Home and Community Care Guide For disabled Veterans, Adults With I/DD in Cheyenne and rural communities Nationwide
Finding the Right Level of Care in and Around Cheyenne
Finding the right level of care for someone you love is one of the hardest decisions a family can face. In and around Cheyenne, families often have to choose among several options: in home support, day programs, shared homes, VA Medical Foster Homes, assisted living, or nursing facilities. The choices are even more complex when the person is a Veteran or an adult with an intellectual or developmental disability (I/DD), or when the family lives in a rural area where services are spread out.
This guide is written to give you a practical, step by step way to think through those choices. It is not legal, financial, or medical advice. Instead, it is designed to help you organize what you are seeing at home, understand the main types of care, and ask better questions so you can make decisions with more confidence. You can use this guide whether you are caring for a Veteran, an adult with I/DD, or an older adult with chronic health needs.
Step 1: Clarify What You Are Seeing At Home
Before you look at specific programs or facilities, it helps to get clear about what is happening day to day. Many families skip this step and start calling around without a clear picture of needs, which can lead to confusion and frustration.
Questions to ask yourself about safety and daily living
Is your loved one safe when left alone for several hours at a time?
Are medications being taken correctly and on time without reminders?
Have there been falls, near falls, wandering, or emergencies in the last few months?
Is personal hygiene being maintained, including bathing, dressing, and toileting?
Is your loved one able to prepare meals, eat regularly, and stay hydrated?
Is money being managed safely, with bills paid and scams avoided?
If you answer “no” to several of these questions, the person may need more consistent support than family alone can safely provide.
Questions to ask yourself about caregiver stress
Are you or other family caregivers sleeping poorly, getting sick more often, or feeling exhausted most days?
Do you feel guilty when you take even a short break?
Have work, relationships, or your own health started to suffer because of caregiving?
Caregiver burnout is a serious risk and one of the reasons national organizations stress the importance of planning ahead for additional support at home or in the community (Veterans Affairs).
Write down your answers. This “snapshot” becomes the foundation for choosing a level of care that fits the real situation, not the ideal one.
Step 2: Understand The Main Types Of Home And Community Based Care
Once you have a clear picture of needs, the next step is to understand the major care options that exist in and around Cheyenne. You may not need to know every detail, but it is helpful to understand the categories.
In home supports
In home services are designed to help the person remain in their own home or in a family home with added support:
Personal care and homemaker services: These supports help with bathing, dressing, grooming, meal preparation, light housekeeping, and basic supervision. They can be arranged privately or, for eligible Veterans, through VA Home and Community Based Services such as Homemaker and Home Health Aide Care (Veterans Affairs).
Skilled home health care: For people who need intermittent nursing, therapy, or other clinical services at home, skilled home health care can be arranged, often after a hospital stay or as part of a doctor’s care plan (Veterans Affairs).
In home supports can work well when the person is still somewhat independent or when a strong family caregiver is present but needs help with specific tasks.
Community based day programs
Community programs can provide structure, social contact, and supervision during the day:
Adult day health care and day programs: These programs offer social activities, meals, and sometimes health services during the day, allowing the person to come home at night. For Veterans, Adult Day Health Care is one of the VA’s Home and Community Based Services (Veterans Affairs).
Day habilitation and community integration for adults with I/DD: For adults with I/DD, day programs focus on building skills, community participation, and meaningful daily routines while providing supervision and support.
Day programs are often a good fit when the primary safety concerns happen during the day and the family is available at night.
Residential options in the community
Residential options provide both housing and support services:
Shared home or host home: In a shared or host home, an individual lives with or near a caregiver in a small, home like setting. The focus is on daily support, participation in the community, and a consistent relationship with the caregiver.
VA Medical Foster Home: A VA Medical Foster Home is a private home where a trained caregiver provides 24 hour supervision and support for a small number of Veterans who meet nursing home level of care but prefer a home setting. Medical care is provided through VA Home Based Primary Care teams who come into the home (Veterans Affairs).
Supported living for adults with I/DD: Supported living typically refers to individualized supports provided in a home or apartment, often funded through a state developmental disability waiver. The goal is to help the person live as independently as possible while remaining safe and connected to the community.
Assisted living and nursing facilities: Assisted living and nursing facilities provide varying levels of on site care in a larger setting. Assisted living typically supports people who need help with some activities of daily living, while nursing facilities provide 24 hour nursing care and supervision. National organizations and federal agencies provide detailed guidance on how to evaluate these facilities for safety and quality (Medicare).
No single option is right for every situation. The right level of care depends on needs, preferences, funding, and available support.
Step 3: Match Needs To Levels Of Care
With a basic understanding of the options, you can now match what you are seeing at home to the likely level of care.
When home with support may be enough
Home with added services may be a good starting point when:
Your loved one is generally safe alone for short periods but needs help with some daily tasks
There have been no recent serious falls, medication errors, or wandering
A family caregiver is available but needs relief with bathing, housekeeping, or supervision
In these situations, a mix of in home personal care, homemaker services, and possibly adult day programs can stabilize the situation and delay or prevent a move.
When community based care plus strong family support is needed
A combination of services may be required when:
Your loved one cannot be left alone safely for long periods
There are increasing memory problems or behavioral changes that create risk
The primary caregiver is nearing burnout but wants to keep the person at home as long as possible
Here, a plan might include daily or frequent in home support, structured day programs, planned respite, and clear back up plans for emergencies. For Veterans, this might involve multiple VA Home and Community Based Services, such as Homemaker and Home Health Aide Care, Adult Day Health Care, and Respite Care.
When a residential setting is the safer choice
In some situations, moving into a residential setting may be the safest and most stable option:
Your loved one is unsafe at home around the clock, despite reasonable supports
There are repeated crises, hospitalizations, or near misses
The physical and emotional demands on family have become unsustainable
Options in these scenarios may include a shared home, VA Medical Foster Home, supported living, assisted living, or a nursing facility. Looking at objective safety, quality of life, and long term sustainability can make this decision clearer and reduce guilt.
Step 4: Consider Rights, Funding, And Eligibility
Choosing care is not only about need. It is also about rights, eligibility, and the financial realities that shape what is possible.
Disability and community integration rights
For people with disabilities, including many adults with I/DD, federal civil rights law supports access to community based services and community living when appropriate. The Americans with Disabilities Act (ADA) requires public entities to provide services in integrated, community settings when those services are appropriate, the person does not oppose community based options, and reasonable modifications can be made.
This means that, where possible, people should have the option to receive services at home or in the community rather than in segregated settings.
Veteran specific programs and HCBS
For eligible Veterans, the Department of Veterans Affairs offers a range of Home and Community Based Services such as Homemaker and Home Health Aide Care, Skilled Home Health Care, Home Based Primary Care, Veteran Directed Care, Adult Day Health Care, Respite Care, Telehealth, Palliative Care, and Hospice Care. These services are designed to support independence and keep Veterans in their homes or home like settings whenever possible (Veterans Affairs).
Eligibility depends on clinical need, enrollment in VA health care, and local program availability. A VA social worker or care team member can explain which services are available through the Cheyenne VA and surrounding systems.
Other funding streams
In addition to VA programs, families may rely on:
Medicaid and developmental disability waivers for eligible adults with I/DD or low income older adults
Medicare for time limited skilled home health and rehabilitation services
Private long term care insurance or private pay for in home care, assisted living, or other services
Because rules and coverage details change, it is important to confirm current information with VA, state agencies, or qualified benefit counselors rather than relying on assumptions or outdated information from friends or social media.
Step 5: Evaluate Quality And Fit In Any Home Or Facility
Once you have identified a level of care and potential providers, the next step is to evaluate quality and fit. National organizations and federal agencies stress that there is no perfect setting, but thoughtful evaluation can significantly improve the match.
Questions to ask about care and safety
How are medications managed and who is responsible for administering or supervising them?
What systems are in place to prevent and respond to falls and emergencies?
How are infections prevented and controlled, especially in group settings?
How often are staff on site and what is the training and experience of direct care staff?
Guidance from public health agencies highlights the importance of infection prevention, vaccination, hand hygiene, and clear communication between staff, residents, and families in long term care settings.
Questions to ask about dignity, routines, and community life
Can residents keep their own routines for waking, eating, and activities as much as possible?
How are people supported to stay connected to family, friends, and the wider community?
Are there meaningful activities that match your loved one’s interests and abilities?
How are cultural, spiritual, and personal preferences respected?
For people with disabilities, including many adults with I/DD, community integration is not just a preference but a key part of their civil rights. Guidance on community integration emphasizes that community based settings should allow people to interact with others, make choices, and participate fully in daily life.
Questions to ask about communication and transparency
How are families informed about changes in health, behavior, or staffing?
Is there a clear process for raising concerns and resolving problems?
Is there a resident or family council, and how are they involved in decisions?
Nonprofit caregiver organizations recommend using formal and informal conversations, reviewing written policies, and observing staff interactions to understand how a residential setting truly operates.
Listening to your instincts matters. If something feels unsafe, disrespectful, or dismissive, it is appropriate to slow down, ask more questions, or consider other options.
Step 6: Two Cheyenne Style Scenarios To Make This Real
Sometimes it is easier to understand options through real world examples. The following scenarios are fictional, but they reflect common patterns that providers and families see in and around Cheyenne.
Scenario 1: A rural Veteran with increasing medical needs
A Vietnam era Veteran lives outside of Cheyenne with his spouse. He has heart failure, diabetes, and mobility limitations. His spouse manages medications, appointments, and daily care, but she is exhausted. There have been two recent hospitalizations after falls and missed medications.
After talking with his VA primary care team, the family and social worker create a plan that includes Home Based Primary Care, Homemaker and Home Health Aide services several times per week, and Respite Care so the spouse can rest (Veterans Affairs).
As his needs grow and nights become more difficult, the family reassesses. Together with the VA team, they decide that a VA approved Medical Foster Home in Cheyenne, connected to the same Home Based Primary Care team, will provide the consistent 24 hour support he now requires in a small, home like setting.
Scenario 2: An adult with I/DD ready for more independence
A young adult with I/DD lives with a parent in Cheyenne. He attends a day habilitation program and receives limited in home support. As the parent ages and his needs increase, everyone recognizes that a planned transition will be safer than an emergency move later.
The team explores supported living and shared home options that provide consistent caregivers, opportunities for community participation, and clear overnight supervision. Together they look at homes where residents are engaged in daily routines, staff are trained in disability support, and the environment respects preferences and rights under disability law.
In both scenarios, the key is planning: understanding needs early, using available home and community based services, and recognizing when a residential setting will provide better safety, stability, and quality of life.
Step 7: Next Steps For Families In And Around Cheyenne
If you are reading this guide, you are already doing one of the most important things: seeking clear information before making a major decision. To move from information to action, you can:
Write down what you are seeing at home, including safety concerns and caregiver stress.
Circle the level of care that seems closest to your situation: home with support, community day programs, or residential options.
Make a short list of providers or programs that match that level of care, including VA programs if the person is a Veteran.
Use the questions in this guide to structure your calls, visits, and conversations with providers.
Ask trusted professionals, such as VA social workers, physicians, case managers, or disability advocates, to review your thinking and offer their perspective.
If you are in or near Cheyenne and are considering a home like setting for a Veteran or an adult with I/DD, you can include options like shared homes or Medical Foster Homes in your research. The goal is not only to find a bed, but to find an environment where safety, dignity, and community life are all taken seriously.
References
Centers for Disease Control and Prevention. Infection Prevention and Long term Care Facility Residents.
https://www.cdc.gov/long-term-care-facilities/about/index.htmlU.S. Department of Justice, Civil Rights Division. Community Integration. ADA.gov.
https://www.ada.gov/topics/community-integration/U.S. Department of Veterans Affairs. Geriatrics and Extended Care - Home and Community Based Services.
https://www.va.gov/geriatrics/pages/Home_and_Community_Based_Services.aspFamily Caregiver Alliance. Residential Care Options: Choosing the Right Place.
https://www.caregiver.org/resource/residential-care-options-choosing-right-place/Harvard Health Publishing, Harvard Medical School. Choosing a senior living community.
https://www.health.harvard.edu/staying-healthy/choosing-a-senior-living-community
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