Allowing people to remain in the community minimizes personal trauma for the consumer and saves valuable staff time and financial resources. Centers should advocate for expansion of Medicaid waiver programs to include a broader array of services and supports. Even minimal policy changes, such as redefining funding for home modifications and adaptive equipment, can mean the difference between remaining at home or moving to an institution. While no conclusion can be drawn about whether or not distinct services for multicultural populations are needed, it is clear that center board and staff composition should reflect the racial and ethnic mix of the consumer population. Most important multicultural issues should be considered at the program design stage, not as an afterthought.
Additional information is needed about how various populations can be served effectively.
These formerly interred individuals should be used at all levels of program design and implementation, especially in the provision of direct services and advocacy. A consumer group of nursing home residents can also be an important vehicle for obtaining consumer participation and involvement. Centers commonly stake claims for additional funding upon cost savings of community versus institutional living and should bolster these claims with accurate documentation. Many centers have stayed away from provision of highly concentrated service and the necessity of meeting medical requirements, such as a staff nurse, because these demands are believed to be antithetical to the philosophy of independent living. Most centers are not well known among hospital personnel, and many referrals are obtained after the individual has already been placed in a nursing home.