Welcome to Episode 8 of our GoodLife U Video Blog Series, with Dr. Mike Strouse. This month we are excited to talk with you about our Professional Extended Family Model, which is similar to other Shared Living programs, or what some would call “host homes;” however, our model has some distinct differences, and we’ve learned a lot across the last 20 years.

Let’s Begin with Some History 

In 1999 our Professional Extended Family program began with a proposal from a very long-term and well-loved DSP and their family. One employee wanted to serve one client who would join their family and live with them.  

We talked with that couple, the client, and the client’s family to see if this would be possible because we felt it would offer an incredible quality of life to the individual served. At the time, there were not many examples of how this could be done. Specifically, we were concerned about how this could be done while treating the host family as an employee. In the end, since the approach was similar to foster care, we decided to treat the caregiver as an independent contractor (rather than an employee).  

The IRS has provisions for adults with I/DD to be served in an adult version of foster care, similar to what we were developing, so we took the opportunity to  visit other programs across the country who had been pioneering foster care with I/DD, mostly for older children.

Across the next several years we worked closely with our partners at the University of Kansas Department of Applied Behavioral Science and the State of Kansas to develop an outcome-based service model that is now called GoodLife’s Professional Extended Family model, becoming the first agency to utilize this new approach to care for adults with I/DD in Kansas. 

Not surprisingly, the program grew rapidly and now, the Professional Extended Family model constitutes about 30% of all our residential placements, growing annually by about 3%.

So, How Does it Work?

At its core, the Professional Extended Family model is relationship-driven. Placements stem from connections that are cultivated over time, typically from GoodLife’s DSP workforce. Most of our Extended Families were Direct Support Professionals (DSPs), Professional Roommates, Professional Families, Professional Neighbors (all discussed in Episode 7), or served in other roles at GoodLife where they are able to bond with the individuals served.  

GoodLife developed a career ladder for DSPs (another key strategy for workforce stability) where the Professional Extended Family opportunity is highlighted as a part of new staff training, enabling each DSP to immediately begin cultivating the skills, relationships, and resources needed to move along this path. We also offer opportunities for employees to provide vacation respite for existing Professional Extended Families, which is a great way to experience the lifestyle first hand.

Through this process, GoodLife is able to make between 5-10 Professional Extended Family placements each year.

Our Educational and Vetting Process

Those who are interested in pursuing the Professional Extended Family lifestyle with GoodLife must go through an important educational and vetting process. Most people enter this program with an individual in mind who they would like to serve. Others might be attracted to this lifestyle but are open to who might be placed in their home. In either case it is our job to identify the lifestyle they want to lead as a Professional Extended Family, and explore possible placements that would be a good match for them, and up to two placements can be made per home.

We also complete a home study to ensure that the environment is enriching, safe, and acceptable. Often, we are able to provide an establishment grant to Professional Extended Families who are in need of a home that they can own/lease that matches the combined needs of both their family unit and those they want to serve.

Overall, because families are being joined together, our Professional Extended Family placement process is comprehensive and much more detailed than the hiring process we use for our employment-based programs. When we are onboarding a Professional Extended Family that already has a relationship with the individual(s) served, this process takes about 4 months–if a relationship between caregiver and individual(s) served doesn’t already exist, the process takes much longer. 

Ongoing Training and Quality Assurance

At GoodLife, all Professional Extended Families participate in regular home and community visits by a consultant and a specially trained Service Coordinator. We follow a curriculum of quality assurance standards that has been developed across several decades and includes training courses, coaching, key service and lifestyle reviews, and formal satisfaction evaluations by key stakeholders.  

Professional Extended Families must be certified annually, ensuring the arrangement promotes an enriched life for each person involved. In the end, an Professional Extended Family placement must be a win-win-win process for the Professional Extended Family, the person served/family, and for GoodLife.

Contract and Pay

Each Professional Extended Family has a contract which specifies the primary outcomes to be achieved (including critical lifestyle documents like the Person Centered Support Plan), and the essential processes that must be followed to meet licensing requirements and GoodLife’s standards of care.

The contractual relationship between the Family and GoodLife is similar to one you might have with a home-builder. For example, you provide detailed plans for the home and critical standards that must be met, but the builder owns many aspects of how these elements are achieved, within reasonable limits. The bottom line is that our Professional Extended Families have more flexibility and control than an employee does, but must meet the full requirements of the contract, which includes satisfaction of key stakeholders and all quality standards.

Importantly, under certain circumstances, the payment for this type of contract can be considered tax exempt by the IRS. Of course any provider would need to fully understand these requirements and meet them, which goes beyond the scope of what we can cover in this episode. However, if you want more information on this, our GoodLife U team would love to help.  

Outcomes and Benefits

Properly done, the Professional Extended Family model is a win-win-win for the Professional Extended Family, the person served (including their guardians and family members), and GoodLife.  

Advantages for Persons Served (and their families). Approximately 15 years ago we (along with our partners from KU) completed a retrospective study of people who were served across GoodLife’s residential programs and within the Professional Extended Family model.  The study enabled us to quantify the many advantages of the model for persons served, and we now collect quality of life outcome measures through this study continuously. Here are some key takeaways:

• This approach to care has far fewer different people involved in care–in fact, about 700% fewer different people are involved in care compared to standard employment-based residential programs.
• The model promotes deep and long-lasting relationships as seen by turnover rates across the last two decades. At GoodLife, this model boasts just 1 to 3% turnover annually. 
• Those served in the Professional Extended Family model show significant improvements in care and quality of life satisfaction: 100% of the parents and guardians of individuals served report being satisfied or very satisfied. 
• Overall, personal outcomes also improved, including achieving ideal weight, experiencing fewer behavioral problems, having better health outcomes, enjoying more inclusive community integration, taking fewer medications, and more! We’ve also seen significantly fewer care concerns, medication errors, and other care challenges in this approach.
• Most importantly, this model offers unparalleled stability where people are served consistently from 5 to 20 years.

Advantages for the Professional Extended Family. For the caregivers who choose the Professional Extended Family lifestyle, the benefits also add up! They experience:

• Tax-free compensation, often along with additional housing or transportation funding support;
• A life-style choice that ranks high on the compassion-satisfaction scale. ;
• In some cases, the flexibility to work outside the home along with becoming professional caregivers;
• Greater independence and quality of life for everyone under their roof.

Advantages for GoodLife. Even before we were hit with a staffing crisis, the Professional Extended Family model offered meaningful diversity within our service portfolio. But especially now, these advantages are important to GoodLife.

• Each Professional Extended Family placement reduces the need for about seven (7) direct support employees across a year. 
• This model also reduces the agency’s reliance on limited infrastructure and resources, including transportation, and critical health/behavioral services.  
• It does not consume significant replacement staffing and it does not consume as much overhead support. 
• From a COVID care perspective it was amazingly helpful as all families simply sheltered in place and the number of different people involved in care was very limited.  
• The Professional Extended Family model is the one model that can expand census for residential services without the agency needing to acquire additional housing and vehicles.  

Usually, even individuals with very challenging needs can be served in this program as long as the family has the skills and support and is matched well to provide care. However, there are some disadvantages. For example, clients who are often up at night are generally not a great fit for this program. It is also more difficult to place individuals who are non-abulatory within this model, because of the lack of accessible housing and transportation.

The reasons for an Professional Extended Family placement ending is often due to a life change (new family need, medical issue, etc.) of the Professional Extended Family. When a placement no longer works in an Professional Extended Family home, the person served is usually the one who needs to move. Interestingly, we’ve discovered that clients often move more frequently in employee-based programs compared to Professional Extended Family homes. Also in our experience, when this change occurs, a Professional Extended Family will provide months–or even years–of notice and will work to cultivate a replacement Professional Extended Family. More times than not, the placement has a very seamless transition. 

To Wrap Up

Todd Risley, a famous professor and life-long advocate for people with I/DD from the University of Kansas Department of Applied Behavioral Science, once authored a great training manual for staff working with persons with I/DD called “Get a Life.”

Get a Life describes how to advance the quality of life of persons we serve by helping them join interesting, integrated, community-based, REAL lives. That is exactly what we accomplish with GoodLife’s Professional Extended Family model.  

We encourage you to explore GoodLife’s website that has videos, testimonials, and contact information for our team here that loves to help people pursue the Professional Extended Family lifestyle.
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