Person-Centered Planning in IDD Community Homes: Balancing Choice, Safety, and Quality of Life Beyond Compliance

Community homes for people with intellectual and developmental disabilities face a critical challenge: how to honor individual choice while meeting safety requirements. This article brings together expert perspectives on practical strategies that balance autonomy with compliance in residential settings. Learn how shared risk agreements and targeted technology solutions can transform daily life for residents without compromising regulatory standards.

In This Article

• Shared Risk Agreements Elevate Autonomy
• Personalized Tech Supports Build Community Confidence

Shared Risk Agreements Elevate Autonomy

True person-centered planning is not a document; it is a clinical and ethical commitment to the "dignity of risk." In my work with neurodevelopmental disorders, I advocate for the Shared Risk Agreement as an advanced approach. This framework moves beyond the traditional "safety first" model by identifying a resident's specific desire—such as walking to a local store alone—and collaboratively mapping out the smallest necessary safety nets to make it possible. Instead of a flat "no" based on regulatory fear, the team documents the specific training and environmental modifications provided to mitigate risk while honoring the individual's agency.

To measure if this approach is truly improving life rather than just satisfying a checklist, we must shift our metrics toward "Self-Directed Milestones." In my psychiatry practice, I look for a rise in autonomous choice frequency—the number of times a resident successfully makes a decision that differs from the house routine. We also track "felt safety," which is a patient's reported sense of comfort and belonging in their environment. When a resident's personal story moves from "I am allowed to" toward "I chose to," we know the quality of life has shifted in a way that no administrative metric can fully capture.

Contributor: Ishdeep Narang
Title: Child, Adolescent & Adult Psychiatrist | Founder
Organization: ACES Psychiatry, Orlando, Florida

Personalized Tech Supports Build Community Confidence

I am always in favor of Person-Centered Planning (PCP). It is about helping adults with intellectual and developmental disabilities to independently define their goals and preferences and incorporate them into a support plan.

In my practice, I have repeatedly encountered examples where this approach truly changed a person's life. For instance, one adult woman with an intellectual disability had long been afraid to leave her home and was completely dependent on her family's help. Together, we developed a plan that reflected her interests and preferences, gradually introduced devices that allowed her to handle some daily tasks independently, implemented monitoring through medical alert systems, and supported her safe participation in small community groups. Within a few months, she was independently planning her day, managing everyday tasks such as going to the store and pharmacy, and attending interest-based clubs, which significantly increased her confidence and quality of life.

In my experience, the key elements for successful implementation are active involvement of the person with support in expressing their preferences, technological and organizational support — alert systems and professional assistance with decision-making — and integration of the plan into everyday life, so that it reflects real daily decisions rather than just formal requirements.

Contributor: Karmela Rafael
Title: Senior Care Specialist
Organization: Be Well Medical Alert

Closing Statement from the Editor

Person-centered planning succeeds when it moves beyond documentation and into daily lived experience. The perspectives shared in this article reinforce that meaningful choice, dignity, and safety are not competing goals in IDD community homes. When teams commit to shared decision-making, measured risk, and practical supports that align with real preferences, quality of life improves in ways that compliance checklists alone cannot capture.

Editorial note

Contributor language and intent remain unchanged. Formatting updates were applied solely to improve clarity, structure, and search visibility.

Related resource: Personal Care Services for Adults with I/DD in Cheyenne, Wyoming