50 Years at Foothills Gateway: A Look Back at Supported Living Services
February 09, 2022
Pat Carney, the Support Services Case Management Director, began his tenure at Foothills Gateway in 1995 as a part time DSP and Supported Living Consultant (SLC). Today he takes a look back at the beginnings of Supported Living Services and the foundational role this program played in bringing person-centered practices to the forefront at Foothills Gateway.
In 1991 the federal government created the Community Supported Living Arrangement (CSLA) demonstration pilot, and Colorado was one of eight states participating in the pilot. This pilot was revolutionary because it allowed adults with disabilities to receive services while living in the family home. Prior to this, the only options were residential programs which required the person to live in a provider-controlled home, usually with several other people with disabilities. Foothills Gateway started participating in CSLA in 1992. By the end of the three-year CSLA pilot, the Foothills Gateway program had enrolled 45 individuals. Foothills Gateway was the primary provider of all direct services through this pilot program.
After the three-year CSLA pilot expired, the federal government did not reauthorize the pilot. However, in 1995 Colorado received federal authorization for Supported Living Services (SLS) as a Home and Community Based Services (HCBS) Medicaid Waiver. This opened the door for many new service options that took place in less formal settings than previous options.
At this time, the newly created SLS department leased two basement apartments at the Aspen Leaf Apartments in Fort Collins and used them as home base for all activities. The office shared a single computer and a very small photocopier. If someone needed to make more than 10 copies, they were required to trek to the Foothills Gateway main building and use the copier there.
The SLS Waiver provided services both in the home–such as cooking, money management, personal care–and outside of the home (community access). SLS pioneered the concept of personal choice and control as enrolled individuals could choose who provided the services and what types of services were provided. Along with the concept of choice was the goal of respecting the choices individuals made, even when the choice created risk.
SLS also offered an innovative service: Supported Living Consultation (SLC). The SLC role advanced person-centered thinking at Foothills Gateway. SLC’s were trained to conduct person-centered PATH (Planning Alternative Tomorrows with Hope) plans and worked with individuals to develop meaningful personal goals, as well as explored means of achieving these goals through paid and unpaid supports and resources.
The state introduced a significant system’s change starting in 1998. This change focused on growing the SLS program. SLS was an attractive option for Colorado as the support model provided the opportunity to provide services to individuals at a relatively low cost compared to the HCBS-DD waiver. With this change came more funding and increased enrollments. Colorado leveraged existing state funded programs and used these program dollars to match federal funding through new Medicaid services and enrollments. This change also incorporated additional services such as pre-vocational and vocational services.
During this time the program hired several employees who continue to be valued Foothills employees. In 1998 Amber Duffy (current SLS/CES Lead Case Manager) was hired as an SLS Team Leader and SLS enrolled 75 individuals. In 1999 Rachel Souders, now an Intake Case Manager, was hired as the SLS Administrative Assistant. In 2001, Foothills Gateway hired Stacy Hill as the SLS/CES Administrative Assistant. Now the Foothills Gateway Development and Communications Director, Stacy also served as an SLS Team Leader.
In the late 90’s, SLS administration and SLC’s shared space with Early Intervention and Family Support Services Program (FSSP) case management in a rented commercial building on Magnolia Street in downtown Fort Collins. While this location provided great lunchtime opportunities for staff, the 20(+) minute commute time to 301 Skyway Drive was a logistical hurdle. In 2002, once the Larimer County Youth Safe ended their residential programming lease, these programs moved to “The Mothership” and began working in the northern part of the FGI building where Case Management currently resides. In 2002, SLS served 221 individuals and contracted with 11 agencies and 15 independent contractors.
Foothills Gateway was the designated Support Coordinating Agency for Larimer County. This designation made Foothills Gateway responsible for managing most administrative aspects of the program in Larimer County. Foothills Gateway was responsible for enrolling providers, allocating funding, and determining the number of enrolled individuals, setting rates, and monitoring providers.
Throughout this time Foothills Gateway SLS found ways to improve the lives of enrolled individuals by offering specialized health and safety classes, men and women’s groups, YMCA Weekend Getaways, and self-advocacy/self-defense trainings.
In 2009, SLS experienced significant changes. At this time, SLS moved from a quasi-managed care system to a fee-for-service model. This meant that Foothills Gateway was no longer responsible for managing enrollments, setting rates for services, or overall responsibility for the quality of all services billed. This change was a result of a federal audit which highlighted that too much control was being delegated by the state agency to the Community Centered Boards.
The 2009 Waiver Renewal also changed the services offered through the waiver. One significant change is that it eliminated the SLC role. The state expressed concerns that the role created the risk of duplication of the responsibilities attached to case management. Several of the SLCs moved into case management, became independent contractors, or found other positions within FGI. Notable SLC alumni include Laura Sidener, EI Coordinator, Heather Seipelt (now EI Lead Case Manager) and Rachael MacKinnon Johnson, SLS-CES Case Manager.
It was also in 2009 that case management created specializations and created separate teams for SLS-CES and HCBS-DD.
In 2015, the Colorado Legislature approved funding to eliminate the waiting list for SLS. Since that time, enrollments have grown from 200 individuals to over 350 individuals enrolled in Medicaid SLS, and the service provider options for program approved service agencies has grown from the original three to over 50.
Despite all the growth and changes throughout the years, Supported Living Services has succeeded in providing personalized, person-centered services and maintained the original ideals of choice and community inclusion. Much of the success of the program has come from the excellent staff—both past and present—who have kept the focus on the ideals that gave rise to the program 30 years ago.