All disabled people have the right to live in the community with the supports they need. The UN Convention on the Rights of Persons with Disabilities (CRPD) Article 19 affirms the right to live independently and be included in the community, with access to personal assistance and support services.
This page centers disabled people's expertise on getting care in your own home and community—not in institutions.
Jump to your country or region:
Home and community-based services (HCBS) are supports that help disabled people live in their own homes and communities rather than in institutions like nursing homes, group homes, or residential facilities.
These services can include:
Disabled people have organized for decades against institutionalization. Key principles:
Choice and control: Disabled people should decide where they live, who provides their care, and how they spend their time.
Real homes: People should live in their own homes or apartments—not facilities, even small ones.
Integration: Living as part of the community, not segregated.
Self-direction: Where possible, disabled people should be able to hire, train, and manage their own care workers.
Quality: Services should be adequate—not just "warehousing" people in the community instead of institutions.
Olmstead v. L.C. (1999): Supreme Court ruling that unjustified institutionalization is discrimination under the ADA. States must provide community-based services to people who can live in the community with support.
ADA and Section 504: Prohibit discrimination; support community integration.
Medicaid: Primary funder of HCBS for many disabled people.
Medicaid is the largest payer for long-term services and supports (LTSS). Options include:
State Plan Services: Covered for all Medicaid beneficiaries who need them (personal care, home health).
1915(c) HCBS Waivers: Allow states to provide services not normally covered by Medicaid to help people stay in the community. Each state has different waivers with different eligibility and services.
1915(i) State Plan HCBS: Similar to waivers but as a regular state plan option.
1915(k) Community First Choice: Optional state program providing attendant services.
Money Follows the Person (MFP): Federal program helping people transition from institutions to community living.
Step 1: Determine Medicaid eligibility
Step 2: Apply for specific programs
Step 3: Assessment
Step 4: Choose providers
Many states allow self-directed services, meaning you:
Self-direction options:
Many states have long waiting lists for HCBS waivers—sometimes years. This means:
What to do:
Medicare (not Medicaid) covers limited home health services:
ADAPT has fought for community living since the 1980s, pushing for Medicaid expansion, against nursing home bias, and for attendant services.
Not Dead Yet advocates against assisted suicide and for community living resources.
National Council on Independent Living (NCIL) represents Centers for Independent Living working on HCBS policy.
SABE (Self-Advocates Becoming Empowered) advocates for people with intellectual and developmental disabilities to live in the community.
Healthcare and disability services are provincially administered, so programs vary significantly.
Most provinces provide:
Ontario:
British Columbia:
Alberta:
People First of Canada advocates for people with intellectual disabilities to live in the community.
Independent Living Canada and provincial IL organizations support self-directed living.
Provincial disability organizations advocate for HCBS expansion.
In England, adult social care is provided by local authorities (councils) under the Care Act 2014.
Assessment: Contact your local council for a care needs assessment. If eligible, you'll receive a care and support plan.
Eligibility: Based on care needs (not diagnosis). Must have significant impact on wellbeing.
Personal Budgets: Many people receive funding as a personal budget, which can be taken as:
Self-Directed Support: Direct payments allow you to hire your own personal assistants, including family members in some cases.
For people with significant ongoing health needs:
Inclusion London and other disability-led organizations advocate for social care reform.
Disabled People Against Cuts (DPAC) campaigns against austerity cuts to social care.
Independent Living movement in UK has fought for direct payments and self-directed support.
NDIS provides funding for disability supports for eligible Australians.
Eligibility:
What NDIS Funds:
NDIS Plans: Individualized plans based on your goals and needs. Funding can be managed by:
People who become disabled after 65 aren't eligible for NDIS. They access:
This is a significant gap—disabled people have organized against the age 65 cutoff.
People with Disability Australia (PWDA) is a national cross-disability rights organization.
Every Australian Counts campaign advocated for NDIS establishment.
Young People in Nursing Homes National Alliance campaigns for young disabled people to live in the community, not aged care facilities.
The CRPD (Article 19) establishes that disabled people have the right to:
In many countries:
Disabled people of color face:
Who's organizing: Organizations centering disabled people of color, culturally specific disability services.
LGBTQ+ disabled people may face:
Who's organizing: LGBTQ+ disability organizations, SAGE (for LGBTQ+ elders).
Rural disabled people face:
Who's organizing: Rural health organizations, telehealth advocates, rural disability groups.
May face:
Self-direction means you:
Contact your local Center for Independent Living (US), local council (UK), or equivalent in your country. They can assess your needs and explain available programs.
Explore all available programs—you might qualify for multiple. Contact CILs for assistance. Look into charitable programs. Document your needs for appeals.
Ask about self-direction options in your program. This may require switching to a different waiver or program. CILs can help you navigate.
Look into respite care programs. Some programs allow family to be paid as caregivers. Connect with caregiver support services.
Request reassessment. Document your needs carefully. Appeal the decision. Contact disability rights organizations for assistance.
Do you receive home and community-based services? Navigate the system? Advocate for HCBS policy?
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We especially welcome:
This page centers disabled people's expertise. Community living rights were won through decades of organizing against institutionalization.
Last updated: November 2025