Autism Housing Adaptations: Severe Autism

For more information on housing solutions for individuals with autism, go to www.myarchway.org Also, join ARCHway at www.myarchway.ning.com

George Braddock is the founder of Creative Housing Solutions www.gbcchs.com a leading housing consultant and general contractor with a 25 year proven track record in pioneering the implementation of person-centered planning principles to more than 1,500 projects and homes for people with autism and other disabilities. He is also an ARCHway Consortium member.

This blog article is a first of many articles ARCHway will be posting that George Braddock has written in order to show you the many examples of housing adaptations and modifications for improving the quality of homes for people with autism.

ANNA’S STORY: Severe Autism

Topics Covered:

• Windows
• Backyards
• Water play/Indoors and Outside
• Fencing
• Pica: Eating Hedge Plants
• Lights
• Bathroom
• Kitchen
• Entertainment Center
• Flooring
• Privacy vs. Monitoring
• Scald Prevention

Vigilance and Duct Tape Aren’t Enough Anymore

In 1997 Anna’s parents wrote to us in desperation. Anna was “getting bigger, stronger and quicker, doing things she couldn’t do before”. She was breaking the windows. “Anna has an intense interest in moving water and her powerful need for constant access to water to calm herself is creating serious health and safety issues. She turns on faucets full blast and plays in the water damaging the building and stressing her family.”
It is important to access the whole-person in the context of their environment before you design.

What the professionals told us:

• Anna experiences Autism at a severe level further complicated by enormous sensory processing problems making Anna one of the most challenging children they have encountered.
• Anna is constantly bombarded by sights, sounds, sensations and information that her brain cannot process. The filters and sorters in her brain just don’t work properly.
• Ordinary activities such as eating, sleeping and sitting down are a constant struggle for Anna.
We learned from Anna:
• She needs a home where she can do the things she likes to do without negative consequences.
• She needs a home that makes sense to her and where she is safe.
• Her home must be durable and withstand her “testing the strength of its materials”.
• She wants/needs a home where she can be in control and make choices.
• She needs a home where there are interesting things to do outside and inside that support her love of water and movement.
• Change and surprises are very difficult for Anna/
Anna’s Family Needs a Home:
• Where we can really enjoy Anna without constant intervention and re-direction.
• That will enable our family to remain together in our family home.
• That will keep everyone safe.
• That will allow Anna to safely use the bathroom the way she wants without harm or damage.
• That will provide Anna choices in preferred activities inside and outside the home.
• That is easily modified and adaptable to our family’s changing interests, abilities, needs and lifestyle.


PROJECT GOAL: A safe and sound family home where supports can be always aware of Anna’s activities and whereabouts to help her stay safe. The home needs to be a place where she can do the things she enjoys and learn new skills without hurting herself or others or damaging the building.

Disability is a consequence of the wrong environment.

Windows

Our work began with the most pressing health and safety concerns. Anna was banging on the large single-glazed picture window in the living room and kicking the window next to her bed. Anna had already broken other windows. The family had put up plexi-glass but it made their home “feel like a battle zone”.

New 3/8 inch tempered glass

Lexan installed over the existing window

Plexi-glass, Lexan or other poly-carbonate materials will protect glass from breakage. However, it scratches easily and discolors over time. More importantly, it makes the home “feel like a war zone”.
The sliding glass door and other targeted windows in the house were replaced with tempered glass.




Tempered glass is extremely strong. If it is broken it disintegrates into hundreds of small harmless pieces. Typically ¼ inch glass is placed on the inside and 1/8 inch glass laminated to the outside; this will withstand most heavy abuse. If a person uses tools or has significant head banging or kicking behaviors, 3/8 inch glass can be installed which will withstand extreme testing.





A window was added in the dining room to provide a view to the back yard. It is critical that Anna’s whereabouts and activities are known so that she can remain safe.

It is important to support the needs of the individual and their caregivers.

Backyard

Anna loves to be active in her backyard. She particularly loves running water and the stimulation of swinging. At first a standard backyard swing was adequate. But over time she out-grew it but not her love for the vestibular stimulation it provides. A new appropriate swing was required.




Anna’s fascination with running water was damaging the backyard and undermining the foundation of the house. The watering “square” and a drainage system were installed to collect and route water away from the house. Anna could do the things she loved to do without harming anyone or damaging the house.




The needs and lifestyle of a person with disabilities changes over time.

Fencing

A large Arborvitae provides protection and privacy in the backyard. Unfortunately it is poisonous and can cause seizures if ingested. By installing a coloured wire fence inside the hedge line the privacy afforded by the hedge was preserved.

Anna is all wrapped up in the fabric the family had installed to keep her from eating the hedge.




Safeguarding the reputation of a person with disability is paramount.

Lights

Standard glass ceiling globes were easily broken by balls and other flying objects. These were replaced with wire protected lenses or recessed cans.



Health and safety is improved for everyone in this simple, cost effective modification.

The Bathroom

“Anna’s water play, incontinence and perpetual motion is destroying our bathroom and creating constant stress.”



• Because Anna likes to take 5-10 baths each day, the bathroom floor is always wet and slippery. We use 25-30 towels to mop up excessive water each day.
• Anna pounds on the window and the mirror.
• “Anna is bigger, stronger and quicker. She turns the faucet on full-blast. She gets upset when we run out of hot water.
• “We are afraid Anna will get scalded. We are afraid to leave her alone in the bathroom.”
• Standing water is unsanitary and a slip-hazard.
• “Anna jumps vigorously in and out of the tub.”
• “We have no place to store wet items or bath toys. The existing two-sink vanity is impractical.”



Anna spends many hours each day in the bathroom in intense water play, a source of tremendous stress on her family and damaging to the physical structure of the house. Based on an evaluation of the space, Anna’s desires and her family’s needs, a remodel plan was developed to improve the layout and technical performance of the bathroom. Grab bars, impervious materials, heated surfaces, improved lighting, durable fixtures and other elements were introduced.




New Vanity and Tub/ Shower


Radiant heat mat under the tile keeps the floor warm and helps it to dry faster.

Floor drain eliminates need for 25-30 towels to mop up excessive water after every bath




•Old toilet area is now a place to store wet items
•Tempered glass mirror


Basket provides place to store wet toys. Window with 3/8” tempered glass


Anna will not use the existing toilet.
The space is cramped making it difficult to assist.
There needs to be additional room around the toilet.
It needs to support a toileting ritual that makes sense for her.
The space needs to be inviting and comfortable for Anna.



The new toilet location provides adequate room to assist.
It is bright and inviting.
The area is warmed by the floor heat.
Tile surfaces are easily cleaned and sanitized.
Shelves support use of picture schedules.



The evaluation of the completed project and its effect on Anna’s life shows that she can now do what she clearly enjoys without negative consequences. Safety is improved, damage to the building is minimized and her family experiences significantly less stress and more freedom because they spend less time doing intensive supervision and clean-up. Anna has exhibited a reduction in behavioral episodes because she experiences more choice, control and independence in her life.

The Kitchen

The kitchen in Anna’s home has always been the center of activity. When she was little she had to have the water running near-by in order to eat her food. When she was not in the bathroom or outside playing with water, she was at the kitchen sink.



“Anna’s water activities at the sink have caused significant damage to wood, walls, sheetrock, countertops and cabinets.” Dry rot has and will continue to occur.

Plastic installed to protect walls and countertops detracted from the feeling of home.



New post-form laminate countertop and cast iron sink with heavy duty faucet supported Anna’s use of the kitchen without damage.




over time Anna has developed a love of cooking, she is an expert at pouring and measuring liquids “she never spills a drop”.



A supportive physical environment promotes individual independence and empowerment.


Entertainment Center

Anna needs a water proof entertainment center because she will fill her mouth with water and will spit on the TV when she is upset. There were six water-logged televisions in the garage.

Anna’s bedroom is her ‘safe place’. The TV and VCR are her favorite ‘comforting things’. Her large photo albums, favorite tapes, story books and beads need to be in her bedroom.



The entertainment center has a water-proof, lockable area for the TV. Vent holes were drilled to prevent over-heating; speakers were installed in the ceiling, to keep the sound from disturbing her brother next door. The unit was inset in the wall to save floor space and ensure a solid connection to the framing. Space was provided for her favorite things closer to the floor.




Over time Anna gained more experience and developed the capacity to use her TV without assistance. With more control came more opportunities. She no longer needs a locked cabinet in her room and freely uses the entertainment center in the family room.


Flooring

Although carpeting is ‘home like’, even the best of it is difficult to keep clean or sanitize. Anna “has toileting accidents, food spills and then there is always the water”. The biggest issue is in the bedroom, her sleeping and leisure space. We need to be able to clean and deodorize this environment easily.




The carpet was replaced with a commercial grade vinyl. The material was coved up the walls to protect the edges from water. Throw rugs that can be simply picked up and laundered as needed help to soften the look of the vinyl floor coverings.


Privacy Versus Peace of Mind



When Anna was in her safe place, her family needed to know if she was okay or needed their help to stay safe. When they opened the door to check on her, the interruption would trigger an immediate change in whatever she was doing often for the worse.

After much discussion of privacy versus peace of mind a wide angle door viewer was installed that enabled the family to look in on Anna without disturbing her.


Scald Prevention

Because Anna was able to turn the faucets on “full blast” by herself scald prevention became a concern. We installed a whole house tempering valve on the hot water heater that prevents hot water from being delivered at a dangerous temperature.

Adults with Autism Need a Good Quality of Life

Adults with Autism Need a Good Quality of Life

For those interested in exploring quality of life issues fully, go to our website at www.myarchway.org and Join ARCHway. Also go to our social networking site at www.myarchway.ning.com

Below, a parent of a teenager with autism gives a very detailed and excellant description in simple, every day terms of quality of life factors that contribute to a very good life for people on the autism spectrum.

This article is taken fully from: An Alternative View on Outcome in Autism – Written by Lisa Ruble and Nancy Dalrymple, Focus on Autism & Other Developmental Disabilities, Spring, 1996. Vol 11, Issue 1. For full article, go to: http://www.starautism.louisville.edu/images/pdf/rubleanddalrymple1996.pd...

A person with autism should participate in activities with family members or close friends (e.g., travel, eat out, shop, favorite games or activities, church, dinners). Included in family/close friends’ events and passages (e.g., holiday gatherings, weddings, funerals, births, birthday celebrations, illnesses and accidents). Contact with family members and friends as frequently as desired (e.g., make and receive phone calls, write and receive letters, send and receive cards, visits, invitations.)

A person with autism should be active and comfortable in familiar community:

Ride transportation, walk, ride with family or friend, ride bike;
Shop for groceries, clothes, gifts, cards, crafts, needed equipment, personal
Choose movies, videos, places to eat out, ordering in;
Go to special events: sports, circus, shows, movies concerts;
Participate in the YMCA, bike club, or other interest or philanthropic clubs.
A person with autism should work at a valued job to earn money:

Like job and feel good about doing it;
Supported by people on the job;
Can do job competently; know performance is good.
A person with autism should enjoy good health and wellness through proper nutrition, awareness of weight management, and access to appropriate medications when and if needed.

A person with autism should have own special possessions and personal space to keep as desired and has time and space to be alone when desired.

A person with autism should makes choices about purchases and manages own money to the greatest extent possible.

A person with autism should receive enough information to make valid choices and not have to refuse them because of lack or information, lack of experience, or lack of support.

Autism Housing: What are the Options?

Here we provide a description of the types of of group homes, supportive living, supervised living, farmstead programs, community living options, family teaching model, cooperatives, shared housing and other residential models. For a state by state listing of group homes and residential service providers, go to www.myarchway.org and to talk with other parents who want to discuss this topic, go to www.myarchway.ning.com

Supported Living: Provides residential services to adults with developmental disabilities who are able to live in self-owned or leased homes in the community. Programming and instruction are directed by the consumer, not the program. Much emphasis in on community integration. Staff may help with some assistance in daily living. Supported living models may be more suited for individual with an established repertoire of life skills and those who do not engage in significant levels of challenging behavior.

Supervised Living: A residential model designed to provide services with greater oversight and direction than might be provided in a supported living context, but less than a group home. Homes may be self-owned or leased, usually with one or two adults with ASD per residence, there may be a number of such residences scattered though out the building or housing complex, allowing for greater staff accessibility oversight. Crisis support is available 24 hours/day. Daily schedules are generally provided, with input from the individual consumer, and staff is available to provide direct instruction or support.

Group Homes: Provides residential services in more typical homes in the community setting. Ownership of the house usually lies with the provider agency, as do staffing decisions. Most have fewer than 6-8 consumers living in one residence and in most states, there is a recent trend where developmental disabilities service systems will not provide funding support for group homes who house more than, three-four consumers. A primary goal of group home living is to promote increasingly greater levels of independence in the residents. Instruction is provided in daily living and self help skills including meal preparation, laundry, housecleaning, home maintenance, money management, hygiene, and showering, dressing and appropriate social interactions are provided by agency staff. Staff may be trained in behavior management interventions.

Farmstead Program: A residential model set within the context of a working farm. While isolated by nature farmstead programs endeavor to meet the complex needs of adults with ASD and other developmental disabilities through the development of individually designed instructional programs focused on farm living. Vocational training is generally limited to farm-related work (e.g., horticulture, greenhouse management, woodworking, animal care, landscaping, etc.) although other opportunities may be available in nearby communities. Residents work along with staff at tasks relevant to the care and maintenance of the grounds and the farm. There is often little in the way of community integration or community based-instruction and life skill instruction is generally provided relevant only to those skills associated with life within the farmstead community. Bittersweet Farms, in Whitehouse, Ohio was the first Farmstead Program for people with ASD established in the United States and remains the most widely recognized model for this, very specific, category of residential services.

Teaching Family Model: A specialized model of group home service provision where usually a married couple lives in the house in separate quarters rent-free and provides supervision to other members of the treatment team and direct service to residents.

Shared Equity Models – Co-ops and Co-housing
There are variety of shared equity strategies such as cooperatives, to help many families take their first steps to home ownership. A cooperative (co-op) is an autonomous association of persons united voluntarily to meet their common economic, social and cultural needs and aspirations. Cooperatives are member-owned and democratically controlled enterprises. Members may unite in a cooperative for many reasons--to get services otherwise not available, to get quality supplies at the right time, to have access to markets or for other mutually beneficial reasons.

These paths can lead to home ownership opportunities for those otherwise unable to afford to buy. In exchange for this opportunity, the new homeowner agrees that when they sell in the future, they will receive only a portion of the equity appreciation. This will keep the property affordable and enable future buyers the opportunity for home ownership. Over the last few years, strategies including community land trusts and affordability restrictions related to inclusionary housing, along with cooperative housing, have substantially increased the availability of shared equity options for both developers and government policy makers to enable low- and moderate-income families to become homeowners.

The National Capital Bank: Capital Impact group has an excellent manual called Home Base: The Playbook for Cooperative Development which lays out a full understanding of the basics of cooperatives, and provides a step by step process for developing co-ops. NCP Capital Impact integrates their efforts with Community Development Corporations and Community Based Organizations, government agencies, investors and foundations. Their mission is pulling together private and public resources to fully leverage resources for the communities we serve. They have worked extensively with the Department of Developmental Disabilities in Maryland, but provide assistance on a national level.

These are some models that they offer expert technical assistance in:

Co-Housing
The underlying components of cohousing include optimal community engagement, communal design features, resident management, common facilities, private multifamily units, lessened impact on infrastructure and lower energy costs. Cohousing units are generally more affordable than conventional housing units due to the multifamily nature of units, but also because a core component to cohousing is to control costs. Cohousing units tend to be studio, 1-bedroom and 2-bedroom units. Buildings are clustered, and therefore use less land. Shared utilities or facilities, like shared water or gas mains and laundry facilities, utilize less energy.

As cohousing is resident-led, volunteer groups may be established to provide aid to seniors while certain services may be conducted by contracted service providers. Cohousing designed for people with disabilities and seniors may pay more attention to ease of access for all levels of physical ability and incorporate universal design elements. Cohousing communities may include optional studio residences in or near the common house to provide living quarters for service provides/home health aides, allowing for partial or full 24-hour services provision.

Limited Equity/Shared Equity Housing Cooperative
You may also want to consider a limited or shared equity housing cooperative for the project. This would provide an opportunity for people with autism and the moderate/low income direct care workers to come together to cooperatively own a multi-family building. By forming a cooperative there is a shared ownership structure that can provide limited equity to perpetuate affordable housing and community living options for a variety of populations. You may want to look at consumer controlled housing models found in Minnesota - http://rtc.umn.edu/guide/

Community Land Trusts (CLTs)
CLTs are membership-based non-profit organizations that own the land under the housing in order to preserve affordability of these homes for future residents. I am not certain if CLTs can be owned/operated by a government entity but I don't see why the state couldn't be a member of the organization to preserve the use of the land for affordable community living. This model provides a long term lease or in some cases covenants on the title of the housing property to ensure the CLT is consulted and involved every time a home is sold. This model could be used in conjunction with both the Cooperative and Co-housing models but you would want to get a consultant to advise you of the best structure to maximize ownership and control by the residents.

Please also see a new paper on housing options for adults with autism on the SAARC website.

Help for Autism: Creating a Good Quality of Life for Adults with Autism

To find out more about how you can improve the quality of life for adults with autism, go to www.myarchway.org

Quality of Life may be defined as the degree to which a person enjoys the important possibilities of his or her life. Quality of Life for people with autism spectrum disorder consists of the same aspects of life as for all other people. But people on the autism spectrum have their own specific needs that must be met to ensure a good quality of life, to include the quality of the environment (group homes, residential facilities and community living options) in which the person with autism lives.

Quality of Life for adults with autism always starts with dignity and respect for each person, but in addition, there are also specific needs for an adult on the autism spectrum that must be met to ensure a good quality of life.

Dr. Susan Bryson wrote about the central needs of adults with autism and the essential qualities that need to be part of any services and supports for adults with autism to ensure a quality life. She summarizes the major needs of people with autism as:

The need to communicate wants and desires and to interact meaningfully with others;
The need for highly structured, predictable and familiar surroundings;
The need for work and recreational-leisure activities to give meaning to existence and provide a sense of accomplishment and being valued by others;
The need for a safe and caring place of residence chosen from options along a continuum of residential services;
The need for adequate and sensitive health services;
The need for advocates to ensure that rights and needs are respected and not violated, and that existing services are appropriate and adequate for each individual.
Regarding quality of life issues, the declaration by The Autism and Asperger's Syndrome Independent Living Association (whose majority membership are adults with autism) states:

Measuring “quality” assures standards that exceed current professional practice and calls for periodic redefinition of "best practices." Any measurement of quality should consider "the satisfaction and preferences of the individual with autism and Asperger's Syndrome first and foremost and the satisfactions of family, friends and advocates as secondary." Supports and services for people on the autism spectrum are said to have quality when:

They are designed with maximum control by people with autism and Asperger's Syndrome;

They would be acceptable to people without disabilities;
They are delivered in settings people without disabilities would use;
They are individualized and relevant to individual needs;
They are changed as the needs of individuals change;
They are adequately funded;
They help people develop maximum independence;
They respect the dignity and privacy of individuals.
To improve the quality of life for adults on the autism spectrum, the quality of their living environment, i.e., community housing options, residential facilities, residential programs, residential schools, group homes, supported housing, and housing alternatives should be carefully considered.

A quality environment:
Provides basic needs including healthy and appealing food, shelter, safety and social contact;
Provides a caring place of residence chosen from options along a continuum of residential services;
Provides a range of opportunities within the individual’s potential;
Provides control and choice within that environment;
Provides proper autism treatment for consumers and autism-specific training of direct support staff and their supervisors to ensure a proper understanding of the issues that affect adults with autism spectrum disorder; and
Provides augmentative communication tools, technology and related services to help consumers with autism communicate wants and desires and interact meaningfully with others.
Overall findings on Quality of Life (QOL) issues were reported in Quality of Life – Dream or Reality? Life for People with Developmental Disabilities in Ontario by Ivan Brown, Dennis Raphael and Rebecca Renwick (Quality of Life Research Unit, Centre for Health Promotion, University of Toronto, 1997).

Overall QOL scores were found to be "poor" (indicating a strong need to improve QOL) for people in large institutional settings and large residential facilities and residential schools for nonverbal people everywhere. People with autism are "nonverbal" in that they either do not use speech at all, or they do not use functional speech as compared with typical people. Moreover, adults with autism have seldom been appropriately supported with augmentative and alternative means of communication. The factors involved in QOL may be expressed more positively.

People with higher QOL were associated with the following characteristics:

Living in community settings;
Having verbal skills;
Having higher functional abilities;
Not seeing a psychiatrist or taking psychotropic medications;
Not having complex medical needs;
Nonverbal people with higher QOL were associated with:

Having an occupational activity of some kind;
Not having marked behavior problems;
Having leisure activities in community;
Having community access;
Being more independent;
Making own decisions;
Having opportunities available from which decisions can be made;
Having practical support from other people;
Having emotional support from other people.
Quality of life for people with autism spectrum disorder and other developmental disabilities consists of the same aspects of life as for all other people. But adults on the autism spectrum, many of whom can not effectively communicate their needs, have specific needs that must be met to ensure a good quality of life. Many of these needs center on a range of sensory integration issues they struggle with, and those need to be recognized and appropriately addressed by caretakers.

Quality of life for people with autism and other developmental disabilities is based on common aspects of life for all humans, but it also reflects, from person to person, varying degrees of importance placed on those aspects of life. Quality of life for all people reflects how satisfied they are with aspects of life that are important to them. People live in environments. Thus, quality of life results from the interconnection between people and the environments in which they live.

To find more information on how you can help improve the quality of life for adults with autism spectrum disorder and other pervasive developmental disorders, contact the www.myarchway.org

Also see our public service announcement on You Tube with Annie Potts called “A Perfect Storm” on developing community housing options for adults with autism http://www.youtube.com/watch?v=Jtdo6Zh4ok4

Autism Housing: What are the Options?

Here we provide a description of the types of of group homes, supportive living, supervised living, farmstead programs, community living options, family teaching model, cooperatives, shared housing and other residential models. For a state by state listing of group homes and residential service providers, go to www.myarchway.org and to talk with other parents who want to discuss this topic, go to www.myarchway.ning.com

Supported Living: Provides residential services to adults with developmental disabilities who are able to live in self-owned or leased homes in the community. Programming and instruction are directed by the consumer, not the program. Much emphasis in on community integration. Staff may help with some assistance in daily living. Supported living models may be more suited for individual with an established repertoire of life skills and those who do not engage in significant levels of challenging behavior.

Supervised Living: A residential model designed to provide services with greater oversight and direction than might be provided in a supported living context, but less than a group home. Homes may be self-owned or leased, usually with one or two adults with ASD per residence, there may be a number of such residences scattered though out the building or housing complex, allowing for greater staff accessibility oversight. Crisis support is available 24 hours/day. Daily schedules are generally provided, with input from the individual consumer, and staff is available to provide direct instruction or support.

Group Homes: Provides residential services in more typical homes in the community setting. Ownership of the house usually lies with the provider agency, as do staffing decisions. Most have fewer than 6-8 consumers living in one residence and in most states, there is a recent trend where developmental disabilities service systems will not provide funding support for group homes who house more than, three-four consumers. A primary goal of group home living is to promote increasingly greater levels of independence in the residents. Instruction is provided in daily living and self help skills including meal preparation, laundry, housecleaning, home maintenance, money management, hygiene, and showering, dressing and appropriate social interactions are provided by agency staff. Staff may be trained in behavior management interventions.

Farmstead Program: A residential model set within the context of a working farm. While isolated by nature farmstead programs endeavor to meet the complex needs of adults with ASD and other developmental disabilities through the development of individually designed instructional programs focused on farm living. Vocational training is generally limited to farm-related work (e.g., horticulture, greenhouse management, woodworking, animal care, landscaping, etc.) although other opportunities may be available in nearby communities. Residents work along with staff at tasks relevant to the care and maintenance of the grounds and the farm. There is often little in the way of community integration or community based-instruction and life skill instruction is generally provided relevant only to those skills associated with life within the farmstead community. Bittersweet Farms, in Whitehouse, Ohio was the first Farmstead Program for people with ASD established in the United States and remains the most widely recognized model for this, very specific, category of residential services.

Teaching Family Model: A specialized model of group home service provision where usually a married couple lives in the house in separate quarters rent-free and provides supervision to other members of the treatment team and direct service to residents.

Shared Equity Models – Co-ops and Co-housing
There are variety of shared equity strategies such as cooperatives, to help many families take their first steps to home ownership. A cooperative (co-op) is an autonomous association of persons united voluntarily to meet their common economic, social and cultural needs and aspirations. Cooperatives are member-owned and democratically controlled enterprises. Members may unite in a cooperative for many reasons--to get services otherwise not available, to get quality supplies at the right time, to have access to markets or for other mutually beneficial reasons.

These paths can lead to home ownership opportunities for those otherwise unable to afford to buy. In exchange for this opportunity, the new homeowner agrees that when they sell in the future, they will receive only a portion of the equity appreciation. This will keep the property affordable and enable future buyers the opportunity for home ownership. Over the last few years, strategies including community land trusts and affordability restrictions related to inclusionary housing, along with cooperative housing, have substantially increased the availability of shared equity options for both developers and government policy makers to enable low- and moderate-income families to become homeowners.

The National Capital Bank: Capital Impact group has an excellent manual called Home Base: The Playbook for Cooperative Development which lays out a full understanding of the basics of cooperatives, and provides a step by step process for developing co-ops. NCP Capital Impact integrates their efforts with Community Development Corporations and Community Based Organizations, government agencies, investors and foundations. Their mission is pulling together private and public resources to fully leverage resources for the communities we serve. They have worked extensively with the Department of Developmental Disabilities in Maryland, but provide assistance on a national level.

These are some models that they offer expert technical assistance in:

Co-Housing
The underlying components of cohousing include optimal community engagement, communal design features, resident management, common facilities, private multifamily units, lessened impact on infrastructure and lower energy costs. Cohousing units are generally more affordable than conventional housing units due to the multifamily nature of units, but also because a core component to cohousing is to control costs. Cohousing units tend to be studio, 1-bedroom and 2-bedroom units. Buildings are clustered, and therefore use less land. Shared utilities or facilities, like shared water or gas mains and laundry facilities, utilize less energy.

As cohousing is resident-led, volunteer groups may be established to provide aid to seniors while certain services may be conducted by contracted service providers. Cohousing designed for people with disabilities and seniors may pay more attention to ease of access for all levels of physical ability and incorporate universal design elements. Cohousing communities may include optional studio residences in or near the common house to provide living quarters for service provides/home health aides, allowing for partial or full 24-hour services provision.

Limited Equity/Shared Equity Housing Cooperative
You may also want to consider a limited or shared equity housing cooperative for the project. This would provide an opportunity for people with autism and the moderate/low income direct care workers to come together to cooperatively own a multi-family building. By forming a cooperative there is a shared ownership structure that can provide limited equity to perpetuate affordable housing and community living options for a variety of populations. You may want to look at consumer controlled housing models found in Minnesota - http://rtc.umn.edu/guide/

Community Land Trusts (CLTs)
CLTs are membership-based non-profit organizations that own the land under the housing in order to preserve affordability of these homes for future residents. I am not certain if CLTs can be owned/operated by a government entity but I don't see why the state couldn't be a member of the organization to preserve the use of the land for affordable community living. This model provides a long term lease or in some cases covenants on the title of the housing property to ensure the CLT is consulted and involved every time a home is sold. This model could be used in conjunction with both the Cooperative and Co-housing models but you would want to get a consultant to advise you of the best structure to maximize ownership and control by the residents.

Please also see a new paper on housing options for adults with autism on the SAARC website.