Can People With Disabilities Stay at Home and Get Care?

Yes — in fact, this is one of the most common and encouraged models in special needs housing today. It goes by several names depending on your state: host home, adult family/foster care home, shared living, or supported living arrangement. Here’s what you need to know as a direct support professional (DSP) considering this path.

What This Living Arrangement Is Called

Most states use one of these terms:

• Host home / shared living. A caregiver opens their private residence to one or more individuals with disabilities.

• Adult family care home / adult foster care. Similar concept, sometimes with slightly different licensing rules.

• Supported living. Broader term covering various levels of in-home support, including in the individual’s own home rather than the provider’s.

Each state’s Medicaid Home and Community-Based Services (HCBS) waiver program typically funds one or more of these models, so terminology and rules vary by state.

Is It Legal? Yes — With Requirements

It’s fully legal and actively promoted as an alternative to institutional care, but it usually requires:

1. State licensing or certification. Most states require you to be certified through the state’s developmental disabilities agency or a licensed provider agency you contract with.

2. Home inspection and safety compliance. Your home typically must pass a safety inspection (fire safety, accessibility, cleanliness standards)

3. Background checks. Required for you and any other adults living in the home

4. Training. Many states require completion of specific training hours (medication administration, CPR/first aid, person-centered planning, etc.)

5. A service agreement or contract. Usually with a licensed provider agency that handles Medicaid billing, oversight, and case management, rather than the individual paying you directly.

Legal Protections That Support This Model

• The Americans with Disabilities Act (ADA) and the Olmstead v. L.C. (1999) Supreme Court decision establish a legal right to services in the most integrated setting appropriate, reinforcing the shift toward home-based models like this. In 2026, however, DOJ signaled it will no longer enforce this the way it has for the past 27 years, though the underlying legal right hasn’t changed. Host home providers should watch for state-level developments as this plays out.

• The Fair Housing Act protects individuals with disabilities from housing discrimination, which also affects zoning disputes some communities raise against group or host homes.

How to Get Started as a Provider

1. Contact your state’s Medicaid HCBS waiver office or developmental disabilities agency to learn local rules and available waiver slots

2. Connect with a licensed provider agency in your area. Most host home/shared living arrangements operate through an agency rather than a fully independent, private arrangement

3. Complete required training and background checks.

4. Prepare your home for inspection and compliance

5. Get matched with an individual whose needs and personality fit your home and caregiving capacity.

A Quick Note

Rules vary significantly by state, and some details (funding sources, licensing bodies, allowed number of residents, zoning restrictions) can be quite specific to your location. For your specific situation, consult your state’s disability services agency or an attorney who specializes in disability law or special needs planning to make sure you’re set up correctly from day one.