supervision. They were first started
in 1998 under WA Administrative Code 388-829C (see attachment #5).

Karistad started in 1989 by Bill & Kathy Sellars with the intent on establishing a shared living
arrangement for (5) housemates that have a developmental disability, one of which was their daughter
Kari. Their employment or Social Security would cover their room & board and personal needs without
requiring any financial subsidy from their families. In the last eight years only one housemate has
changed. There is a live-in person in case of emergencies. The care provider who comes in during the day
contracts with DSHS to provide Medicaid Personal Care and Waiver services. There have been only 4
different care providers in the last 8 years. For more information about Karistad, see attachment #6.

Life Enrichment Opportunities (LEO) is a parent based, grass roots 501(c)3 non-profit organization
seeking innovative solutions for local housing for people with developmental disabilities. LEO currently
owns two houses that are licensed as Adult Family Homes (AFH) and is hoping to open their 3rd next
month. They have raised most of the funding through donations. To read more about their story, see
attachment #7 and their website: www.leoorganization.org.

Community Homes (www.community-homes.org) is a non-profit started by family members to create
rich, full lives for adults with developmental disabilities by providing quality, long-term Adult Family
Homes. Community Homes operates (6) AFHs with funding almost completed for home #7. Different
than LEO, all the homes were developed primarily using public housing funding.


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                                                                                        Innovative Housing and Services (continued)
Innovation Services

The original pilot project definition of ―Cluster Care‖ by Home and Community Services Division in a 1999
Management Bulletin was: ―Cluster Care offers personal care services to a group of Medicaid clients who live
near each other. The services are provided by a coordinated team of home care agency aides. The home care
agency prepares a work schedule for the team of aides to follow each week. The schedule must be designed in a
way that personal care tasks are provided for each client, achieves maximum efficiency of worker time and
provides flexibility to accommodate client choice. This schedule might include having one or more home care
aides assigned to a client and may allow certain tasks to be grouped together such as shopping, laundry and
transportation needs. This work schedule must meet the personal care needs required by each cluster care pilot
client. The team of home care aides is also expected to be accessible throughout their scheduled work shift to
perform unscheduled tasks for cluster care pilot clients as needed.‖ This is truly THE innovative approach to
supporting people who have a limited number of Medicaid Personal Care or COPES funded hours but need
access to 24/7 services. More importantly, there are people who are living in community-based licensed
facilities (i.e. AFH) that could live in a more independent setting if their limited number of Medicaid hours
could be ―clustered‖ with enough other folks so that they could access support, although intermittently, 24/7. In
attachment #8 is the 1999 Management Bulletin.

The Washington Initiative for Supported Employment (WiSe) started My Home, My Life Family Network
Project to focus on the housing needs and supports of individuals with a developmental disability who will be
leaving their family home and moving into the community to work and live. The first network group started in
2005 to provide families the opportunity to connect with one another, and learn how others have problem-
solved and approached this next step in their family member‘s life. Their son or daughter may have little or no
residential funding and a networking group gives them the platform to explore this transition with other
families. For more information about this project see attachment #9 and go to the WiSe website at
www.theinitiative.wa.

Lifetime Secure Personal Assistance Network (LifeSPAN) is a family directed non-profit organization that
exists to support families to develop safe and secure futures for their children and relatives with disabilities.
LifeSPAN helps to answer the question ―What will happen to my son or daughter or family member when I
die?‖ LifeSPAN addresses this concern through the establishment of personal networks designed to be in place
for the lifetime of the individual. LifeSPAN believes that safety and security and a good life are achieved
through relationships, and work in the community to be sure that the contributions of all members are received
and acknowledged. For more information see attachment #10 and go to their website at www.lifespan-wa.org.

Rehab Without Walls was started in Seattle in 1988 by a group of professionals who saw a need to support
people with traumatic brain injury. Instead of just learning to prepare a meal, people learn to shop in their local
grocery store and use their own kitchen. Rather than simply focusing on grooming skills, people learn to
navigate their own bathrooms. The ultimate goal of Rehab Without Walls is to provide care in a comfortable,
familiar environment. They provide mostly OT, PT, and Speech services. In 1992 they became a division of
Gentiva Health Services. In attachment #11 is an interview with Paula Gage and you can go to their website at
www.gentiva.com/patients_caregivers/rehab_without_walls.

Seattle BrainWorks, a program of PROVAIL, ―is a community-based Clubhouse program providing short and
long-term support to people who have experienced traumatic brain injury. Our mission is to empower survivors
of brain injury to relearn skills and create strategies that will help them reintegrate as happy and successful
members of the community. The Clubhouse is based on the idea that "work is healing." Members and staff work
side by side to operate the Clubhouse.
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                                                                               Innovative Housing and Services (continued)

Through participation in the Clubhouse, members are able to transition from being "patients" to again
being active participants in life. At the Clubhouse, members work on strengthening relationships with
friends and family, and on gaining skills and accessing opportunities to pave the way back to work. For
more information about the Clubhouse, go to: http://www.provail.org/sbw.php.

The Mockingbird Society (www.mockingbirdsociety.org) has developed the Mockingbird Family Model
(MFM) approach to supporting families and children. ―The MFM is a simple, yet innovative concept
which establishes a sense of extended family and community around the participating children, youth, and
families. In each MFM Constellation, six to ten families (foster, kinship, foster-to-adopt, and/or birth
families) live in close proximity to a central, licensed foster care family (Hub Home) whose role is to
provide
    assistance in navigating systems
    peer support for children and parents
    impromptu and regularly scheduled social activities
    planned respite nearly 24/7, and crisis respite as needed‖

Jim Theofelis, Executive Director and Founder of The Mockingbird Society, thought this model could
easily be adapted to work in supporting individuals with a traumatic brain injury. In attachment are
attachments #12, #13, and #14 about the Society and the MFM.

Recommendations

   1. The Clustered Care model of providing services to Medicaid clients needs to be re-visited for how
      it might be modified to work for more service providers and clients. For a better part of 10 years,
      Sunrise Services has been the only provider to offer the Clustered Care model.

   2. There aren‘t any non-profits in the state that are dedicated to developing residential options for
      people with a traumatic brain injury. There should be a focused effort to cultivate an existing non-
      profit or to encourage the creation of a new non-profit to develop housing regionally or on a
      statewide basis specifically for individuals with a traumatic brain injury. This would be similar to
      the many non-profits that are dedicated to developing housing for a variety of special needs
      populations including the homeless, individuals with mental illness, and people with
      developmental disabilities.




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Attachment #1

                                                  Sue Closser

                                       Sunrise Services - Everett


 The business started in 1977 serving the developmentally disabled. They advocated to close DD group
 homes so that people could be in their own homes. Sunrise helped folks find rentals. They eventually
 purchased homes for folks with behavior issues. In 1988 Sunrise started offering home care and
 employment services and started to serve elders and folks with other disabilities.

 In 1999 Sunrise participated in a joint effort to develop a residential model for young adult TBI survivors.
 Stakeholders included representatives from family members, HCS, Western State Hospital, and local
 mental health administrators from the North Sound Regional Support Network. In 2000 Sunrise
 contracted with the state to provide a home for three adult male TBI survivors. They were provided 24
 hour staff support at a flex rate above nursing home rate to start and that was stepped down to 16 hours of
 staff support at a flex rate of 85% less than nursing home costs over a period of a year. Two of the
 original three participants are still under Sunrise‘s care.

 They have a Home Care license and it has no capacity. Their Adult Family Home license has a capacity of
 six per home.

 They do have a wait list of six or seven, but there is no funding for services. The usual waiting period is
 about two years. They currently have 30 units available but these will probably not go to TBI survivors
 because there are no service funds available. They would be interested in starting another program if
 service funding were available.

 Most clients are funded by DSHS and Sunrise needs a minimum of 3 hours a day per person at $17.30
 hour. They currently have 8 TBI survivors and one mental health client who each receive only 30 hours a
 month through Homecare Services. Traditional Home Care models don‘t allow for behaviors, memory
 problems or mental illness issues. There is no funding for TBI survivors who don‘t have a physical
 disability.

 There will be no Section 8 housing vouchers available for 3 – 4 years and the county is running out of
 mental health money. Sunrise is breaking ground on 8 units but they probably won‘t go to TBI survivors
 because of service funding issues.

 It is difficult to attract and maintain staffing due to low wages. Sunrise spends quite a bit of time and
 money training staff. Once they are trained and get a little bit of experience, they leave for better paying
 positions.




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Attachment #2


                TERRY HOME: A FORMULA FOR HOUSING SUCCESS

On May 12, 1984, Terry Norman and two friends headed home at approx. 3:30 a.m. after a night of
drinking. While Terry slept in the backseat, the driver lost control and the car crashed into a tree. The
driver and front passenger were not seriously injured, but Terry sustained a Traumatic Brain Injury (TBI).

After a three-month coma and one year in the hospital, Terry needed to transfer to a facility that could
support his specific needs and help him recover and rebuild functions he lost or damaged from the
accident. Mary Norman, Terry‘s mother, discovered that no such place was available. In fact, she found
that geriatric nursing homes were the only facilities that could care for Terry. She said she knew right
away that a nursing home was not an appropriate care provider for her son.

―Nursing homes are geared for the elderly,‖ Mary said. ―My son was 18 years old at the time, and he had
roommates who were 80, 90 and 100 years old. I started talking to people, and I asked, what about a home
for people with TBI?‘‖

Mary answered that question in 1986, when she created Terry Home, a non-profit corporation,—named
after her son—an organization designed to build a home specialized for people with TBI. Mary and her
sister, Myla Montgomery—the President of the Board of Directors since 2005—formed a team and
started to call around the country for information about establishing this unique care facility.

―On the way to Sibley, Iowa—where we visited family—we would tour different places designed for
people with head injuries,‖ Mary said. ―We adopted a few ideas from each place, and then Myla and I put
the design together.‖

Throughout the design process, Terry Home still needed to raise enough money to buy the land and then
build the home. During a 10-year period (1986-95), the group received state funds and raised more than
$900,000 with support from organizations like the Auburn Eagles to assist with fundraiser.

After tireless efforts, Terry Home raised enough money to buy the land. And in Nov. 1994, Terry was the
first to shovel dirt during the ground-breaking ceremony. Terry Home opened its home on June 6, 1996 in
Pacific, Wash.

―Everybody needs a place that they can call home,‖ said Joanne Norman, Terry Home‘s administrator
since 2007 and Terry‘s sister-in-law. ―At Terry Home, they can do that.‖

Since its inception, Terry Home has graduated 10 residents into independent living. With 10 residents
currently living at Terry Home, there are also 25 people on the waiting list. Joanne Norman said families
call her often looking for availability at Terry Home.

―Most people don‘t put their names on the waiting list because they need a place right away, ―she said. ―I
have to tell them that it could be a years before there‘s an open spot. Most people just can‘t wait that
long.‖




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                                                                                            Terry Home (continued)

Current and future waitlist members have reason to hope, as Terry Home has started the process for a
second Terry Home. The group has purchased a 27,500 sq. ft. lot in Auburn, where 12 residents—four of
which will be veterans—could call home in 2012.

While the second Terry Home brings promise to a small population, Terry Home‘s leaders are still
concerned about the lack of housing options for people with TBI. Mary Norman said that legislators were
not very responsive towards their efforts to start the first Terry Home in the early 1990‘s. ―I sent a letter to
every legislative member in the state and only two responded, ―she said




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Attachment #3

                                                    Richard Hanika

                                            Starbird Farm – Mt. Vernon


  Richard Hanika was working at University of Washington Hospital in the OT department and he saw there was no
  place for folks recovering from TBI to go to. They would be discharged and often ended up at Western State
  Hospital and then eventually be readmitted to the hospital.

  He opened the first AFH (Hacienda) in Woodinville about 14 years ago. Today that home caters to folks who need
  more intensive care. They are licensed for six clients.

  About ten years ago Rick saw the need for a place where the more active client could get outside and have room to
  roam and have activities to keep them busy. He purchased what had been an 80 acre dairy farm with numerous
  homes and outbuildings in Skagit County. His wife runs The Hacienda and he runs Starbird Farm along with
  Danielle the wife of one of the residents. Starbird is licensed at an adult family home and has 5 beds.

  In the beginning, the biggest challenge was balancing the homes‘ and clients‘ needs with their own family needs.
  They tried living in the first home, but with teens at home, that didn‘t work well. When the second home opened
  there were other challenges of that nature. Rick shared that taking care of their own mental health and staying
  focused has been important. Dealing with clients‘ behaviors, changes in business regulations, changes in rates and
  cost of licensing are other challenges. When asked if they‘d do anything differently today, if starting over, he said,
  ―Not much.‖

  Staffing has its usual challenges. It‘s hard to attract quality staff for the type of work and the pay. However, they
  have worked out a ―tag‖ system. When a staff member finds a client difficult, another staff member will step in and
  take over or provide support. Some of their staff have been with them 10 years. Rick said that the good ones stay
  and the others weed themselves out.

  They do have a list of folks who have made inquiries and they get calls every week. They try to choose a client
  from their list that would be appropriate for Starbird. They might have a turnover about once a year.

  When asked if he would be interested in starting another program if funding were made available, he said that
  funding wasn‘t the issue. It would be a matter of having the energy to start another program. Creating the right
  environment that sets the tone for the home and your whole life being there is a challenge. As the owner you spend
  a lot of time in a home so it needs to be the right environment. Getting the right staff, training the staff, getting the
  right clients in the house and constantly tweaking it requires lots of energy.

  He currently has no VA clients although they get frequent calls. He has one private/trust fund, three DSHS and one
  L & I client. DSHS rates are not typically high enough and there are no exception to policy rates anymore. The
  minimum rate for care that is necessary is about $2,800 a month.

  Rick‘s idea of a good working situation would be to have a place like Starbird Farm set for folks to come to during
  the day (with their caregivers, if needed) from AFH‘s to work, train and get outside and be active and then go back
  to the AFH at night




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Attachment #4


                                        Companion Homes RCW
 Chapter 388-829C WAC                                               Last Update: 9/24/09
 Chapter Listing
 WAC Sections
 PURPOSE
 388-829C-005
 What is the purpose of this chapter?
 DEFINITIONS
 388-829C-010
 What definitions apply to this chapter?
 COMPANION HOME SERVICES
 388-829C-020
 What are companion home residential services?
 388-829C-030
 Who may receive companion home residential services?
 388-829C-040
 Who is eligible to contract with DDD to provide companion home residential services?
 388-829C-050
 Who may not provide companion home residential services?
 388-829C-060
 Where are companion home residential services provided?
 PROVIDER QUALIFICATIONS AND RESPONSIBILITIES
 388-829C-070
 Who must have a background check in the companion home?
 388-829C-080
 What minimum skills and abilities must companion home providers demonstrate?
 388-829C-090
 What values must companion home providers focus on when implementing the ISP?
 388-829C-100
 What rights do clients of DDD have?
 PROVIDER TRAINING
 388-829C-110
 What training must a person have before becoming a contracted companion home provider?
 388-829C-120
 What training must a companion home provider complete within the first ninety days of serving the client?
 388-829C-130
 What training must a companion home provider complete after the first year of service?
 ABUSE AND NEGLECT REPORTING
 388-829C-140
 Are companion home providers mandatory reporters?
 388-829C-150
 How must companion home providers report abuse and neglect?
 HEALTH CARE AND MEDICATIONS
 388-829C-160
 What health care assistance must a companion home provide a client?
 388-829C-170
 How may a companion home provider assist a client with medications?
 388-829C-180
 What is required for a companion home provider to administer medications and provide delegated nursing tasks?


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                                                                                        Companion Homes (continued)

388-829C-190
What is required for a companion home provider to perform nursing tasks under the registered nurse delegation
program?
388-829C-200
When must a companion home provider become delegated to perform nursing tasks?
388-829C-210
What records must the companion home provider keep regarding registered nurse delegation?
INDIVIDUAL SUPPORT PLAN
388-829C-220
What is an individual support plan (ISP)?
RESPITE
388-829C-230
Are companion home clients eligible to receive respite?
388-829C-240
Where may respite care be provided?
TRANSPORTATION
388-829C-250
Are companion home providers responsible to transport a client?
388-829C-260
What requirements must be met before a companion home provider transports a client?
MANAGEMENT OF CLIENT FUNDS
388-829C-270
May a companion home provider manage a client's funds?
388-829C-280
What are the companion home provider's responsibilities when managing client funds?
388-829C-290
What happens if a companion home provider mismanages a client's funds?
388-829C-300
What documents must companion home providers keep to protect a client's financial interests?
388-829C-310
Must clients pay for room and board in the companion home?
SAFETY
388-829C-320
What physical and safety requirements exist for companion homes?
388-829C-330
How must companion home providers regulate the water temperature at their residence?
PROVIDER RECORDS
388-829C-340
What information must companion home providers keep in their records?
388-829C-350
What written reports must be submitted to DDD?
388-829C-360
What are the requirements for record entries?
388-829C-370
Must a companion home provider document a client's refusal to participate in services?
388-829C-380
Must companion home providers keep client's property records?
388-829C-390
Are clients' records considered confidential



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                                                                                          Companion Homes (continued)

388-829C-400
How long must a companion home provider keep client records?
EMERGENCY PLANNING
388-829C-410
What must companion home providers do when emergencies occur?
EVALUATION OF COMPANION HOMES
388-829C-420
How must DDD monitor and provide oversight for companion home services?
388-829C-430
How often must the companion home be evaluated?
388-829C-440
How must the companion home provider participate in the evaluation process?
388-829C-445
What occurs during the review and evaluation process?
388-829C-450
What happens if the companion home provider is found to be out of compliance?
TERMINATION AND DENIAL OF A COMPANION HOME CONTRACT
388-829C-460
When may DDD stop the authorization for payment or terminate a contract for companion home services?
388-829C-470
When may DDD deny the client's choice of a companion home provider?
388-829C-480
What if the companion home provider no longer wants to provide services to a client?
APPEAL RIGHTS
388-829C-490
What are the client's appeal rights if DDD denies, or terminates a companion home services contract?
388-829C-500
Does the provider of companion home services have a right to an administrative hearing?


388-829C-005
What is the purpose of this chapter?
 This chapter establishes rules governing the division of developmental disabilities (DDD) companion home
residential services program per chapter 71A.12 RCW for eligible clients of the division.
[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-005, filed
7/31/07, effective 9/1/07.]


388-829C-010
What definitions apply to this chapter?
 The following definitions apply to this chapter:
   "ADSA" means the aging and disability services administration within DSHS and its employees and authorized
agents.
   "Adult protective services" or "APS" means the investigative body designated by ADSA to investigate
suspected cases of abandonment, abuse, financial exploitation and neglect as defined in 74.34 RCW.
   "Calendar year" means the twelve month period that runs from January 1 through December 31.
   "Case manager" means the DDD case resource manager or social worker assigned to a client.




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                                                                                             Companion Homes (continued)

 "Competence" means the capacity to do what one needs and wants to do. There are two ways to be competent. A
person may be self-reliant and able to do things for themselves or may have the power to identify and obtain the
help needed from others.
    "DDD" or "the division" means the division of developmental disabilities, a division within the DSHS aging
and disabilities services administration, of the department of social and health services.
    "DDD specialty training" means department approved curriculum to provide information and instruction to
meet the special needs of people with developmental disabilities.
    "DSHS" or "the department" means the state of Washington department of social and health services and its
employees and authorized agents.
    "Health and safety" means clients should live safely in environments common to other citizens with
reasonable supports offered to simultaneously protect their health and safety while promoting community inclusion
    "Individual support plan" or "ISP" is a document that authorizes and identifies the DDD paid services that
meet a client's assessed needs.
    "Integration" means clients being present and actively participating in the community using the same resources
and doing the same activities as other citizens.
    "Mandatory reporter" means any person working with vulnerable adults required by law to report incidents of
abandonment, abuse, neglect, financial exploitation, etc., per chapter 74.34 RCW.
    "NA-R" means nursing assistant-registered under chapter 18.88A RCW.
    "NA-C" means nursing assistant-certified under chapter 18.88A RCW.
    "Positive recognition by self and others" means a client being offered assistance in ways which promote the
client's status and creditability. Providers offer assistance in ways that are appropriate to the age of the client,
typical to other members of the community and contribute to the client's feelings of self worth and positive regard
by others.
    "Positive relationships" means clients having friends and family that offer essential support and protection.
Friends and family lend continuity and meaning through life and open the way to new opportunities and
experiences.
    "Power and choice" means clients experiencing power, control and ownership of personal affairs. Expression
of personal power and choice are essential elements in the lives of people. Such expressions help people gain
autonomy, become self-governing and pursue their own interests and goals.
    "Registered nurse delegation" means the process by which a registered nurse transfers the performance of
selected nursing tasks to a registered or certified nursing assistant in selected situations. (For detailed information,
please refer to chapter 18.79 RCW and WAC 388-840-910 through388-840-970 .)
    "Regulation" means any federal, state, or local law, rule, ordinance or policy.
    "Respite" means care that is intended to provide short-term intermittent relief for persons providing care for
companion home clients.
    "RCW" means the Revised Code of Washington, which contains all laws governing the state of Washington.
    "Service episode record" or "SER" means documentation by DDD of all client related contacts including
contacts during the assessment, service plan, coordination and monitoring of care and termination of services.
    "Unusual incidents" means a change in circumstances or events that concern a client's safety or well-being.
Examples include, an increased frequency, intensity, or duration of any medical conditions, adverse reactions to
medication, hospitalization, death, severe behavioral incidents, severe injury, running away, physical or verbal
abuse to themselves or others.
    "WAC" means the Washington Administrative Code, which contains the rules for administering the state laws
(RCW).

[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-010, filed
7/31/07, effective 9/1/07.]




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                                                                                         Companion Homes (continued)

388-829C-020
What are companion home residential services?
   (1) A companion home is a DDD residential service offered in the provider's home to no more than one client.
   (2) Companion home residential services provide twenty-four hour instruction and support services.
   (3) Companion home residential services are based on the client's ISP.
   (4) Companion home residential services are provided by an independent contractor.



[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-020, filed
7/31/07, effective 9/1/07.]

388-829C-030
Who may receive companion home residential services?
 Clients who may receive companion home residential services must:

     (1) Be at least eighteen years old;
     (2) Have an assessed need for companion home services; and
     (3) Meet one of the following conditions:
          (a) Be authorized by DDD to receive companion home residential services, as outlined in this chapter; or
         (b) Have a written agreement with the provider to purchase companion home residential services using the
 client's own personal financial resources.

 [Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-030, filed
 7/31/07, effective 9/1/07.]

388-829C-040
Who is eligible to contract with DDD to provide companion home residential services?
 To be eligible to contract with DDD to provide companion home residential services, a person must:

   (1) Be twenty-one years of age or older;
   (2) Have a high school diploma or GED;
   (3) Clear a background check conducted by DSHS as required by RCW 43.20A710;
   (4) Have an FBI fingerprint-based background check as required by RCW 43.20A.710, if the person has not
lived in the state continuously for the previous three years;
   (5) Have a business ID number, as an independent contractor; and
   (6) Meet the minimum skills and abilities described in WAC 388-829C-080.

[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-040, filed
7/31/07, effective 9/1/07.]

388-829C-050
Who may not provide companion home residential services?
 DDD may not contract with any of the following to provide companion home residential services:

   (1) The client's spouse.
   (2) The client's natural, step, or adoptive parents.
   (3) The client's court-appointed legal representative.
   (4) Any person providing department paid services to any other DSHS client.



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                                                                                          Companion Homes (continued)

[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-050, filed
7/31/07, effective 9/1/07.]

388-829C-060
Where are companion home residential services provided?
 (1) Companion home residential services are offered to clients living in the provider's home.
 (2) The provider's home must be approved by DDD, to assure client health, safety, and well-being consistent with
the requirements in this chapter.

[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-060, filed
7/31/07, effective 9/1/07.]

388-829C-070
Who must have a background check in the companion home?
 (1) All individuals living in the household, except the client, must have a current DSHS background check if they:
        (a) Are at least sixteen years old; and
        (b) Reside in the companion home.

   (2) Household residents who have not lived in Washington continuously for the previous three years must also
have an FBI fingerprint-based background check as required by RCW 43.20A.710.
   (3) Background checks must be completed every two years or more frequently when requested by the
department.

[Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title 71A RCW. 07-16-102, § 388-829C-070, filed
7/31/07, effective 9/1/07.]




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Attachment #5
                                                  KARISTAD

                                                 Shared Living
    In July 1989, the Sellars family purchased a large second home nearby in the Maple Leaf neighborhood in
 Seattle and moved into it with their daughter, Kari, age 21.Their intent was to establish a shared living
 arrangement within the financial resources of the residents. Their employment, SSI, or Social Security would
 cover their room and board and persona needs without requiring any financial subsidy from their families.
 What had attracted the Sellars was that the house was modern construction, three storey, 4500 sq-ft, with 7
 bedrooms and 5 baths, a large dining room, 3 common rooms and was located near the University of
 Washington on a major metro line with a stop near the front door.
    During 1993 the intentionally inclusive ―mix‖ of home sharers stabilized and parents Bill and Kathy moved
 back into their original home. Since then Kari has shared her home with a succession of housemates and care
 providers. In the last eight years only one housemate has changed. Presently, three women and two men share
 Karistad. There have been only 4 different care providers, the current on, Janet, having also been the second.
 All care providers were located through family and close friend contacts. Each took the training required for
 state compliance. The benefits were mutual in that originally the care provider received free room and board in
 exchange for on-site property management and , as mentioned, Karistad is near the University. The residents
 require more guidance than control.
    The layout of Karistad allows the care provider to have private space, essentially an apartment, thou not
 permanently separated from the rest of the house. Since the present care provider lives in her own home
 nearby, the ―apartment‖ is occupied by the sister of one of the residents who provides an overnight presence
 and back-up when the care provider is on vacation.
    The care provider contracts with DSHS to provide Medicaid Personal Care and Waiver services to the
 residents. In addition to the individual help authorized by the individual assessments, the care provider sets up
 schedules for dinner preparation, dishes, laundry and general house cleaning. Dinner is the only common
 meals, since each person‘s work schedule is different, and is the social highlight of each day. Each person
 prepares their individual breakfasts and lunches to suit. The care provider arrives every afternoon to prepare
 the evening meal, with resident assistance, and provide whatever assistance each resident needs.
    Over the years the housemates have developed into a mutual support network; evenings frequently include
 reading aloud, playing cards, knitting, taking busses or sharing a taxi to classes, meetings or social events.
 Involvement in sports is encouraged and presently all participate in one or more Special Olympics
 competitions such as swimming, skiing, baseball, bowling or track and field. All the residents maintain their
 relationships with their families by rarely sleep away from Karistad unless on a trip, and all love to travel.
    The attached cost accounting is from 1999 and 2000 to illustrate the typical incomes and expenses of
 Karistad. The cost to operate Karistad was covered by the month rent of $450 from each resident, which
 included $100 for food and consumables. Kathy Sellars does the shopping and financial management of the
 house. She can be credited for keeping the cost of food and consumables constant for 13 years, plus
 maintaining a good and healthy diet for the residents.
   Karistad, up until two years ago, received no state funding, housing subsidy or tax break and was a privately
 operated entity that was neither a group home, adult family home, or licensed facility. Regular inspection is
 provided by the Division of Developmental Disabilities (DDD), related to the Medicaid Personal Care.

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                                                                                               Karistad (continued)

We have the strong support of DDD because of the high level of support, the independence of the residents
and the much lower cost to the state. Karistad has been a model for independent living for individuals who do
not require 24 hour supervision and are employed or have a regular out of home activity. The rules to live at
Karistad are attached and are very simple. The size of Karistad has minimized conflict because there is a
private space for each resident, five bathrooms, and three large common areas for shared activities.
   Why should there be any changed to such a successful Program? Bill and Kathy are getting older, have sold
their own house and have helped develop an intentional community cohousing facility where they now live.
  For any interested in the cohousing residential model, we can talk later about the inclusion of three young
men with developmental disabilities who share one of the 27 townhouses in Jackson Place Cohousing.
   Seven year ago, Bill and Kathy started transferring ownership of Karistad to Parkview Services, a local
non-profit which acquires local residences and rents them to individuals with developmental disabilities or
agencies that provide residential support programs. Because of the time required to pay off the mortgage, and
the desirability of having each year‘s charitable gift an amount deductible from our annual income, the transfer
was structured as five yearly portions. This was completed in December of 2004.
    Parkview has taken on a new role, to help individuals with developmental disabilities become home
owners. They provide workshops and training about available resources and encourage individuals to establish
utility and other accounts in their own names, requirements to obtain mortgages.
   Kari is preparing for future condo ownership by putting extra SS money into a special needs trust and
contributing to her 401 K retirement plan. We are keeping our eyes open for a condo in a suitable
neighborhood near her work and church.
    The residents of Karistad have now qualified for Section 8 rental subsidies. This does not basically change
the amount of rent but does allow Parkview to establish maintenance and replacement reserves, such as
roofing replacement, that were discontinued during the transfer period. Karistad has no mortgage and because
it is a non-profit, pays no property taxes. The residents, Bill and Kathy and Parkview Services have all
benefited from the transfer. The families of the residents are becoming more involved in the tenants
relationship and activities of Parkview Services.
    Are things different for Bill and Kathy? Last year Bill and Kathy took the month of September to lease a
villa in Tuscany.

Bill and Kathy Sellars

812 Hiawatha Place S.

Seattle, WA 98144



206-522-3099




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Attachment #6




                                         Life Enrichment Options

                               Employment  Housing  Community  Recreation

                           “A quality life for th ose with developmental disabilities”

 May 12, 2011

 Life Enrichment Options (LEO) is a parent based, grass roots 501c3 non profit organization seeking
 innovative solutions for local housing for people with developmental disabilities as well as creating a
 community in which their personal goals can be achieved.

 In the greater Issaquah/North Bend area there are 68 adults with developmental disabilities over age 21,
 living with their parents. There are approximately 225 students in the Issaquah and Snoqualmie Valley
 School Districts special education programs, who may need assistance with independent living in future
 years. Like all other adults, most aspire to live as independently as possible, away from their family
 home, but in the community where they are connected and feel most comfortable. The parents of children
 with developmental disabilities know as they age, it will become increasingly difficult to provide the care
 and supervision that is necessary for their adult children. Compounding this situation is the lack of State
 supported housing for this population.

 The last State funded group home for adults with developmental disabilities was built in 1986. Today, the
 State provides housing only for those in a crisis situation. Consequently, current non-crisis needs are not
 met. To help fulfill this need in the greater Issaquah/North Bend area, the LEO organization has
 established the goal of starting several Adult Family Homes to provide a safe, affordable, long-term
 housing solution for adults with developmental disabilities.

 The purpose of our housing program is to provide supported living to adults with developmental
 disabilities. LEO has developed a successful model to help adults with developmental disabilities become
 self reliant and realize their full potential for independence. In February 2003, we opened the first Adult
 Family Home for these individuals in Issaquah, the Rose House. This home was made possible through
 the collaborative efforts of LEO, Polygon Northwest Company, the City of Issaquah, and the Issaquah
 School District. Many subcontractors donated their time and/or materials to this project in coordination
 with Polygon. The LEO organization has an agreement with the City, protecting this property for 50
 years as a home for people with developmental disabilities. In 2006, we purchased and opened our second
 home, the Ann House. This was a surplus house we purchased from King County, all with private
 funding.

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                                                                                               Leo (continued)



This past year, we have been fund raising for house #3, which will be started June 1,2011. This home will
be located in the Issaquah Highlands, where we helped them meet their low income homes quota. Again
this is being accomplished with all private donations, and as the others, will be debt free.
The Rose House, and the Ann House is home to ten individuals with varying degrees of developmental
disabilities. The live-in care providers are the essence to the success of these homes. Each week LEO
receives calls from either a desperate parent, case manager, or the State agency looking for a home for an
adult with developmental disabilities. Currently, we have a waiting list of 20 people for another home,
just from the greater Issaquah/North Bend area.

The LEO organization owns these homes, and leases them to the care providers who are licensed to run an
Adult Family Home for persons with developmental disabilities. Each resident has a plan of care
developed between the case managers, parents and care provider before the resident moves in. In this
plan, goals are identified to assist the individual in achieving the highest degree of independence that is
possible. Residents are encouraged to have some employment or day program. All of them are involved
with some of the recreational activities at the Community Center. We carefully chose our care providers
to create a safe, caring, and stimulating environment for five individuals. As part of being licensed,
extensive trainings are required by the State. The State in turn provides additional oversight of the well-
being of the residents.

Since the opening of these homes, it has been heartwarming to see the smiles of the ten adult residents, as
they live for the first time away from their families, building self-reliance and gaining confidence. This
scene is the driving force for the LEO organization to start the next home, so others on our waiting list
will have this opportunity towards independence.




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Attachment #7
                               Cluster Care Implementation Procedures


                                               September 29, 1999

                                       MB-AASA-AAA/HCS/RCS/DDD-99-53

                                            MANAGEMENT BULLETIN


                             TO:         Area Agency on Aging (AAA) Directors
                           Home and Community Services (HCS) Regional Administrators

 SUBJECT: CLUSTER CARE IMPLEMENTATION PROCEDURES – PILOT PROJECT

 Background:
 AASA, AAA‘s and home care providers have studied cluster care service delivery models in New York,
 Massachusetts and Maine. Study results from these states led AASA to pilot cluster care projects in our own state.
 A steering committee made up of AAA, HCS, AASA, home care agency providers and housing providers
 developed a framework for implementing cluster care pilot projects. Each AAA with interest in implementing a
 pilot project is expected to use this framework to evaluate the potential for implementing cluster care projects with
 their subcontracted home care agencies. AASA is expecting four or five projects to develop in various parts of the
 state.

 Cluster Care Service Definition:
 ―Cluster Care‖ offers personal care services to a group of Medicaid clients who live near each other. The services
 are provided by a coordinated team of home care agency aides. The home care agency prepares a work schedule
 for the team of aides to follow each week. The schedule must be designed in a way that personal care tasks are
 provided for each client, achieves maximum efficiency of worker time and provides flexibility to accommodate
 client choice. This schedule might include having one or more home care aides assigned to a client and may allow
 certain tasks to be grouped together such as shopping, laundry and transportation needs. This work schedule must
 meet the personal care needs required by each cluster care pilot client. The team of home care aides is also
 expected to be accessible throughout their scheduled work shift to perform unscheduled tasks for cluster care pilot
 clients as needed.

 Evaluation:
 In the cluster care pilot projects, AASA will evaluate the components of service delivery to see if the pilot can
 achieve the following objectives:
       Increase access to home care services
       Maintain or reduce home care costs
       Prevent more costly, higher level care
       Increase client satisfaction
       Increase service efficiency
       Increase home care aide availability
       Reduce home care aide turnover
       Develop a payment rate based on managed care principles

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                                                                                                  Cluster Care (continued)

Coordination:

The AAA‘s that wish to develop pilot projects are responsible for coordinating the development of cluster care pilot
projects with local stakeholder providers. Prior to implementation, AASA will review each cluster care project
proposal.

IMPLEMENTATION PROCEDURES:

The implementation procedures outlined below are intended to guide AAA and HCS offices in developing and
implementing cluster care pilot projects in their local service areas.

    Aging and Adult Services Administration (AASA) will:

1. Pay the AAA a monthly payment rate up to ninety percent (90%) of the assessed personal care hours for each
   cluster care client. AAA will set the actual percentage rate, based on cost estimates, and will inform AASA of
   the percentage rate established. The cluster care payment rate negotiated between the AAA and the home care
   agency it contracts with may be the same (90%) or less than the established payment rate between AASA and
   AAA.


        For example, if the negotiated cluster care payment rate is 90 percent and the client is assessed for 60
        personal care hours on their CA; AASA will pay the AAA $646.38 per month using the following payment
        rate calculations:

                60 personal care hours multiplied by .90 (90% percent) = 54 cluster care hours
                54 hours * multiplied by the AAA contracted Home Care agency hourly rate
                54 hours multiplied by ($11.97 example only) = $646.38 per month
                ( * Round down if the decimal is .1 -. 4 hrs; round up if the decimal is .5 -.9 hrs.)

2. Make monthly payments to the AAA using the new cluster care SSPS codes 4580 MPC or 5280 COPES. AAA
   will receive a monthly SSPS report showing the cluster care service authorizations. (See attached SSPS
   codes.)



3. Provide pre- mid- and ending-point supplemental assessment instruments. The instrument will be used by the
   AAA case manager/aide to gather client baseline data and document client satisfaction information at the pre-,
   mid-, and ending-point of the pilot project. (Supplemental assessment instruments available upon request.)


4. Provide a report showing the percentage of personal care hours utilized for the state and county in which the
   cluster care pilot site will operate.


5. Evaluate the development of a cluster care rate structure based on information provided from the pilots




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                                                                                                    Cluster Care (continued)

     Area Agency on Aging (AAA) will:

1.   Negotiate cluster care pilot projects based on the following program criteria:

            Cluster care clients must meet MPC or COPES program eligibility.
            Cluster care pilot contract cannot exceed 12 months unless amended for an additional period by mutual
             agreement.
            Client participation in the pilot is voluntary.
            Clients may terminate their involvement in the pilot at any point by requesting authorization of their
             previous service plan.
            Any party may terminate the pilot within 30 days notice.

2.   Develop an estimated budget that includes case management costs for the cluster care pilot project if costs are
     estimated to be greater than those under the traditional home care model.

3.   Subcontract with a home care agency to provide cluster care services in the cluster care pilot site.

4.   Negotiate a payment rate with their subcontracted home care agency based on actual cost estimates. The
     payment rate may not exceed ninety percent (90%) of the assessed personal care hours for each cluster care
     client. Clearly state in the subcontract any criteria used to lower or increase the payment rate. Also include
     any scheduled review periods when the payment rate may be re-negotiated.

5.   Approve the proposed subcontracted home care agency‘s cluster care staffing plan and the approach they
     intend to use to facilitate initial and subsequent meetings with clients to discuss the benefits of cluster care
     services.

6.   Submit the home care agency subcontract, cluster care staffing plan and pilot budget to AASA prior to
     implementation.

7.   Include in the subcontract with their home care agency the following items:

            The negotiated cluster care payment rate, billing procedures, criteria for adjusting the payment rate and
             any scheduled review dates.
            The reporting requirements, including due dates and list of individuals who are to receive the following
             reports:

                Monthly Home Care Task Report showing the cluster care hours worked and the description of the
                 daily tasks performed for each pilot client.
                Monthly Indirect Service Report showing the indirect client time worked by home care assistants.
                 These hours are the difference between time available in the building and time spent performing
                 tasks for clients. Examples of this time might include training, coordination with other assistants in
                 the building about coverage and scheduling issues, etc.
                Monthly Cost Report showing the average monthly cluster care costs expended to operate the pilot
                 site. (See description of Cost Report items listed in item 9 below.)


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                                                                                                                   Cluster Care (continued)

8.   Notify the Regional HCS office as to the negotiated home care agency cluster care payment rate, services provided
     under the subcontract with the home care agency, and the name/phone number of the AAA case manager assigned
     to the cluster care pilot project.

9.   Ensure that AASA receives a copy of the following monthly reports. Submit the reports no later than the end of
     the following month. Sample reports are available upon request.

             Monthly Home Care Task Report showing the cluster care hours worked in each month and a description
              of the daily tasks performed for each client.
             Monthly Indirect Service Report showing the indirect client time worked by home care assistants. These
              hours are the difference between time available in the building and time spent performing tasks for clients.
              Examples of this time might include training, coordination with other assistants in the building about
              coverage and scheduling issues, etc.
             Monthly log documenting instances where traditional home care services may not have been enough to
              keep client in own home, but increased access to care under a cluster care concept allowed client to stay in
              own home. The report will be submitted at the end of each quarter. The report will include the following:
               Client name
               Date client authorized for cluster care services
               Date client began having needs that could no longer be met by traditional home care, if different from
                   start date
               Brief description of the situation, including why cluster care services enabled client to remain
                   independent in own home
               Date client was terminated from cluster care or improved to point where alternate placement was no
                   longer considered.
             Monthly Cost Report showing the average monthly cluster care costs expended to operate the pilot site.
              The report will include the following:
               Personnel (aide & supervisor) hourly/salary expenses
               # of employees funded at the pilot site
               Benefits
               Travel
               Advertising
               Average turnover of employees at the pilot site
               Training
               Telephone/pager systems
               Utilities/leases at the pilot site only


10. Review and analyze the home care agency‘s cluster care Cost Reports and Home Care Task Reports.

   AAA Case Manager will:
1. Offer cluster care services to clients who are currently on either Medicaid Personal Care Services or COPES
   Services and who reside in the pilot site location.
2. Contact the home care agency subcontracted to provide cluster care services to ensure a coordinated service plan is
   developed.
Complete an SSPS form for authorizing cluster care services by using either the monthly SSPS code 4580 Medicaid Personal Care or 5280
COPES.

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                                                                                                       luster Care (continued)

3. Calculate the monthly payment rate by using the percentage rate established in the AAA/Home Care Agency
   subcontract. (For calculation instructions, see page two, AASA will: item #1.) Enter the client‘s monthly cluster
   care service payment rate on the SSPS form along with entering the number ―1‖ (one) in the monthly unit box.
   Payment for mid-month begin dates or mid-month termination dates will be prorated automatically on a daily
   basis. (See attached SSPS codes.)
4. Re-assess all cluster care pilot clients prior to implementation of the pilot. If the client has been re-assessed in the
   past 60 days or is a new client being transferred from an HCS social worker, a re-assessment if not required.
5. Administer the pre-project supplemental assessment instrument prior to implementation of the pilot. The
   assessment instrument takes approximately 10 minutes to complete and is designed to gather client baseline data
   and document client satisfaction information. Submit the pre-project assessment data to AASA within 30 days of
   administering the assessment instrument. (Pre-project supplemental assessment instrument available upon
   request.)
6. Contact each cluster care client quarterly to ensure services are being delivered and client satisfaction is being met.
   Complete a re-assessment ONLY if the client‘s care needs change significantly during the pilot period requiring a
   change in the cluster care service plan and authorization.
7. Administer, at the pilot mid-point and ending-point, the supplemental assessment instruments. Submit the mid-
   point and ending-point assessment data to AASA within 30 days of administering the assessment instrument.
   (Supplemental assessment instruments available upon request.)
8. Keep a monthly log documenting instances where traditional home care services may not have been enough to
   keep client in own home, but increased access to care under a cluster care concept allowed client to stay in own
   home. Log will be submitted to AASA at the end of each quarter. (A monthly log example is available upon
   request.)
9. Terminate the client‘s SSPS cluster care code(s) if the client is absent (social leave, hospitalizations, etc.) from
   their apartment/home for seven (7) consecutive days or more. SSPS codes may be re-opened when the client
   returns. (See example below)

        For example, if a client is hospitalized on 3/10/99 for three days, then is authorized for two weeks of nursing
        home placement, and later returns to his/her apartment, the case manager would terminate the client‘s cluster
        care SSPS authorization on the first day on which the client is gone (3/10/99) and then re-open the cluster care
        SSPS codes on the day the client returns home (3/27/99).

        For example, if a client is hospitalized on 3/10/99 for six days and then returns to his/her apartment, the case
        manager would leave the client‘s cluster care SSPS authorization open throughout the hospitalization.

    Home & Community Services (HCS) Social Worker will:

1. Offer cluster care services to new clients who are eligible for either Medicaid Personal Care Services or COPES
   Services and who reside in the pilot site location.

2. Contact the home care agency and the AAA case manager assigned to the cluster care pilot project to ensure a
   coordinated service plan is developed prior to transferring the case.

3. Complete an SSPS form authorizing cluster care services by using either the monthly SSPS code 4580 Medicaid
   Personal Care or 5280 COPES.




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                                                                                                Cluster Care (continued)

4. Calculate the monthly payment rate by using the percentage rate established in the AAA/Home Care Agency
   subcontract. (For calculation instructions, see page two, AASA will: item #1. Contact the AAA office for the
   percentage rate.) Enter the client‘s monthly cluster care service payment rate on the SSPS form along with
   entering the number ―1‖ (one) in the monthly unit box. Payment for mid-month begin dates or mid-month
   termination dates will be prorated automatically on a daily basis. (See attached SSPS codes.)

   AASA Evaluation Team will:
1. Analyze the data gathered from the cluster care pre- mid- and ending-point supplemental assessment instruments,
   client comprehensive assessments, and SSPS reports. At the end of the pilot period, AASA will prepare a final
   evaluation report of the cluster care pilot projects.

2. Review Cost Reports on an on-going basis and share significant observations with the AAA and the home care
   agency as appropriate. At the end of the pilot period, AASA‘s Home and Community Rates Section will prepare a
   final cost analysis report of the cluster care pilot projects.

3. Provide on-going pilot data and outcome evaluation reports to the AASA Continuous Quality Improvement
   Steering Committee for informational purposes.

Inquiries:     Bea Rector, Project Manager
               State Unit on Aging
               P.O. Box 45600
               Olympia, WA 98504-5600
               rectobm@dshs.wa.gov
               360/407-528

_______________________________                          __________________________
Kathy Leitch, Director                                   Denise Gaither, Director

         Home and Community Services Division Management Services Division




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Attachment #8




The Washington Initiative for Supported Employment (WiSe) is a private, non-profit organization
dedicated to expanding employment opportunities for people with developmental disabilities. Our
consultant team works intimately with private businesses, county governments, school districts, social
service providers, and families to offer the following:

      Technical Assistance
      Innovative Project Design and Demonstration
      Americans with Disabilities Act (ADA) Consulting
      Financial Systems Analysis and Design
      Information Technology Assessment
      Organizational Development and Management Coaching

As we all know, cookie-cutter solutions are rarely the best answer when facing challenges in our lives.
WiSe is committed to trying new and innovative ways to support people in their communities. One of
these projects is the My Home, My Life Family Network Project. This project focuses on the housing
needs and supports of individuals who will be leaving their family home and moving into the community
to work and live.

The My Home, My Life Family NetworkProject provides families the opportunity to connect with one
another, and learn how others have problem-solved and approached this next step in their family
member’s life. Their son or daughter may have little or no residential funding and a networking group
gives them the platform to explore this transition with other families.

In 2005 the first network group was formed in Seattle, since then the project has grown to 4 network
groups with monthly meetings across King County including Shoreline, Newcastle and Auburn. Families
requested network meetings in their own communities in order to seek out other families and individuals
who were interested in establishing households in the same geographical area.

In each location there is a parent group and a young adult group. The network meetings are pot luck,
everyone eats together and then the groups break apart for their meetings. The young adult groups are
facilitated by work study students from local universities.

When an individual prepares to move into the community WiSe offers facilitation of household plans and
provides house rules plans in order to help support the individuals to set personal boundaries and
establish shared household work and chore expectations between the housemates.

As an added layer of initial support WiSe will match a work study student to be a community mentor for
an individual who has just moved to the community. The individual, student and family will identify two
to three goals to work on together. Examples include, operating the household

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                                                                                             WiSe (continued)

appliances, knowing when to clean out the fridge, connecting to the local library, classes, church,
activities and shopping. The work study students and the individuals who are moving work in a “peer
mentoring” relationship rather than directly with the parents to develop natural relationships in the new
locations.

On a monthly basis WiSe;

      Provides the places to meet and sends out the meeting notices
      Identifies and coordinates speakers on various housing related topics that have been requested by
       both the young adult and parent groups. Here is a sampling:
     Section 8 Housing Voucher Program- King County DDD, Home Ownership and Down Payment
       Assistance programs- Parkview Services
     Panels of families who have set up their own households
     LifeSpan, Partners 4 Housing, TLC’s Community Guides
     Adult family Homes- Community Homes, LEO Group
     Relationships- Robbie Rigby of DSHS
     Red Cross disaster plans, Police and Fire Department, Home Alive (self-defense)
     Community Transportation- Bus, Light Link Rail and Train
     Public Benefits--SSI, SSDI, SSDAC and Medicaid- Scott Leonard King County DDD
     The families of the Seattle group created a “Household Operations Manual” for the use and
       benefit other families. You can download it from the WiSe web site at www.theinitiative.ws
     Disseminates information from other non-profit and government agencies that families may want
       to keep up on
The project design encourages families to start to address the issues of the move from the family home
sooner rather than later. Being pro-active will ease the transition for your son or daughter and yourself.
WiSe and our speakers encourage open discussion and questions during the presentations. Everyone in the
family and extended family are welcome to join in. Even if a move for your family member is a bit
farther down the road, the family networking meetings are a great opportunity to meet other families,
get ideas and begin the “pre-planning” process. And also to seek out possible housemate matches.

This project is supported by King County DDD.




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Attachment #9


                                                     LifeSPAN
 LifeSPAN (Lifetime Secure Personal Assistance Network) is a family directed organization that exists to
support families to develop safe and secure futures for their relatives with disabilities. LifeSPAN answers
the question asked by those who have a son or daughter with a disability ―What will happen after I am
gone?‖ For the first time in history, people with disabilities are outliving their parents. LifeSPAN addresses
this concern through establishment of personal networks designed to be in place for the lifetime of the
individual with disabilities, and by helping parents develop financial and legal plans. We believe that safety
and security and a good life are achieved through relationships, and work in the community to be sure that
the contributions of all members are received and acknowledged. This means that besides our direct work
with families, we also focus on creating healthy communities that will benefit everyone.

Our mission is a simple one: We want everyone to have a good life.

LifeSPAN is modeled after and affiliated with PLAN (Planned Lifetime Advocacy Network) of Vancouver,
British Columbia which has been in existence for over 20 years. LifeSPAN is a tax exempt 501(c)(3)
organization that has been in operation in Washington State for over 10 years.

We provide:

         Assistance with developing a Personal Future Plan for the individual with a disability. Beginning with
          the question ‗What is a good life?‘ we look at each element including friends and relationships, a
          welcoming home, financial security, having choices honored and making a contribution - and then we
          help families to create a plan to make these things happen. In our work we have learned that planning for
          the future creates peace of mind in the present.

         Ongoing facilitation of a circle of social support (Personal Network) in the life of the person with a
          disability to address isolation and create opportunities to connect into community. Personal networks are
          comprised of all kinds of people who are invited to participate through family ties, shared interests,
          church, school, work or neighborhood connections. LifeSPAN trains and provides facilitators to
          organize the networks and keep them engaged.


         Through peer mentorship we provide assistance in developing a will and estate plan, as well as locating
          information regarding special needs trusts, maintaining government benefits, home ownership and other
          housing choices, and legal guardianship options (in collaboration with professional service providers).

         Ongoing overview of the services received by the individual - particularly after their relatives are no
          longer able to meet this need.

         Our Core Values:

         Commitment to family leadership - We are structured to ensure that we will always be directed by and
          accountable to families. The majority of volunteer leaders of LifeSPAN are relatives of an individual
          with a disability.


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                                                                                                LifeSPAN (continued)

    Relationships are the key to a good life – Families know that the well being of their loved one is directly
     related to the number and quality of friends in his or her life. LifeSPAN believes that no disability
     precludes meaningful, reciprocal relationships.

    Contribution equals citizenship - People with disabilities have important contributions to make to our
     communities. LifeSPAN works to challenge all of us to recognize the contributions of individuals with
     disabilities by inviting them to participate more fully in their communities.

    Independence from government funding - Organizational self-sufficiency is necessary to monitor and
     advocate for people with disabilities when their parents or relatives are no longer able to provide support.
     Self-sufficiency requires that LifeSPAN rely on community partnerships and that LifeSPAN charge
     families a partial fee for services, thus making LifeSPAN accountable to the families served (while at the
     same time supporting individual efforts to maintain needed personal governmental support).

With regard to the State-wide housing needs assessment, LifeSPAN does currently support two networks for
people with a traumatic brain injury. In one case the network helped the family through the process of
purchasing two condos to replace the family home – one for the focus person and one for his parents, in close
proximity. Although his mother has since passed away, the arrangement continues to work well. In the other
case, the focus person was living in her own condo when her family joined LifeSPAN. The family feels that
this arrangement will not always work for her, and it is expected that the network will help find another type
of housing that will work best for her.




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Attachment #10


                                                     Paula Gage

                                     Rehab Without Walls - Lynnwood
Rehab Without Walls was started in 1988 by a group of professionals who saw a need for neuro care in the Seattle
area. The organization was called NeuroCare until it became a division of Gentiva Health Services in 1992. It was
initially developed for traumatic brain injury. They are CARF accredited in Home and Community Based
Rehabilitation. They serve all of Washington, Alaska and Portland.

They are not Medicare or Medicaid certified. Insurance doesn‘t cover home and community based rehab, although
insurance will sometimes flex benefits. Gentiva has more resources and that helps.

Staff is mostly OT, PT and Speech and some have been there10+ years. Some of them work on a per diem basis and
that gives them flexibility.

They do not have a waiting list. They serve about 15 clients at a time and about 200 clients a year and are licensed as a
home health agency.

They would be interested in starting another program is there were ways to provide more services. They are always
looking to see how they can expand their programs.

Clients are funded by private insurance, L & I, TriWest (must be active duty), Molina Medicare, and Community
Health Plan of WA (managed Medicaid). Their minimum hourly rate is $192.

As a service provider they try to align their client and family‘s needs with the payer‘s needs. The client wants to be
home as soon as possible, achieve functional gains and productive activity and they want to get better. The payer wants
to decrease costs and length of stay, decrease unnecessary continued medical costs, enhance likelihood of a durable
outcome and wants the patient to get better.




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Attachment #11




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Attachment #12




                         The Mockingbird Family Model




     The Mockingbird Family Model is an award-winning, innovative model for foster care delivery
     that offers practical, cost-effective solutions to improve the lives of our most vulnerable children
     and youth.

     The Mockingbird Family Model (MFM) is a simple, yet innovative concept which establishes a
     sense of extended family and community around the participating children, youth, and families.
     In each MFM Constellation, six to ten families (foster, kinship, foster-to-adopt, and/or birth
     families) live in close proximity to a central, licensed foster care family (Hub Home) whose role
     is to provide

           assistance in navigating systems
           peer support for children and parents
           impromptu and regularly scheduled social activities
           planned respite nearly 24/7, and crisis respite as needed

     The Mockingbird Family Model builds in the predictable resources necessary to support
     families, stabilize children, and increase opportunities for birth family reunification, adoption,
     and other permanency options.

     Parents and children no longer have to face problems alone; they can rely on the experience and
     support of an extended community of peers who understand the challenges they face each day.

     ―Being part of the Constellation has added to the enrichment of my foster children by creating
     relationships between my children and others. I feel the Constellation makes all of us better
     individuals.‖ – Mockingbird Family Model Hub Home Parent




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