What is an Intermediate Care Facility for Individuals with Intellectual Disability?

If you or someone you know needs comprehensive residential, medical, and rehabilitation services for intellectual disabilities or similar conditions, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) can be a great option. These places provide a safe and supportive environment where individuals can receive the care and attention they need to thrive. 

What is intermediate care?

Whether you are looking for long-term care or temporary assistance, ICF/IID facilities can help you find the right care plan for your unique situation.

ICF/IID stands for Intermediate Care Facility for Individuals with Intellectual Disabilities. 

An ICF provides a level of care that is more than basic custodial services but less intensive than a hospital or nursing home. IID refers to serving people with intellectual disabilities or related conditions that impair functioning in certain life activities.

Intermediate care provides more intensive services than primary custodial care but less than a hospital or skilled nursing facility. ICF/IIDs offer 24-hour supervision, health care, therapies, activities, and training. The goal is to maximize clients' self-determination and independence based on their needs and abilities.

Who is eligible for ICF/IID benefits?

To qualify for an ICF/IID, individuals must need "active treatment" services. Active treatment means consistently implementing training, therapies, and other interventions to acquire skills and functioning. It does not include essential services to maintain generally independent clients.

States define ICF/IID eligibility criteria within federal guidelines. Your care recipient must have an intellectual or developmental disability or a related condition that started before age 22 and continues indefinitely. Associated conditions are functionally defined by how they affect the person, not by specific diagnoses. 

Here are some conditions that might require this level of care:

1. Intellectual Disabilities: The primary group of individuals these facilities serve are those with intellectual disabilities.
2. Physical Disabilities: Many individuals in these facilities have physical conditions that render them non-ambulatory.
3. Seizure Disorders: Individuals with seizure disorders often require the level of care provided by ICFs/IID.
4. Behavior Problems: These facilities are equipped to handle individuals with behavior problems.
5. Mental Illness: Individuals with mental illnesses can benefit from the services provided by ICFs/IID.
6. Visual or Hearing Impairments: Those with visual or hearing impairments may also require this level of care.

States differ in how they interpret related conditions. Family caregivers can work with a case manager to determine if their loved one meets the eligibility criteria.

Services included in ICF/IID care

The core service provided under the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) program is active treatment. It involves ongoing specialized and generic training and therapies aimed at maximizing the self-determination of the individuals. The interventions are based on comprehensive evaluations and individualized plans developed by an interdisciplinary team. 

This team usually includes physicians, nurses, therapists, social workers, and other healthcare professionals working closely to provide your recipient with the best possible care. The ultimate goal of the ICF/IID program is to help individuals with intellectual disabilities lead a fulfilling and independent life.

Comprehensive medical, rehabilitative, and personal care

In addition to active treatment, ICF/IIDs provide a wide range of required services such as health care, dental, nutrition, nursing, pharmacy, and therapies. Staff assist clients with personal care and activities of daily living based on individual needs.

Meeting facility and staffing requirements

ICF/IIDs must comply with federal certification standards for staffing, governance, individual protections, and the environment. For instance, facilities must have adequate direct care staff and a specially trained program director.

Providing work and community activities

Clients can participate in prevocational, work, or community activities tailored to their interests and goals. The ICF/IID coordinates and provides supervision and transportation for these day programs as part of active treatment.

Licensed, residential settings only

ICF/IID services are only available in licensed, certified facilities providing 24-hour residential care and supervision. They are not offered in private homes, adult day care, or as a community-based service. Family caregivers should determine whether a facility meets licensing requirements.

Preadmission screening and resident review

States evaluate ICF/IID applicants to prevent unnecessary placement and find appropriate services. First, a preliminary screen determines if the person may have an intellectual disability or mental illness. Those with positive results get an in-depth evaluation of ICF/IID eligibility and service recommendations before admission.

Periodic resident reviews for those already in ICF/IIDs identify individuals who could transition to community settings. This process helps states comply with the Olmstead decision on community-based services.

Accessing ICF/IDD level of care at home

It is possible for someone who requires the level of care provided by an ICF/IDD to receive care at home through a Home and Community-Based Services (HCBS) Medicaid waiver. This is known as "diversion" or "transition" from institutional care to community-based care, and it is a key feature of HCBS waivers.

Here's how it generally works:

1. Assessment: An individual's eligibility for an HCBS waiver is typically determined through an assessment process conducted by the state's Medicaid agency or another designated entity. This assessment considers the person's medical, functional, and support needs to determine if they qualify for the waiver.
2. Choice of setting: If the assessment shows that the individual qualifies for an HCBS waiver and expresses a preference for receiving care at home or in a community setting rather than in an ICF/IDD, they can choose to transition from the institutional setting to the community.
3. Development of a care plan: Once the choice is made to transition, a person-centered care plan is developed in collaboration with the individual, their family or legal guardian, and a team of professionals. This plan outlines the specific services and supports needed to meet the individual's needs in a community setting.
4. Access to HCBS: With the care plan in place, the individual can access HCBS through the Medicaid waiver. These services can include personal care, respite care, behavioral support, home modifications, transportation, and other supports that enable them to live in the community.
5. Monitoring and adjustments: The individual's care plan is regularly monitored and adjusted to ensure it continues to meet their needs and preferences. This can include changes in the types or levels of services provided.

Transitioning from an ICF/IDD to HCBS allows individuals to receive care in a less restrictive, more community-integrated environment, often more aligned with their preferences, and promotes greater independence. It's important to note that the specific eligibility criteria and available services under HCBS waivers can vary by state, as Medicaid is administered at the state level. Therefore, the process and services available may differ from one state to another.

Participant-direction for individuals who require ICF/IDD level of care

Participant direction, also known as self-direction or consumer direction, is an option available in HCBS Medicaid waivers. It gives individuals with disabilities and their families more control and flexibility over the services and supports they receive.

This approach includes budget authority, allowing individuals to allocate and manage funds for services and hire caregivers. It also fosters closer provider relationships and encourages responsibility and compliance with program rules. While participants enjoy autonomy, they receive support from program coordinators and ensure service quality and safety through accountability measures, ultimately promoting advocacy and empowerment for individuals with disabilities.

The availability of participant direction can vary by state and the specific HCBS waiver program. Not all HCBS waivers offer participant-directed options, and the particular rules and procedures may differ from one program to another. Individuals interested in participant direction should work closely with their state's Medicaid agency or waiver program to understand the eligibility criteria, application process, and guidelines for participating in a participant-directed program.

Suppose an individual or their family is interested in participant-directed services and requires an ICF/IDD level of care. In that case, they should contact their state's Medicaid agency or the agency responsible for administering HCBS waiver programs to inquire about the availability of participant-directed options and the specific requirements for participation in their state. This will help them understand how to access and navigate the participant-directed services within their particular program and location.

How this information can help family caregivers

Intermediate Care Facilities for Individuals with Intellectual Disabilities provide necessary active treatment and services for people with significant support needs. Understanding the eligibility criteria, required services, and facility standards can help family caregivers determine if an ICF/IID is the most appropriate option to meet their loved one's needs.

Remember, the availability of these services can vary depending on where you live, so it's important to explore the options in your area. These services aim to help aging adults maintain their independence and quality of life while easing the caregiving burden for families.