DRAFT – Lockable Doors and Privacy in the Residential Setting

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.21.00X

Purpose:

This Information Bulletin outlines the requirement for Home and Community Based Services (HCBS) Waiver residential providers to ensure individuals who reside in provider owned or controlled settings have the means to lock/unlock their homes and bedroom doors and have privacy in their residential living spaces.

Background:

The Federal Centers for Medicare and Medicaid Services has determined that Home and Community-Based Services (HCBS) settings must have all of the qualities specified in 42 CFR §441.301(c)(4)(i-v), based on the needs of the individual as indicated in their Personal Plan. For provider-owned or controlled residential settings that serve individuals who are enrolled in a DD Waiver program, additional conditions specified in 42 CFR §441.301(c)(4)(vi)(A) through (E) must be met.

Policy:

Provider-owned or Controlled Settings

A provider-owned or controlled setting is a physical setting in which the individual resides that is a) owned, co-owned, leased or rented by a provider of HCBS; or b) owned, co-owned, leased or rented by a third party that has a direct or indirect financial relationship with a provider of Home and Community-Based Services.

 Locked Doors and Access

When a residential setting is provider-owned or controlled the provider must ensure the individual's home and bedroom have entrance doors that are lockable by the individual with only the individual and appropriate staff having access (through keys, key fobs, codes, key cards and any other devices used to gain access through any door lock mechanism) to the doors.

Right to Privacy

 Individuals have the right to privacy unless there is an identified and documented health and safety concern. In such cases, the health and safety concern must be based on individual and assessed need and must also be documented in the Personal Plan and Implementation Strategy as indicated in the Modification section below. The provider agency should not have a policy that prohibits bedroom locks for individuals.

 Staff entering an individual's bedroom must knock and receive permission (unless there is an emergency, health or safety concern). In an emergency, health, or safety situation, it may be appropriate for staff to enter an individual's locked room without permission. The Personal Plan and Implementation Strategy should address the circumstances in which this might happen. Access to the individual's home and room should be limited to individuals who reside in the setting, identified staff and based on circumstances and/or purposes described in the Personal Plan.

 Individuals should be afforded the same respect and dignity as a person not receiving home and community-based services, and as such, must have:

  • The option for a lockable front door to their home; have access (through keys, key fobs, codes, key cards and any other devices used to gain access through any door lock mechanism) to their bedroom and/or home.
  • If the home is shared between others (non-relatives), the bedroom must be lockable from the inside and the outside.
  • The staff person(s) allowed to have access to a person's room should be determined by the provider, the person and guardian, if applicable.
  • The Implementation Strategy must document staff that can have access to a person's home and room.
  • Staff must respect the person's privacy by requesting entry into the bedroom or home (e.g., staff will knock or request to enter a room and receive the person's permission prior to entering).
  • Staff only access a person's bedroom or home as needed to address emergency, health or safety concerns.
  • If there are circumstances that would prevent an individual from having a locked home/bedroom door, the circumstances must be discussed during the person-centered planning process, described and documented in the Personal Plan and outlined in the Implementation Strategy as described below.

Modification of the Requirement

Modifications to an individual's access to keys or right to privacy must be reviewed by the residential agency's Human Rights Committee. In addition, modifications must be supported by a specific assessed need and justified in the Personal Plan. The following must be documented in the Personal Plan and Implementation Strategy:

  • 1) Identify a specific and individualized assessed need for which the modification is required.
  • 2) Document the positive interventions and supports used prior to including any modifications to the Personal Plan.
  • 3) Document less intrusive methods that were used to meet the need that have been tried but did not work.
  • 4) Include a clear description of the condition(s) that is directly proportionate to the specific assessed need.
  • 5) Include regular collection and review of data to measure the ongoing effectiveness of the modification.
  • 6) Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated.
  • 7) Include the informed consent of the individual and guardian, if applicable.
  • 8) Include an assurance that interventions and supports will cause no harm to the individual.

The prospective, or current residential provider agency, is responsible for providing items 1-8 above and documenting these items in the Implementation Strategy. In addition, the Implementation Strategy must address the specific supports that will be provided to assist the individual to have access to their locked home/bedroom. The Independent Service Coordination agency (ISC) will work with the residential provider agency to provide available supporting documentation. The ISC is responsible for ensuring items 1-8 are reflected in the Personal Plan at the time of initial modification and are updated as appropriate per periodic review.

Effective Date:

Provider agencies must ensure the requirements outlined in this information bulletin are implemented by July 1, 2021.