ICF vs. HCBS: Understanding Levels of Care for People With Disabilities
For people with disabilities, the right level of support can make an enormous difference in everyday quality of life. Families and individuals often face the challenge of choosing between different disability care options, ranging from institutional care to more flexible community-based services. Each pathway offers unique benefits, responsibilities, and funding structures that shape daily life.
Understanding these differences helps families make informed decisions and ensures that individuals with disabilities receive the best possible support. Families can weigh options that align with independence, inclusion, and personalized support. Choosing the right disability services and provider is an important step in making sure those supports meet individual needs.
What Is an Intermediate Care Facility (ICF)?
An ICF is a type of residential care facility designed to provide round-the-clock support for individuals with disabilities. It offers a level of care that is higher than what is typically available through community-based services but lower than nursing homes. ICFs are all-inclusive, meaning the facility provides for all the individual’s needs, including medical care, therapy, nursing, food, clothing, utilities, and necessary medical equipment.
A typical day at one of these facilities might include assistance with personal care such as bathing and dressing, meals in a communal dining area, and participation in scheduled activities. Residents often have access to therapeutic services, including physical, occupational, or speech therapy. The environment emphasizes safety and routine, with staff available 24/7 to provide medical oversight and support, while opportunities for social interaction and skill building help promote personal growth and a sense of community.
Key features of ICFs include:
24/7 access to nursing and health services
Access to therapies such as physical, occupational, or behavioral support
Structured daily routines and programming
Group living settings with shared staff support
A focus on health, safety, and stability in a residential care setting
ICFs often serve individuals with intellectual and developmental disabilities who need significant support in their daily lives. This mode of care provides consistent medical attention, personal care, and structured activities. Families considering this type of support may find it helpful to explore residential service options that provide both structure and compassion.
What Are Home and Community-Based Services (HCBS)?
While ICFs provide structured care, HCBS focus on helping individuals remain in their own homes or integrated community settings. In HCBS homes, individuals use their own income to cover rent, utilities, and food, and they access medical care and other services through community providers using their personal insurance.
A typical day might include receiving in-home assistance with personal care tasks, support attending school or work, and help with transportation. Rather than following a strict institutional schedule, the day is shaped around the individual’s preferences and routines, allowing people with disabilities to live in their own homes or family settings.
Home community services may include:
Independent home care support for daily routines
Skill-building programs for employment and education
Community living support for transportation, social activities, and inclusion
Help with managing health needs while remaining in a family or independent setting
HCBS often emphasize flexibility and the creation of personalized care plans. Families often work with providers to design supports that fit individual strengths and preferences. By promoting independent living, HCBS enable individuals with disabilities to thrive while maintaining a greater degree of autonomy.
Funding Differences: ICF vs. HCBS
One of the most significant differences between ICFs and HCBS lies in how they are funded:
ICFs receive funding directly from Medicaid to cover the full range of services provided in a residential setting. This funding ensures 24/7 support but often comes with less flexibility in tailoring care.
HCBS are funded through Medicaid waivers. These waivers allow states to use Medicaid dollars for more flexible, individualized services that support people in their own homes and communities.
In Ohio, HCBS waivers are funded through both state Medicaid dollars and local levy dollars. The community’s support of their local Human Services/County Board of Developmental Disabilities (DD) levy is critical to funding these HCBS services.
Families should know that HCBS funding may come with waiting lists, as demand for these programs is high. Despite this, the adaptability of HCBS often makes it a preferred option. Families can access a variety of resources and support networks to help navigate available services and make informed decisions for their loved ones with special needs.
Why Supporting HCBS Matters
Using HCBS is a preferred option for many individuals with disabilities because it allows people to live in familiar surroundings while receiving the care and support they need. However, demand for these programs often exceeds availability, leading to long waiting lists that can leave families and individuals without timely access to support.
Expanding HCBS funding and services is crucial to meeting this demand. By supporting HCBS, policymakers and communities can ensure that more individuals have the opportunity to thrive in their own homes and communities.
Here’s how to support HCBS:
Vote in favor of your local Human Services levies!
Advocate for increased state and federal funding for HCBS programs.
Contact local legislators to share stories about the importance of community-based support.
Support organizations and nonprofits that provide HCBS or raise awareness of its benefits.
Educate others about the value of independent living and community integration for people with disabilities.
Participate in public comment periods for HCBS waiver programs or policy proposals.
Encourage media coverage and social media campaigns that highlight the successes and challenges of HCBS programs.
Moving Forward With Confidence
Deciding between an ICF and HCBS can feel overwhelming, but knowledge empowers families to move forward with confidence. Both residential care facilities and home-based services have their place in the continuum of disability care, depending on the individual’s needs.
For some, ICFs offer the necessary structure and 24/7 health monitoring. For others, HCBS represent a pathway toward independence and inclusion through community living support and independent home care.
Families should start by assessing the individual’s needs, goals, and preferences, and then work with professionals to create a sustainable plan. Direct support professionals play a critical role in this process, providing hands-on care, guidance, and support to help individuals achieve their daily goals and maintain independence.
Investing in Community, Investing in People
Understanding the distinctions between ICFs and HCBS is essential for families seeking the best possible care for a loved one with disabilities. While intermediate care provides structured support in group settings, home and community services emphasize independence, flexibility, and inclusion.
Both levels of care contribute to a continuum of services that ensures individuals can access the right support at the right time. Ultimately, whether through ICFs or HCBS, the goal remains the same: to provide compassionate, high-quality disability care that supports every individual in living a fulfilling and empowered life.
At Resident Home Association (RHA) Dayton, our vision is to provide the highest-quality compassionate care to individuals with IDDs. We aim to offer support and services to these individuals and their families so that they may live long, fulfilling lives. As a provider of excellence, we are continually driven to enhance the quality of our services. We strive to cultivate safe, stable environments guided by a culture of integrity, honesty, and respect. Whether you’re seeking day services, exploring independent living solutions, or want to support our mission, RHA Dayton is here for you.