Housing and daily support

Living with family, with paid support

Living with family doesn’t have to mean going without paid help. Personal assistance in the home, respite for the caregiver, and skill-building support can all be part of a plan that keeps someone in their own home rather than moving them into one. Some Tennessee programs allow self-direction — choosing and directing your own support workers rather than accepting whoever an agency assigns — ask DDA intake whether that’s an option in your situation.

Where a family member is paid as a caregiver, the rules for who can be paid and under which program vary — ask directly rather than assuming either way.

Supported living and residential services

Residential support in Tennessee mostly runs through TennCare’s ECF CHOICES program and DDA-licensed providers. ECF CHOICES’ own service definitions describe two residential options: Community Living Supports (CLS), a home shared by up to four people with disabilities, with support built around each resident’s independence, choice, and full participation in the community; and Community Living Supports — Family Model (CLS-FM), an adult-foster-care-style arrangement where up to three people live in the home of a trained family caregiver rather than their own family.

Terms vary by waiver and by provider — some of Tennessee’s other DDA waivers use different names, such as residential habilitation, for services that work similarly. Ask DDA or a provider directly which waiver and which service applies before assuming what a term means.

In-home assistance and personal care

In-home help — personal care, meal prep, household tasks, medication reminders — can come from a licensed home-care agency, through ECF CHOICES or another DDA waiver, or be self-directed, where the person or family hires and manages support workers directly. Ask DDA intake or your care coordinator which funding routes are open to you and whether self-direction is available. Find in-home and community-based support and home health, nursing, and personal care in our directory.

Transportation

For Rutherford County and Murfreesboro, MCHRA Transit runs complementary paratransit for people who can’t use the regular fixed-route bus because of a disability: 615-890-2677. In Davidson County/Nashville, WeGo Access is the ADA paratransit service — apply and schedule at 615-880-3970.

TennCare also covers non-emergency medical transportation (NEMT) to get enrollees to covered appointments — ask your TennCare health plan which company currently manages rides in your area, since the broker can change. If driving independently is a goal, a certified driver-rehabilitation evaluation (often run by an occupational therapist) can assess whether driving is realistic and what adaptive equipment might help — ask a rehab hospital or your OT for a referral. Find transportation providers in our directory.

Respite for caregivers

Respite is short-term relief care so a caregiver can rest, travel, or handle something else that needs attention. It can be funded through ECF CHOICES or through DDA’s Family Support Program — though Family Support specifically is not available to someone already enrolled in an HCBS waiver (including CLS/supported living, ECF, or Katie Beckett), so ask which door applies to your situation before assuming both are stackable. Find respite and caregiver support in our directory.

Affordable housing and vouchers

The Murfreesboro Housing Authority administers Housing Choice Vouchers (Section 8) and public housing, funded through HUD; some vouchers are set aside for non-elderly people with disabilities. Waitlists open and close — call or check the Housing Authority’s site for current status rather than assuming based on an earlier attempt.

A housing voucher is not a support service. It helps pay rent; it does not include personal care, supervision, or daily-living help. Those come from ECF CHOICES, DDA, or a private-pay provider — plan for both separately if both are needed.

How to evaluate a support provider

Beyond a clean building and a friendly tour, ask about: staff training and how often it happens; staff turnover; experience communicating with AAC users and people who don’t use speech; experience with personal care and with medical complexity (feeding tubes, seizures, mobility equipment); their behavior-support philosophy, including whether and when they use restraint or seclusion; how they handle it when someone refuses or says no to a task; visitation policy for family and friends; exactly how to leave the service if it isn’t working; current DDA licensing; and how incidents get reported, and to whom.

Safety at home

Home safety, personal safety, and healthy relationships — with support staff, roommates, partners, and strangers — are their own topic. See safety and relationships for that fuller guide.

• What training do direct support staff get, and how often?
• What is your staff turnover rate?
• How do you communicate with someone who uses AAC or doesn’t use speech?
• What personal-care experience does your staff have, and how is privacy handled?
• What is your experience with medical complexity — feeding tubes, seizures, mobility equipment?
• What is your behavior-support philosophy? Do you use restraint or seclusion, and under what circumstances?
• How do you handle it when someone refuses or says no to a task or activity?
• Can family and friends visit anytime, or are there set visiting hours?
• How do we leave this service if it isn’t working, and how much notice is required?
• Are you licensed by the Department of Disability and Aging? Can I see your current license?
• How and to whom are incidents reported?