Lifesharing Directory for Fiscal Year 2005-06

Issued by: The Pennsylvania Office of Mental Retardation in cooperation with the OMR-PAC Lifesharing Subcommittee

December 2005

1 Introduction

This Directory is in response to requests for current information about lifesharing in Pennsylvania’s community mental retardation program. Information provided in this directory includes:

 The names and emails of County, State Center and OMR Regional Point Persons who can be contacted for further information and to address issues and concerns about lifesharing

 Information on services, costs, and people served in lifesharing across County MH/MR Programs.

Summary

Founded in the 1982 as a pilot project in Berks County, lifesharing has become a major form of residential support for people who want to have that support provided by people with whom they live and share their lives.

Lifesharing means living with and sharing life’s experiences with supportive persons who form a caring household. Lifesharing is recognizable as being both a close personal relationship and a place to live. People who receive support in lifesharing include both children and adults with a wide array of needs and challenges. Lifesharing offers an alternative to traditional residential living such an Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) and community homes.

According to a recent HCSIS report for September 2005, there are 1,909 people reported in lifesharing homes in Pennsylvania, including 1,794 people in homes licensed as family living under 55 PA Code 6500, and 115 people in homes which are not licensed due to the minimal support needs of the people. Unlicensed lifesharing means a home providing room and board for one or two people with mental retardation who are 18 years of age or older and who need a yearly average of 30 hours or less direct training and assistance per week at home. Lifesharing options are available in 45 of the 46 County MH/MR Programs across the state. There are currently 99 provider agencies that hold a family living home license for supporting people in a total of 905 licensed homes.

About this Directory

This Directory provides information to assist people who are interested in lifesharing, including: self-advocates and families, perspective lifesharers, provider agencies and County Program personnel. Agencies in 38 of the 46 County Programs provided completed survey responses in June, 2005. 1,068 people receiving support in 897 Lifesharing homes are included in this data.

Part I of the Directory contains information on lifesharing across counties. Information is provided on cost, population, contact persons and service. The information was obtained

2 by completion of a statewide survey during June through August, 2005 by County MH/MR Programs and provider agencies. The information is expected to be current for June, 2005. A copy of the survey questionnaire is provided in the back of the Directory. Additional information on respite services for specific agencies can be obtained by contacting the Regional or County Lifesharing Point Person listed in Part II.

Part I of the Directory may be useful to people who are interested in lifesharing as well as county MH/MR program and provider agency personnel who want to compare their services and cost data with other providers across the state. Persons interested in obtaining lifesharing services or becoming a lifesharer are urged to speak with an agency representative for additional information and should not make any decision regarding services based solely on the information provided in this survey. Lifesharer payments and supports vary from year to year and will also be modified based on the needs of the person as determined by the Individual Supports Plan (ISP). Provider contact information by county is contained in the Part I of the Directory as well as under the County MH/MR Program in which the provider operates.

The following summary information represents average county lifesharing costs based on the information offered by provider agencies for fiscal year 2004-05. The figures are not adjusted for population differences between provider agencies. Lifesharer payments or stipends consist of room and board and service payments, but do not include respite costs. Provider agency annual rates include all residential agency costs associated with the person, including administration, additional in-home supports, and administration.

Average Monthly Lifesharer Payment (Stipend) by County Low end: $573 Average:* $1,581 High end: $3,686, (generally for supporting two people)

Average Annual Provider Agency Budgeted Rate by County Low end: $14,575 Average:* $34,280 High end: $61,893

*Average rates are computed by the adding the average provider Annual Budgeted rate for all providers reporting in the county and dividing by the number of reporting providers. Due to provider agencies being represented in multiple counties and other discrepancies, average rates should be considered approximations.

Part II of the Directory contains a list of County, State Center and Regional Lifesharing Point Persons. These point persons are available to answer questions about lifesharing practices, programs and policy.

3 Information on Respite and Additional Agency Staff Support

This year’s lifesharing survey obtained information on the types of respite services offered to people in lifesharing. Respite means services and support provided to a person when the primary caregiver is not available. Respite can be provided for a few hours during the day or evening, or in 24 hour overnight units.

Provider-specific respite and staff support information is not included in the Directory but should be available to interested persons on request of the provider agency. Persons and families who are considering lifesharing, along with potential lifesharers, are encouraged to obtain information on the type of respite services offered by provider agencies. The Department’s recently issued MR Bulletin 00-05-04 titled: “Lifesharing through Family Living” includes the expectation that lifesharing budgets need to cover the costs of temporary and emergency respite services based on each person’s needs.

A statewide summary of respite information from this year’s Lifesharing Survey follows. In reviewing this data, please note provider agencies allow different types of respite options in their lifesharing programs, and that these respite options vary from agency to agency.

Statewide Results on Respite

 25% of agencies permit lifesharers to use respite but provide no stipend to Lifesharers for times when respite is being provided.  61% of agencies permit lifesharers to receive an allotment for respite services which they can arrange over the course of the year.  38% of agencies permit lifesharers to have a certain allotment of respite money available to them which they can use over the course of the year.  62% of agencies permit lifesharers to have access to respite services above and beyond their normal allotment when there is a family crisis or emergency  44% of agencies provide for hourly respite in the lifesharer’s home for less than overnight periods.  70% of agencies provide for 24 hour overnight respite in the lifesharer’s home when the lifesharer is away for planned vacations or personal reasons  53% of agencies provide hourly respite outside the lifesharer’s home for less than 24 hour overnight periods.  46% of agencies provide for 24 hour overnight respite in a dedicated respite home.  38% of agencies provide for 24 hour overnight respite in a 6400 licensed home.  72% of agencies provide for 24 hour overnight respite in another lifesharer’s home.

Persons and families who consider lifesharing, along with potential lifesharers, are also encouraged to obtain information on the types of staff support available. According to this year’s survey results, 45% of agencies across the various county programs report that their agency provides additional staff support in the lifesharing home for people who

4 require extraordinary support due to their physical, medical or behavioral condition. In reviewing these results, it is important to note that persons needing additional staff support may receive this through other agencies, and that not all persons in lifesharing would be expected to need additional supports.

Additional Information

Please contact your Regional Lifesharing Point Person for additional information or clarification on these survey results. The Regional Lifesharing Point Persons are:

Region Lifesharing Point Person(s) Email Southeast Cheryl Boyle [email protected] Northeast Michelle O’Toole [email protected] Debbie Fox [email protected] Central Dan Kuruna [email protected] Harvey D. Erb [email protected] Western Don Stahlman [email protected]

5 Part I.

Pennsylvania Lifesharing Survey Responses

Central Region

County: Blair Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Family 6 6 6 0 $1250 $1250 $1250 $34,400 Services, Inc. Skills of Central 25 19 19 0 $1101 $1154 $1390 $24,703 PA TOTALS 31 25 25 0 $1101 $1202 $1390 $29,551

County: Cambria Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Cambria 2 1 1 0 $1020 $1020 $1020 $19,000 Residential Skills 3 3 3 0 $1319 $1488 $1603 $28,242 TOTALS 5 4 4 0 $1020 $1254 $1603 $23,621

County: Centre Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Skills 5 4 4 0 $1119 $1295 $1575 $28,146 TOTALS 5 4 4 0 $1119 $1295 $1575 $28,146

County: Columbia/Montour/Snyder/Union Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Shared Supports 2 2 2 0 $1500 $1500 $1500 CMSU 20 15 14 1 $1225 $1313 $1400 $20,940 Residential TOTALS 22 17 16 1 $1225 $1406 $1500 $20.940

County: Cumberland/Perry Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget CPARC 8 5 5 0 $1200 $1293 $1400 $26,500 Keystone Svcs. 1 1 1 0 $1538 $1538 $1538 $31,714 Susquehanna 1 1 1 0 $1650 $1650 $1650 $36,000 Developmental TOTALS 10 7 7 0 $1200 $1493 $1650 $31,404

County: Dauphin Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Keystone 12 10 10 0 $1395 $1402 $1488 $39,363 Residence Susquehanna 11 10 10 0 $1475 $1475 $1650 Developmental TOTALS 23 20 20 0 $1395 $1438 $1650 $39,363

6 County: Franklin/Fulton Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Keystone 9 7 7 0 $1270 $1291 $1417 $42,828 PA Mentor 20 14 12 2 $1515 $1594 $1696 $31,728 TOTALS 29 21 19 2 $1270 $$1442 $1696 $37,278

County: Huntingdon/Mifflin/Juniata Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Mifflin/Juniata 2 1 1 0 $2120 $2120 $2120 $25,440 Special Needs Center Raystown 11 8 8 0 $1501 $1592 $1615 $29,883 Developmental Skills 3 3 2 1 $1118 $1146 $1200 $33,700 Supportive 5 5 4 1 $1200 $1350 $1500 $36,529 Concepts for Families, Inc TOTALS 21 17 15 2 $1118 $1552 $1615 $31,388

County: Lancaster Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Community 0 0 0 0 0 0 0 0 Services Group Keystone 5 4 4 0 $1116 $1258 $1426 $23,341 Residence of Lancaster Friendship 12 8 8 0 $1200 $1800 $2800 Community The PAI Corp. 3 3 3 0 $1460 $1460 $1520 $20,189 TOTALS 20 15 15 0 $1116 $1506 $1520 $21,765

County: Lebanon Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Community 3 2 2 0 $1369 $1400 $2000 $$28,320 Services Group TOTALS 3 2 2 0 $1369 $1400 $2000 $$28,320

County: Lycoming/Clinton Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Hope 13 12 12 0 $1436 $1744 $1845 $30,000 Enterprises, Inc. Community 8 7 7 0 $1779 $1971 $2183 $34,360 Services Group TOTALS 21 19 19 0 $1436 $1857 $2183 $32,180

County: Northumberland Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Keystone 28 22 22 0 $30,00 Service Systems Shared Support 2 2 1 1 $1500 $2000 $2500

7 TOTALS 30 24 23 1 $1500 $2000 $2500 $30,000 County: York/Adams Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Keystone Svcs. 1 1 1 0 $30,000 Systems Bell 1 1 1 0 $1650 $1650 $1650 $20,075 Socialization TOTALS 2 2 2 0 $1650 $1650 $1650 $25,037

Western Region

County: Allegheny Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Achieve/Compro 4 4 4 0 $1520 $1912 $2900 $28,346 Allegheny East 11 10 10 0 $1436 $1686 $3686 $29,000 Chartiers 5 3 3 0 $1000 $1000 $1025 $17,779 Keystone 1 1 1 0 TOTALS 21 18 18 0 $1000 $1532 $3686 $25,041

County: Beaver Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Passavant 1 1 1 0 $2600 $2600 $2600 $61,893 TOTALS 1 1 1 0 $2600 $2600 $2600 $61,893

County: Butler Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget The ARC 26 18 17 1 $1500 $1500 $1500 $36,200 TOTALS 18 17 1 $1500 $1500 $1500 $36,200

County: Clarion Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Passavant Mem. 6 6 6 0 $2387 $2387 $2387 $28,652 Homes United Comm. 6 3 1 2 $833 $1270 $3041 $40,837 Indep. Prog. Person First 1 1 0 1 $900 $900 $900 Choice 4 4 4 0 $1775 $1825 $1875 $20,000 Enterprise TOTALS 17 14 11 3 $833 $1595 $2050 $29,829

County: Clearfield/Jefferson Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Fayette 42 29 29 0 $1832 $1910 $2302 Resources Keystone 1 1 1 0 $30,000 TOTALS 43 30 30 0 $1832 $1910 $2302 $30,000

8 County: Crawford Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget The ARC of 22 21 18 3 $1353 $1581 $1728 $29,815 Crawford Co. Diversified 1 1 1 0 $1186 $1186 $1186 $$48,000 Family Services Erie Homes 2 2 1 1 $1833 $1885 $1937 $32,700 Supports, Inc. 12 11 11 0 $1736 $2261 $2336 $46516 Touch-Stone 18 17 17 0 $1749 $1790 $2015 $38,694 United Comm. 11 10 10 0 $1667 $1351 $2506 Independence TOTALS 66 62 58 4 $1186 $1675 $2566 $39,145

County: Erie Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Barber Nat’l 23 16 18* 0 $1284 $1496 $2659 $$30,025 Institute Erie Homes 5 5 4 1 $1833 $2341 $3242 $36,500 Lakeshore 10 9 2 7 $1250 $1791 $3250 $30,000 Stairways 2 1 1 0 $1250 $1250 $1250 $17,380 Behav. Health TOTALS 40 31 25 8 $1250 $1719 $3250 $28,476 indicates 2 licensed homes waiting for individuals

County: Greene Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Greene ARC 9 7 6 1 $573 $651 $728 $16,107 Fayette 1 1 1 0 $1348 $1348 $1348 $26,946 Resources TOTALS 10 8 7 1 $573 $999 $728 $21,526

County: Lawrence Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Fayette 1 1 0 1 $3385 $3385 $3385 $41,194 Resources TOTALS 1 1 0 1 $3385 $3385 $3385 $41,194

County: Potter Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Potter County 8 5 5 0 $2372 $2372 $2372 $42,622 Human Services TOTALS 8 5 5 0 $2372 $2372 $2372 $42,622

County: Venango Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget United Comm. 5 4 4 0 $1682 $682 $1682 $27,869 Indep. Prog. TOTALS 5 4 4 0 $1682 $682 $1682 $27,869

9 Northeast Region

County: Berks Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 1 1 1 0 $1800 $1800 $1800 $31,500 Access Services 1 1 0 1 $1250 $1250 $1250 $26,875 Prospectus/Berco 17 12 5 7 $1380 $1428 $1650 $25,332 Spectrum 11 9 9 0 $1450 $1500 $1500 $18,250 Supportive Prosp. 21 14 10 4 $1080 $1385 $2250 $41,993 for Families Threshold Rehab 23 15 12 3 $2015 $2170 $2325 $32,083 TOTALS 74 52 37 15 $1080 $1588 $2325 $29,338

County: Bradford Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Martha Lloyd 1 1 1 0 $1276 $1276 $1276 $17,213 TOTALS 1 1 1 0 $1276 $1276 $1276 $17,213

County: Carbon/Monroe/Pike Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Fitzmaurice 17 15 12 3 $1278 $1725 $2678 $14,575 Helping Hand 3 2 2 0 $1900 $1936 $2300 $29,219 Outreach Svcs. Human 4 4 4 0 $1520 $1559 $1643 $42,347 Resource Ctr. PA Mentor 4 4 2 2 $1350 $1350 $1448 $42,617 The ReDCo 10 9 6 3 $1500 $1667 $2700 Grp. Spectrum 10 7 5 2 $1260 $1260 $2100 $19,190 TOTALS 48 41 31 10 $1260 $1582 $2700 $35,589

County: Lackawanna/Susquehanna/Wayne Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget The ARC of 5 4 4 0 $1817 $2247 $2827 $38,325 Lacka. Co. PA Mentor 5 4 4 0 $1350 $1359 $2100 $41,975 St. Joseph Ctr. 1 1 1 0 $1380 $1380 $1380 $33,531 Step By Step 7 7 4 3 $1260 $1335 $1442 $30,000 Keystone 14 11 10 1 $1352 $1352 $1352 $28,824 Comm. Svcs. TOTALS 32 27 23 4 $1260 $1534 $2827 $34,531

10 County: Lehigh Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 31 28 23 5 $1100 $1400 $200 $28,320 Impact Systems 24 19 9 10 $1260 $1679 $1680 $37,960 LifePath, Inc. 12 12 4 8 $1192 $1258 $1273 $26,504 NW Human 2 1 1 0 $1878 $1878 $1878 $50,868 Services of L.V. Step By Step 2 2 2 0 $1052 $1436 $1820 $$32,393 Supp. Conc. for 3 3 3 0 $1080 $$1385 $2250 $42,000 Families Via of the 6 6 1 5 $1200 $1200 $1200 $28.389 Lehigh Valley TOTALS 80 71 43 28 $1052 $1462 $2250 $35,204

County: Luzerne/Wyoming Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Impact Sys. Inc. 1 1 0 1 PA Mentor 21 16 15 1 $1350 $1403 $1665 $35,635 Step By Step 6 4 4 0 $1350 $1361 $1432 $30,000 TOTALS 28 21 19 2 $1350 $1382 $!665 $32,817

County: Northampton Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 26 25 20 5 $1100 $1260 $1500 $23,100 PA Mentor 1 1 1 0 $1500 $1500 $1500 $36,034 TOTALS 27 26 21 5 $1100 $1380 $1500 $29,567

County: Schuylkill Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 17 17 15 2 $1200 $1315 $1400 $30,100 Northwestern 1 1 1 0 $1500 $1500 $1500 $38,243 Human Services TOTALS 18 18 16 2 $1200 $1407 $1500 $34,171

County: Tioga Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Laurel Health 6 5 5 0 $1240 $1550 $2790 $27,493 Systems Martha Lloyd 5 4 4 0 $1350 $1350 $1350 $21,989 TOTALS 11 9 9 0 $1240 $1450 $2790 $24,741

11 Southeast Region

County: Bucks Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 10 10 3 7 $1250 $1250 $1250 $31,600 B.A.R.C. 2 2 0 2 $1540 $1540 $1540 $26,372 Devine Prov. 1 1 1 0 $1430 $1430 $1430 $42,310 Cath. Soc. Svcs. Indian Creek 1 1 1 0 $1300 $1300 $1300 $35,448 Foundation Ken-Crest 5 5 5 0 $1325 $1500 $2000 $53,355 PA Mentor 4 4 1 3 $1961 $1961 $1961 $44,750 TOTALS 23 23 11 12 $1250 $1496 $2000 $38,972

County: Chester Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 2 2 2 0 $1250 $1250 $1250 $27,000 Elwyn 1 1 0 1 $1393 $1393 $1393 $31,000 Indian Creek 1 1 1 0 $1500 $1500 $1500 $47,898 Ken-Crest 12 11 6 5 $1325 $1382 $2353 $45,800 Northwestern 2 2 2 0 $1350 $1475 $1600 $44,979 Human Services TOTALS 18 17 11 6 $1200 $1400 $2353 $39,335

County: Delaware Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 1 1 0 1 $1300 $1300 $1300 $36,023 Catholic Social 4 3 0 3 $1430 $1430 $1790 $28,000 Services Community 2 1 1 0 $1500 $1500 $1700 $25,000 Interactions Elwyn, Inc. 4 4 1 3 $1393 $1767 $2142 $31,000 TOTALS 11 9 2 7 $1300 $1499 $2142 $30,005

County: Montgomery Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Access Services 19 18* 11 8 $1250 $1250 $1250 $31,000 Ken-Crest 31 25 19 6 $1325 $1401 $2000 $46,136 Indian Creek 13 11 3 8 $1260 $1517 $1575 $35,448 Foundation TOTALS 63 54 33 22 $1250 $1389 $2000 $37,528 * denotes a home in which one licensed individual and one unlicensed individual both reside

12 County: Philadelphia Agency # # # # Low End Avg. Mo. High End Av. Annual Indiv. Homes Lic. Unlic. Mo. Stipend Stipend Mo. Stipend Budget Barber National 5 5 5 0 $1860 $2060 $2260 $33,000 Institute Catholic Soc. 1 1 1 0 $1430 $1430 $1430 $29,00 Svcs./Divine/ DHS Cath. Soc. Svcs. 48 43 17 26 $1430 $1460 $1786 $27,000 Community 1 1 1 0 $1500 $1700 $1580 $25,000 Interaction, Inc. Elwyn, Inc. 5 4 2 2 $1393 $1767 $2142 $31,000 Greenwich 14 13 13 0 $1586 $!678 $1636 $23,000 Services, Inc. Intercommunity 1 1 0 1 $1550 $1550 $1550 $30,179 Action Horizon House 5 5 4 1 $1801 $1930 $$1994 $41,652 JEVS 16 13 6 7 $1600 $1600 $2380 $35,000 Ken-Crest 14 12 7 5 $1325 $1546 $2000 $53,355 Northwestern 11 11 10 1 $1625 $1625 $1625 $31,651 Human Services PA Mentor 16 15 8 7 SPIN, Inc. 20 19 9 10 $1800 $2150 $2500 $35,000 RHD 2 2 2 0 $1500 $1750 $2000 $40,000 TAIG 15 15 3 12 $1558 $1818 $2078 TOTALS 174 160 88 72 $1325 $1718 $2500 $30,245

13 PA Lifesharing Survey Response Contacts

Central Region

County: Blair Agency Contact Phone number Email Family Services, Inc. Cathy McFee 814-944-4402 x351 [email protected] Skills of Central PA Sarah Shaw 814-238-3245 x307 [email protected]

County: Cambria County contact: Maryann Arnone 800-272-7310 Agency Contact Phone number Email Cambria Residential No name given 814-266-1829 [email protected] Skills of Central PA Sarah Shaw 814-238-3245 x307 [email protected]

County: Centre Agency Contact Phone number Email Skills of Central PA Sarah Shaw 814-238-3245 x307 [email protected]

County: CMSU Agency Contact Phone number Email Shared Supports Elizabeth DeVett 570-766-4521 [email protected] CMSU Residential Carol Drumheiser 570-275-8691 [email protected]

County: Cumberland/Perry County contact: Mark Evans 717-240-6325 [email protected] Agency Contact Phone number Email CPARC Carol Ferenz 717-249-2611 [email protected] Keystone Services Sunday Zarko 570-286-6325 [email protected] Susquehanna Developmental Karen Santanna 717-238-6161 x16 [email protected]

County: Dauphin County contact: Joy Hafer 717-255-2888 Agency Contact Phone number Email Keystone Residence Pam Foreman 717-635-2713 [email protected] Susquehanna Developmental Karen Santanna 717-238-6161 x16 [email protected]

County: Franklin/Fulton Agency Contact Phone number Email Keystone Services Dawn McCrea 717-267-0442 [email protected] PA Mentor Kathy Watson 717-657-2073 [email protected]

County: HMJ County contact: Michele Kaufman 717-248-6467 Barb Brubaker 717-248-0351 x105 [email protected] Agency Contact Phone number Email Miff/Jun Special Needs Center Deb Fisher 717-248-6261 [email protected] Raystown Developmental Cherie Lawn 814-643-6510 [email protected] Skills of Central PA Sarah Shaw 814-238-3245 x307 [email protected]

14 County: Lancaster County contact: Jennifer Hiester 717-295-3582 [email protected] Agency Contact Phone number Email Community Services Group Patrick Flaherty 717-285-7121 [email protected] Keystone Residence/Lancaster Laura Preiss 717-358-1341 [email protected] The PAI Corporation Laurie Kleynen 717-519-6740 [email protected]

County: Lebanon County contact: Chris Heibel 717-274-3415 [email protected] Agency Contact Phone number Email Community Services Joe Karpinskie 717-274-5170 [email protected]

County: Lycoming/Clinton County contact: Sharon Wilson 570-323-2929 Ellen Donenico 570-323-2929 [email protected] Agency Contact Phone number Email Hope Enterprises, Inc. Doug Bartlett 570-326-7413 [email protected] Community Services Group Kent Young 570-323-6944 [email protected]

County: Northumberland County contact: Judy Davis 570-495-2003 Tera Avellino 570-495-2006 [email protected] Agency Contact Phone number Email Keystone Service Systems Sunday Zarko 570-286-6325 [email protected] Shared Supports Elizabeth DeVett 570-766-4521 [email protected]

County: York/Adams County contact: Steven Warren 717-771-9618 Agency Contact Phone number Email Keystone Service Systems Sunday Zarko 570-286-6325 [email protected] Bell Socialization Rhoda Loerger 717-848-5767 x300

Western Region

County: Allegheny County contact: Dan McKinnon 412-350-6401 [email protected] Marc Cherna 412-350-3695 Agency Contact Phone number Email Achieva/Compro Jeanette Evans 412-995-5000 x419 [email protected] Allegheny East Seth Abrams 412-371-7391 x205 [email protected] Chartiers Andrea Friede 412-221-3302 x140 Keystone Service Systems Sunday Zarko 570-286-6325 [email protected]

County: Beaver County contact: Carole Yuhasz 724-847-6225 [email protected] Agency Contact Phone number Email Passavant Memorial Homes Bill Waldron 412-820-1010 x63 [email protected]

County: Butler County contact: Amy Trempus 724-284-5455 [email protected]

15 Agency Contact Phone number Email The ARC Phil Rosenbauer 724-282-1500 x234 [email protected]

County: Clarion County contact: Thomas Summerville 814-226-6252 x536 Agency Contact Phone number Email Passavant Memorial Homes Bill Waldron 412-820-1010 x63 [email protected] United Community Indep. Prog. Michelle Millett 814-226-7681 [email protected] Person First Tim Griffin [email protected]

County: Clearfield/Jefferson County contact: Susan Hartzfeld 814-265-1060 [email protected] Thomas Brandon 814-265-1060 Agency Contact Phone number Email Fayette Resources Mark Hamilton 814-372-2115 [email protected] Keystone Service Systems Sunday Zarko 570-286-6325 [email protected]

County: Crawford County contact: Valerie King 814-373-2620 [email protected] Agency Contact Phone number Email The ARC of Crawford Co. Jane Baird 814-724-7346 [email protected] Diversified Family Services Nancy Tusinac 724-346-2123 [email protected] Erie Homes Hope Ruedy 814-454-1534 [email protected] Supports, Inc Kathy Lee 814-337-8146 [email protected] Touch-Stone James Henry 814-337-1259 [email protected] United Community Independence Charles Ingram 814-3732620 x1123

County: Erie County contact: John DiMatto 814-451-6826 [email protected] Ron Klonicki Dennis Nevinsky Agency Contact Phone number Email Barber National Institute Carrie Kontis 814-878-4043 Erie Homes Hope Ruedy 814-454-1534 [email protected] Lakeshore Maryann Henning 814-456-9962 [email protected] Stairways Behavioral Health Beth Thomas 814-878-2007 [email protected]

County: Greene County contact: Kevin McElligott 724-852-5276 [email protected] Agency Contact Phone number Email Greene ARC Mary Keim 724-627-5511 [email protected] Fayette Resources Amanda Hardy 724-437-6461 [email protected] County: Lawrence County contact: Daniel Gloclano 724-658-2538 [email protected] Agency Contact Phone number Email Fayette Resources Scott Sennett 724-437-6461 x126

County: Potter County contact: Sherry Hoffman 814-544-7315 Agency Contact Phone number Email Potter County Human Services Sherry Hoffman 814-544-7315 shoffman@pottercountyhumansvcs. org

County: Venango County contact: Joey Zuck 814-432-9754

16 Agency Contact Phone number Email United Community Indep. Prog. Jim Robertson 814-677-9361 [email protected]

Northeast Region

County: Berks County contact: McCall Miller 610-236-4852 Kim Wittich 610-236-3929 [email protected] Agency Contact Phone number Email Access Services Bob Puchyr 610-866-6667 x228 Access Services Kathy Trumbore 610-478-3271 [email protected] Prospectus/Berco Debbie Dellago 610-372-4637 x101 [email protected] Spectrum Devin McFerren 610-372-0776 x213 dmcfeerenspectrumcommunityservices.com Supportive Concepts for Families Drue Robinson 610-372-7712 x113 [email protected] Threshold Rehab Sean McGarvey 610-777-7691 x136 [email protected]

County: Bradford County contact: Amy Updike 570-265-1760 [email protected] Agency Contact Phone number Email Martha Lloyd Cindy Pequignot 570-662-0338 [email protected]

County: Carbon/Monroe/Pike County contact: Fred Beltz 570-420-1900 x3423 [email protected] Agency Contact Phone number Email Fitzmaurice Lisa Hoag 570-424-6227 x11 [email protected] Helping Hand Outreach Services Gary Adams 570-223-9264 [email protected] Human Resource Center Crystal Shaffer 570-253-3782 x122 PA Mentor Marie Boyd 800-825-7014 x208 [email protected] The ReDCo Group Bernadette Beckett 610-377-6730 [email protected] Spectrum Devin McFerren 610-372-0776 x213 dmcfeerenspectrumcommunityservices.com

County: Lackawanna/Susquehanna/Wayne County contact: Rachel Toman 570-346-5741 [email protected] Agency Contact Phone number Email The ARC of Lackawanna Co. Donna Laniewski 570-346-4010 [email protected] PA Mentor Marie Boyd 800-825-7014 x208 [email protected] St. Joseph Center Ann Rink 570-963-1263 [email protected] Step By Step Dawn Coolbaugh 570-829-3477 x122 [email protected]

County: Lehigh County contact: Jackie Roberts 610-782-3126 Agency Contact Phone number Email Access Services Bob Puchyr 610-866-6667 x228 Impact Systems Christine Diehl 610-435-1561 x27 [email protected] LifePath, Inc. Bernadette Page 610-264-5724 x218 [email protected] Northwest Human Services of LV Ellen Miller 610-799-3019 Step By Step Dawn Coolbaugh 570-829-3477 x122 [email protected] Supportive Concepts for Families Drue Robinson 610-372-7712 x113 [email protected] Via of the Lehigh Valley Barbara Kling 610-317-8000 x462 [email protected]

County: Luzerne/Wyoming County contact: Patricia Baran 570-831-7283 [email protected] Agency Contact Phone number Email

17 Impact Systems, Inc. John Ferdinand 570-829-3671 [email protected] PA Mentor Marie Boyd 800-825-7014 x208 [email protected] Step By Step Dawn Coolbaugh 570-829-3477 x122 [email protected]

County: Northampton County contact: Ann Kline 610-974-7522 Norman Weeks 610-974-7509 Bonnie Gerber 610-974-7500 Agency Contact Phone number Email Access Services Bob Puchyr 610-866-6667 x228 PA Mentor Marie Boyd 800-825-7014 x208 [email protected]

County: Schuylkill County contact: Terri Salata 570-628-1180 Agency Contact Phone number Email Access Services Shane Richardson 570-366-1154 [email protected] Northwestern Human Services Michelle Gibson 570-628-3323 x15 [email protected]

County: Tioga County contact: Denise Bess-Krise 570-724-5766 [email protected] Agency Contact Phone number Email Laurel Health Systems Mary Aumick 570-724-0615 [email protected] Martha Lloyd Cindy Pequignot 570-662-0338 [email protected]

Southeast Region

County: Bucks County contact: Mary Beth Mahoney 215-442-0760 [email protected] Joyce Lucas 215-442-0760 Nancy Trearty 215-442-0760 Agency Contact Phone number Email Access Services Kathy Trumbore 215-540-2150 x272 [email protected] B.A.R.C. Karen Geisen 215-536-2097 x308 [email protected] Divine Prov. Cath. Soc. Svcs. Jim Boyle 610-544-7813 [email protected] Indian Creek Foundation Sandie Bernstein [email protected] Ken-Crest Carol Reckard 610-487-1582 [email protected] PA Mentor Karen Reinert-Zook 215-925-3480 x5029 [email protected]

County: Chester County contact: Loretta Eastburn 610-344-5997 [email protected] Agency Contact Phone number Email Access Services Kathy Trumbore 215-540-2150 x272 [email protected] Elwyn Johanna Schaaf 610-891-7012 [email protected] Indian Creek Foundation Sandie Bernstein 267-203-1500 x152 [email protected] Ken-Crest Carol Reckard 610-487-1582 [email protected] Northwestern Human Services Jennifer Kresge 610-840-0880 x356 [email protected]

County: Delaware County contact: Loretta Guttman 610-713-2463 Kathy Moffa 610-544-7813 [email protected] Jim Carlin 610-713-2400 [email protected] Agency Contact Phone number Email Access Services Kathy Trumbore 215-540-2150 x272 [email protected]

18 Divine Prov. Cath. Soc. Svcs. Jim Boyle 610-544-7813 [email protected] Community Interactions Travis York 610-328-9008 x136 [email protected] Elwyn Johanna Schaaf 610-891-7012 [email protected]

County: Montgomery County contact: Marguerite Peashock 610-278-3642 [email protected] Agency Contact Phone number Email Access Services Kathy Trumbore 215-540-2150 x272 [email protected] Ken-Crest Carol Reckard 610-487-1582 [email protected] Indian Creek Foundation Sandie Bernstein 267-203-1500 x152 [email protected]

County: Philadelphia County contact: Helga Krauss 215-685-5904 [email protected] Agency Contact Phone number Email Barber National Institute Yahya Rahmon Divine Prov. Cath. Soc. Svcs. Jim Boyle 610-544-7813 [email protected] Cath. Soc. Svcs. Jim Boyle 610-544-7813 [email protected] Community Interactions Travis York 610-328-9008 x136 [email protected] Elwyn Johanna Schaaf 610-891-7012 [email protected] Greenwich Services (now AVS) No contact info Intercommunity Action Renee Ash 215-487-3150 [email protected] Horizon House Beth Gibson 215-386-5322 x403 [email protected] JEVS Karen Foster 215-848-7855 [email protected] Ken-Crest Carol Reckards 610-487-1582 [email protected] Northwestern Human Services Angelique Scott 215-632-9040 x71 PA Mentor Karen Reinert-Zook 215-925-3480 x5029 [email protected] SPIN, Inc. Jennifer Fenton 215-698-3076 [email protected] RHD Grace Dempter 215-951-0300 x3096 [email protected] TAIG Rita White 215-320-2040 x2294 [email protected]

19 Pennsylvania Lifesharing Averages

Average Stipends and Budgets

Avg. Monthly Stipend Avg. Annual Budget Central Region Blair $1,202.00 $29,551.00 Cambria $1,254.00 $23,621.00 Centre $1,295.00 $28,146.00 CMSU* $1,406.00 $20,940.00 Cumberland/Perry* $1,493.00 $31,404.00 Dauphin $1,438.00 $39,363.00 Franklin/Fulton* $1,442.00 $37,278.00 HMJ* $1,552.00 $31,388.00 Lancaster $1,374.00 $21,765.00 Lebanon $1,430.00 $22,880.00 Lycoming/Clinton* $1,971.00 $32,180.00 Northumberland $2,000.00 $30,000.00 York/Adams* $1,650.00 $25,037.00 Regional average $1,500.00 $28,734.00

Western Region Allegheny $1,532.00 $25,041.00 Beaver $2,600.00 $61,893.00 Butler $1,500.00 $36,220.00 Clarion $1,519.00 $34,744.00 Clearfield/Jefferson* $1,910.00 $30,000.00 Crawford $1,186.00 $39,145.00 Erie $1,710.00 $28,476.00 Greene $999.00 $21,526.00 Lawrence $3,385.00 $41,194.00 Potter $2,372.00 $42,622.00 Venango $1,682.00 $27,869.00 Regional average $1,854.00 $35,339.00

Northeast Region Berks $1,588.00 $29,338.00 Bradford $1,276.00 $17,213.00 Carbon/Monroe/Pike* $1,582.00 $35,589.00 Lackawanna/Susquehanna* $1,578.00 $35,957.00 Lehigh $1,462.00 $35,217.00 Luzerne/Wyoming* $1,382.00 $32,817.00 Northampton $1,380.00 $29,567.00 Schuylkill $1,407.00 $34,171.00 Tioga $1,450.00 $24,741.00 Regional average $1,456.00 $37,631.00

Southeast Region Bucks $1,496.00 $38,974.00 Chester $1,400.00 $39,335.00 Delaware $1,579.00 $30,005.00

20 Montgomery $1,389.00 $37,528.00 Philadelphia $1,718.00 $30,245.00 Regional average $1,516.40 $35,217.00 Central Region average $1,500.00 $28,734.00 Western Region average $1,854.00 $35,339.00 Northeast Region average $1,456.00 $37,631.00 Southeast average $1,516.00 $35,217.00 State-wide average $1,581.00 $34,230.00 * denotes information given for combined counties

Number of Homes and Individuals

Individuals Total Licensed Unlicensed Low High Homes Homes Homes Stipend Stipend Central Region Blair 31 25 25 0 $1,101 $1,390 Cambria 5 4 4 0 $1,020 $1,603 Centre 5 4 4 0 $1,119 $1,575 Columbia/Montour/ 22 17 16 1 $1,225 $1,500 Snyder/Union* Cumberland/Perry* 10 7 7 0 $1,200 $1,650 Dauphin 23 20 20 0 $1,395 $1,650 Franklin/Fulton* 29 21 19 2 $1,270 $1,696 Huntingdon/Mifflin/ 21 17 15 2 $1,118 $1,615 Juniata* Lancaster 20 15 15 0 $1,116 $1,520 Lebanon 3 2 2 0 $1,369 $2,000 Lycoming/Clinton* 21 19 19 0 $1,436 $2,183 Northumberland 30 24 23 1 $1,500 $2,500 York/Adams* 2 2 2 0 $1,650 $1,650 Totals 222 177 171 6 $1,020 $2,500

Western Region Allegheny 21 18 18 0 $1,000 $3,686 Beaver 1 1 1 0 $2,600 $2,600 Butler 26 18 17 1 $1,500 $1,500 Clarion 17 14 11 3 $833 $2,050 Clearfield/Jefferson* 43 30 30 0 $1,832 $2,302 Crawford 66 62 58 4 $1,186 $2,566 Erie + 40 31 25 8 $1,250 $3,250 Greene 10 8 7 1 $573 $728 Lawrence 1 1 0 1 $3,385 $3,385 Potter 8 5 5 0 $2,372 $2,372 Venango 5 4 4 0 $1,682 $1,682 Totals 238 192 176 18 $573 $3,686

21 Northeast Region Berks 74 52 37 15 $1,080 $2,325 Bradford 1 1 1 0 $1,276 $1,276 Carbon/Monroe/Pike* 48 41 31 10 $1,260 $2,700 Lackawanna/ 32 27 23 4 $1,260 $2,827 Susquehanna* Lehigh 80 71 43 28 $1,052 $2,250 Luzerne/Wyoming* 28 21 19 2 $1,350 $!665 Northampton 27 26 21 5 $1,100 $1,500 Schuylkill 18 18 16 2 $1,200 $1,500 Tioga 11 9 9 0 $1,240 $2,790 Totals 319 266 200 66 $1,052 $2,827

Southeast Region Bucks 23 23 11 12 $1,250 $2,000 Chester 18 17 11 6 $1,200 $2,353 Delaware 11 9 2 7 $1,300 $2,142 Montgomery ++ 63 54 33 22 $1,250 $2,000 Philadelphia 174 160 88 72 $1,325 $2,500 Totals 289 263 145 119 $1,200 $2,500

Central Region 222 177 171 6 $1,020 $2,500 Western Region 238 192 176 18 $573 $3,686 Northeast Region 319 265 200 66 $1,052 $2,827 Southeast Region 289 263 145 119 $1,200 $2,500 Totals 1068 897 692 209 $573 $3,686 * denotes information given for combined counties + denotes there were two licensed homes that were waiting for individuals ++ denotes there was one home in which one licensed individual and one unlicensed individual both reside

22 Part II.

County Lifesharing Point Persons Point Person County Program Region Telephone Ext E-Mail Jackie O'Connor Bedford/Somerset Central (814) 443-4891 [email protected] Arlene Shawley Bedford/Somerset Central (814) 443-4891 Helen Terza Blair Central (814) 693-3046 220 [email protected] Mary Ann Arnone Cambria Central (814) 534-2641 [email protected] Deb Gadsby Centre Central (814) 355-6786 [email protected] George Zimmerman Centre Central (814) 355-6786 Karen Dombroski Columbia/Montour/Snyder/ Union Central (570) 275-8691 [email protected]

Sue Carbaugh Cumberland/Perry Central (717) 240-6325 [email protected] Duane Lentz Dauphin Central (717) 780-7051 [email protected] Trish Elliott Franklin/Fulton Central (717) 709-4321 [email protected] Barbara Brubaker Huntingdon/Mifflin/Juniata Central (717) 242-6467 105 [email protected] Sue Blackwell Lancaster Central (717) 399-7368 [email protected] Christine Heibel Lebanon Central (717) 274-3415 [email protected] Brenda Mettley Lebanon Central (717) 274-3415 [email protected] Connie Gieniec Lycoming/Clinton Central (570) 323-2929 [email protected] Tara Avellino Northumberland Central (570) 495-2002 [email protected] Liz Frey York/Adams Central (717) 771-9618 [email protected]

Kim Wittich Berks Northeast (610) 236-3929 [email protected] Bonnie Williams Bradford/Sullivan Northeast (570) 265-1700 [email protected] Fred Beltz Cameron/Monroe/Pike Northeast (570) 420-1900 342 [email protected] 4 Rachel Toman Lackawanna/Susquehanna/Wayne Northeast (570) 346-5741 [email protected]

Pat Baran Luzerne/Wyoming Northeast (570) 831-7283 [email protected] Jacqueline Roberts Lehigh Northeast (610) 782-3531 [email protected] Ann Kline Northampton Northeast (610) 974-7522 [email protected] Cindi Butts Schuylkill Northeast (610) 628-1180 [email protected]

23 Joyce Lucas Bucks Southeast (215) 442-0760 [email protected]

Theresa Myers Philadelphia Southeast (215) 685-5924 [email protected]

County Lifesharing Point Persons Point Person County Program Region Telephone Ext E-Mail Marguerite Peashock Montgomery Southeast (610) 278-3642 [email protected]

Kathy Moffa Delaware Southeast (610) 713-2400 [email protected]

Daniel McKinnon Allegheny Western (412) 350-6401 [email protected] Randa Dunmire Armstrong/Indiana Western (724) 548-3451 [email protected] Carole Yuhasz Butler Western (724) 847-6225 [email protected] Amy Trempus Beaver Western (724) 284-5114 [email protected] Mary Haskins Cameron/Elk Western (814) 772-8016 129 [email protected] Thomas Summerville Clarion Western (814) 226-1080 536 [email protected] Sue Hartzfeld Clearfield/Jefferson Western (814) 265-1060 331 [email protected] Valerie King Crawford Western (814) 373-2620 [email protected] Dennis Nevinsky Erie Western (814) 451-6807 [email protected] Sherri Mitchell Fayette Western (724) 430-1370 [email protected] Kevin Lundeen Forest/Warren Western (814) 726-2100 [email protected] Stacie Lehnen Forest/Warren Western (814) 726-2100 [email protected] Kevin McElligott Greene Western (724) 852-5276 [email protected] Dan Golcalano Lawrence Western (724) 658-2538 [email protected] Mary Haskins McKean Western (814) 772-8016 129 [email protected] Sue Formichella Mercer Western (724) 662-1550 [email protected] Sherry Hoffman Potter Western (814) 544-7315 [email protected] James Kockler Potter/Backup Western (800) 800-2560 Joey Zuck Venango Western (814) 432-9753 [email protected] Tom Jones Washington Western (724) 228-6832 [email protected] Barb Kowalski Westmoreland Western (724) 830-3617 [email protected]

State Center Point

24 Persons Name State Center E-Mail Charles Marcinko Ebensburg Center [email protected] Ann Andracchio Hamburg Center [email protected] Douglas Pickens Polk Center [email protected] Christine Yasenchak Selinsgrove Center [email protected] Michael Lokuta White Haven Center [email protected] OMR Regional Lifesharing Point Persons Name Region E-Mail Dan Kuruna Central [email protected] Harvey Erb Central [email protected] Debbie Fox Northeast [email protected] Michele O'Toole Northeast [email protected] Cheryl Boyle Southeast [email protected] Don Stahlman Western [email protected] OMR PAC Subcommittee Contacts Name Agency E-Mail Lee Koplin Access (610) 866-6667 Jim Boyle Catholic Social Services (610)544-7813 375 83 Maryann Henning Lakeshore Community Services (814) 456-9962

Sarah Shaw Skills Group (814) 238-3245 Julia Goble SPIN, Inc. (215) 698-3072 Dawn Coolbaugh- Step by Step (570) 829-3477 122 Pearce Daniel J. Morfenski Touchstones Solutions, Inc. (814) 337-1259

Lifesharing thru Family Living Information

25 Return completed form by July 1 2005 and refer questions to: Jennifer Fenton, SPIN, Inc. 10521 Drummund Rd, Philadelphia 19154 ph:215/612-7173, or e: [email protected]

County: ______County Contact Name______County Contact Phone/Email______

Agency Name of Agency Contact Person, Telephone Number and E-mail

# of Individuals in # of Families # of Lifesharing # of Lifesharing # of Lifesharing # of 6500 Licensed # of Unlicensed Homes Lifesharing providing Relationships Relationships Relationships Homes Lifesharing over 5 years over 10 years over 15 years

Range of Monthly Stipends which Average Monthly Stipend which consists of room Average Annual Budgeted Rate for Persons consist of room and board and and board and Lifesharer’s service payment in Lifesharing consisting of room and board, Lifesharer’s service payment NOT including Respite Lifesharer’s service payment, respite, NOT including Respite related residential ISP services (e.g. transportation), and agency administration

Please check all that apply to the way your agency can provide Respite Services: _____ Lifesharers can use respite but receive no stipend for times when respite is being provided. _____ Lifesharers receive an allotment for respite services which they can arrange over the course of the year. The average per person allotment for this agency is ______hrs. of respite per year and _____ days of respite per year. _____ Lifesharers have a certain allotment of respite money available to them which they can use over the course of the year. The average per person allotment for this agency is $______of respite money per service year. _____ Lifesharers have access to respite services above and beyond their normal allotment when there is a family crisis or emergency requiring that they be apart from the individual for extended period of time. _____ Hourly respite is provided in the Lifesharer’s home for less than overnight periods.

26 _____ 24 hour overnight respite is provided in the Lifesharer’s home when the family/Lifesharer is away for planned vacations or personal reasons. _____ Hourly respite is provided outside of the Lifesharer’s home for less than 24 hour overnight periods. _____ 24 hour overnight respite is provided in a dedicated respite home. _____ 24 hour overnight respite is provided in a 6400 licensed home. _____ 24 hour overnight respite is provided in another Lifesharer’s home.

Other: Does your agency currently provide additional staff support in the lifesharing home for people who require extraordinary support due to their physical, medical or behavioral condition? Yes___ No ____. If yes, how many homes are provided with this additional staff support? ______.

NOTE: INFORMATION PROVIDED ON THIS SURVEY SHOULD BE CURRENT AS OF JUNE 2005, OR AS CLOSE TO THIS DATE AS POSSIBLE.