How to Open a Group Home

Group homes are one response to a community's unmet housing and treatment needs, which often first present themselves as an increasingly visible presence of runaway teens, homeless adults and children. While some groups may have adequate service, other groups may have no service at all.

Each type of group home has its own set of rules, regulations and requirements that must be met. They may serve adults or children with disabilities, LGB and transgendered individuals, pregnant or at-risk teens, recovering drug or alcohol users, probationers or parolees. Group homes for the elderly, people with disabilities or at-risk mothers are protected from discriminatory community actions by the provisions of the Federal Housing Act of 1963 and the Federal Housing Act Amendment of 1988.

Things You'll Need

• Community needs assessment
• ADA Standards for Accessible Design
• Business plan
• Policies and procedures manual
• Licensure and other regulatory responsibilities
• Fire code compliance

Instructions

Community Needs

1. Identify the under-served population in the community. Speak with community health professionals, social workers, heads of local outreach ministries and any local crisis center staff about the housing and treatment needs in your community. Attend any public board meetings, hearings or panel discussions sponsored by these groups to determine the community's needs.

   Use this information to determine the type and level of services needed in your community. This may include the need for housing only, or for 24-hour supervision, methods of acquiring basic life skills, and help coping with mental illness, drug addiction or adjudicated status.

2. Note barriers to seeking or receiving services. Include both physical and social barriers. Social barriers include lack of awareness of available services, intellectual limitations, emotional disturbance, fear, shame or despair. Use this information to create outreach strategies to those who are unwilling or unable to use existing services.

   Physical barriers might include services located too far from the people who need them, inadequate or nonexistent public transportation networks, lack of funds to use existing networks and limited availability of fully accessible, wheelchair-equipped transportation. Create a plan to enable people to access your services, including how to coordinate available public transportation with what you intend to provide. Develop policies for ongoing fund-raising for transportation needs.

3. Address barriers to seeking and receiving services due to perceived and practiced gender variance, which is one of many criteria that can lead to chronic homelessness. Create policies that address potential discrimination due to perceived gender variance and create protections for those whose presenting gender may not match their assigned birth gender.

4. Choose a site for the home. Each type of group home is subject to different rules, regulations and requirements regarding the physical structure. Design your facility to meet changing community needs by going beyond the minimum standards set by any local, state or federal authority. Provide 80 square feet of available living space per person, not including bathrooms, basements, attics or storage rooms. Residents cannot be required to share a room. Homes must permit married couples to share a room, even if the home is otherwise single-sex only.

   Apply standards of Universal Design when building or retrofitting the home for each resident. Make all hallways, doors and passages a minimum of 36 inches wide, with no sills. Provide bathrooms with a minimum of 36 square feet of turnaround space to accommodate power wheelchairs. Include roll-in showers, shower chairs or benches, grab bars and taller toilets, and lower sinks, counters and mirrors.

   Design kitchens with side hinge ovens, front-loading washers and dryers, roll-up tables and counters at wheelchair height, and side-by-side refrigerators.

   Provide ramps with 2 feet of run for every 6 inches of rise. Make landings and turns a minimum of 25 square feet. Install elevators from the basement to the uppermost floor.

5. Make sure the home is as energy efficient as possible, and that the home will not produce more trash than single-family homes of similar size. This will prevent nuisance complaints from neighbors, which can lead to litigation.

6. Provide off-street parking to the extent that it is possible, and limit the number of cars permitted to park at the home. Parking can easily become an ongoing source of conflict with neighbors, and battles with community members and boards can sometimes be avoided by implementing these good neighbor policies from the beginning.

7. Have the home inspected for compliance with fire codes. Create an escape plan that clearly marks the shortest path to the closest exit in each room or corridor. Display a copy of the plan at each end of every hallway, and in a prominent position in the entryway of the house.

   Hold regular fire drills every month, one per shift. Use different exits and routes each time; group home residents have been found dead of smoke inhalation, huddled against the blocked exit most often used during fire drills.

Recruiting, Training and Policy

1. Use the minimum staffing guidelines for your chosen type of group home to decide how many staff to hire in the initial phase. At minimum, you will need one staff member per shift for every six ambulatory adults, or two staff members per shift for every six children or non-ambulatory adults. Unless residents will share cooking duties, all staff on duty will need to be able to cook by following recipes. You will need at least one staff member capable of performing basic maintenance tasks, unless you subcontract maintenance services.

   Depending on state regulations, you may be required to have a registered nurse on site to pass medications, give injections, take blood pressure and blood sugar readings, start or stop tube feedings, change dressings on wounds, suction airways, change ostomy bags, perform visual assessments of individuals involved in unusual incidents, and to assess the need for further medical intervention. Some states have delegated nursing policies, which permit employees to perform these duties after being trained by an RN.

2. Recruit staff from the widest base possible. Advertise in local newspapers, and in social networking sites such as LinkedIn, Facebook, MySpace, LiveJournal and Craigslist. Make sure to recruit underrepresented segments of the population, such as differently-abled people, new immigrants, individuals from the LGBTQ community, people with hearing and visual differences, other underrepresented minorities and past victims of housing, access and treatment discrimination. This will provide the people you serve with mentors and role models who understand firsthand the specific issues they are facing.

   One of the harsh realities of providing group home care is the extreme dearth of people willing to do the job at the pay rates and hours that are available. It is not uncommon to have positions go unfilled for months. Social networking sites are a very important hiring resource, giving you advance insight into a person's motivations, goals and reliability.

3. Create policies that will protect the rights of all residents and staff. Familiarize staff with issues faced by individuals who are part of the LGBTQ community as well as those who are differently-abled, at risk or returning from probation or parole. These people are least likely to find accommodation for their specific needs. Engage staff members in role-play situations to encourage them to think outside their comfort zone and use compassion and kindness when dealing with each person. Use discussions of case studies to brainstorm acceptable responses to situations that might arise when providing care to persons who do not fit cultural norms.

4. Require staff to attend training in CPR, First Aid and Heartsaver Automated External Defibrillator use. Provide training in the prevention, recognition and reporting of abuse and neglect, the correct procedures for documenting and reporting unusual incidents, and in resident rights. Provide additional training on any specific support needs of the individuals you will be serving.

5. Form community partnerships with groups that represent the needs and interests of the people you intend to serve. Invite members of existing community groups to serve on your group home's board of directors. Arrange presentations from various groups, to explain their purpose and the services they offer. Encourage staff and residents to support groups and businesses which share their common interests and which advocate for their needs. Invite community and group members to celebrations and special events at the group home. Encourage residents to form attachments in community groups.

6. Use a person-centered team approach when planning how to best provide services to each individual. Include the individual in every discussion of her needs, and respect any decision to use or deny services. Consult OT, PT and speech therapists as needed.

7. Assist individuals in acquiring lifelong leisure skills and in accessing available community resources for a balanced life. This includes exposing the individual to activities such as fitness walking, swimming, bowling, lawn games, and adapted leisure such as wheelchair golf, bowling, basketball or dance, beeper ball, tai chi, yoga and calisthenics. It also includes exposure to music, painting, drawing, ceramic arts, scrapbooking, gardening, board games, card games, computer use, model railroad building and photography.

8. Encourage and assist individuals in practicing and participating in faith-based activities of their choice, including arranging transportation to and from activities and providing private space to entertain and converse with members of their faith by mail, phone, email and text message. Respect any decision to forego faith-based activities.

9. Include representatives on your board of directors and in any committees from all groups in the community who need and will use your services, including members of the LGBTQ community. Solicit input from board members, community members, and interested outside parties on whether or not each group's unique needs are being met. This may include issues such as unisex bathroom availability, gender-neutral language in advertising, recruiting and publicity, and variant-gender supportive policies.

Grand Opening

1. Create advertising and publicity, including regular public service announcements. Target all communications toward the people who need the services available. Conduct regular surveys to discover unmet community needs, and develop responses to the information gathered. Use gender-neutral and inclusive language.

2. Hold a grand opening. Serve light refreshments and welcome the community into your facility. Give a tour of the facility, and present the services your home will provide.

3. Begin accepting applications for service. Each application should include a medical, psychological and social history, what level of supervision the person needs, current medications being taken, allergies, special dietary needs and the person's dreams and life goals. List any need for supportive services such as occupational or physical therapy, speech therapy, behavioral supports, adaptive equipment needs, and communication preferences.

4. Conduct a tour of the facility with the individual and any interested family and community members. Introduce staff and current residents, and encourage applicants to take part in any house activities during the tour. Solicit additional information that may not have been included in the application, such as food preferences, favorite leisure activities and the need for alone time versus need for social time.

Tips & Warnings

• Start small. Start by providing a menu of services tailored to the needs of one particular group. Add services as needed and as funding and staffing capabilities permit. Once you are able to meet the current need, decide whether or not to expand. House children in single-sex rooms, unless they are siblings. They cannot share a room with an adult or with another child more than 5 years older. Children can share rooms with opposite sex siblings if their ages are within 5 years of one another, and if neither child has entered puberty. Use an open floor design with clear lines of sight in all directions in group homes for child and adolescent sex offenders, or for probationers and parolees, to prevent victimization by fellow residents, staff or visitors.

• Do not house sex offenders of any age with children or vulnerable adults, even if they are children themselves.

Resources

• Overcoming Barriers to Opening Group Homes for People with Disabilities
• Standards for Childrens' Treatment Group Homes
• Residential Treatment Considerations
• Repairing the Social Fabric
• ADA Standards for Accessible Design