Resource: Service options for individualized home supports (IHS)

Page reviewed and updated: 7/14/26

Individualized home supports (IHS) is a service that provides support and/or training in community living service categories for people who live in their own home or their family’s home. IHS can be provided in the person’s own home, the family’s home or in the community, and either in person or remotely. For policy information, refer to CBSM – IHS.

IHS is a single service authorized in three different ways, depending on the type of support or training the person and/or their family needs. This resource provides lead agencies with information about the differences between service options and when to authorize them.

Service options

There are three service options for IHS:

· IHS without training: Provided to adults or children when they need support, assistance and supervision in at least one of the community living service categories.

· IHS with training: Provided to adults when they need support and training in at least one of the community living service categories.
Note: The person can receive support, but the main purpose of this service is to provide the person with training.

· IHS with family training: Provided to adults or children living in their family’s home when the person and/or their family needs support and training in at least one of the community living service categories.
Note: The person can receive support, but the main purpose of this service is to provide the person and/or their family with training.

Which service do I authorize?

The options available to the person are based on their age, living arrangement and type of support and/or training they need. Lead agencies can use the following descriptions to determine which option to authorize.

Note: If the person is an adult who lives in a residential setting (e.g., community residential services [CRS] or family residential services [FRS]), the lead agency cannot authorize IHS to replicate residential staffing or fill gaps in unpaid supervision.

Support only

The lead agency should authorize support only (through IHS without training) when:

· The person needs consistent assistance to complete tasks safely.

· The person’s goals emphasize maintenance or use of current skills, not acquisition of new ones.

Examples include:

· Cueing for daily routines and guided community access.

· Cueing for household tasks (e.g., meal preparation, safety checks).

· Guidance to access community transportation or resources.

· Assistance with health and safety tasks (e.g., reminders, prompts, monitoring).

· Companion-style help to engage in social or community activities.

Training only

The lead agency should authorize training only (through IHS with training or IHS with family training) when:

· The person needs structured learning to increase their independence or achieve a new skill.

· The person’s goals are measurable in the support plan (e.g., independently prepare a simple meal with a checklist).

· The person’s family or caregivers need support to implement developing skills (IHS with family training only).

Examples include:

· Teaching money management strategies with repeated opportunities and feedback.

· Structured instruction to use community resources independently (e.g., using public transit).

· Skill-building in adaptive areas such as problem-solving.

· Planning sessions to improve household management (e.g., budgeting, meal planning).

· Teaching crisis prevention and behavior support strategies.

Support and training

The lead agency should authorize both support and training (through IHS without training and IHS with training or family training) when:

· The person needs ongoing assistance to function safely and structured learning to build new skills.

· The person’s goals include a mix of skill acquisition and maintenance/generalization of existing skills.

· The person benefits from repetition, coaching and hands-on assistance across different environments (e.g., home, community).

Training teaches new skills, while support reinforces, prompts and applies those skills in real-life settings.

Table: Which service to authorize

Living situation and age	Training needed to remain in home?
Child living with family	· Yes: Authorize IHS with family training · No: Authorize IHS without training
Adult living in own home	· Yes: Authorize IHS with training · No: Authorize IHS without training
Adult living with family	· Yes (person and/or family need training): Authorize IHS with training · Yes (both person and family need training): Authorize IHS with family training · Neither person nor family needs training: Authorize IHS without training

Can a person have separate authorizations for IHS with training and IHS with family training?

No. A person cannot receive IHS with training and IHS with family training, even if delivered by separate providers.

Can a person have separate authorizations for IHS without training and IHS with training (including family training)?

Yes. A person can receive IHS without training and IHS with training when delivered by different service providers. The lead agency must ensure there is no service duplication, and the support plan must clearly distinguish how the services will meet the person’s training and support needs.

Can IHS be used for supervision or safety monitoring?

While waiver services exist to provide the assistance, supervision and care necessary to ensure the person’s health and safety, the lead agency must not authorize IHS solely for “watchful presence,” standby supervision or general safety monitoring when the person is not actively engaged in a covered service.

Active engagement means the person is participating in, completing or receiving instruction in a covered service. It does not include oversight or observation when the person is not engaged in a covered service. For example, the lead agency should not authorize IHS “just in case something happens” when the person is doing a passive activity, such as watching TV or scrolling on their phone. These activities are not tied to a documented skill, goal or instruction. The supervision exists solely due to risk, not because the person is engaging with services.

Can a person schedule a consistent number of hours of training every day?

While a person can receive up to 16 hours of IHS per day, the level of training and number of hours must be based on each person’s individualized need. The number of hours per training session will depend on each person’s cognitive load and ability to retain information. The person and their support team must evaluate these factors when planning for IHS with training services. Providers cannot develop company-wide policies that mandate a certain number of hours of training for the people they support.

Is there a specific process to follow when determining the appropriate service mixes?

The process in this section helps lead agencies align assessed needs with waiver service definitions and requirements. It supports consistent, person-centered decision-making when identifying an appropriate combination of services.

DHS designed this process to clarify how to match available services to different types of support (e.g., skill-building, supportive assistance, activities of daily living [ADL]/instrumental activities of daily living [IADL] help and supervision). The process also explains how to clearly document the reason for the specific services and how they support the person’s goals, health and safety. The lead agency must ensure:

· Service mixes and support plans reflect the primary purpose of the support provided.

· People use IHS appropriately as an active community living support rather than a substitute for residential-level supervision or continuous staffing.

Sample service mix support planning process

Step 1: Assessment of residential-level support needs

The lead agency must consider:

1. Does the person need more than 12 hours/day of paid support and the majority is supervision, presence or ADL assistance?

2. Does the person appear to need 24/7 staffing coverage (even if natural supports fill some hours) that resembles CRS, including:

· Shift staffing?

· Overnight awake/sleep staff?

· Continuous on-duty staff?

· Behavioral/medical support that requires frequent intervention?

3. Has the person used IHS (including IHS with training) to cover long time periods (i.e., 8–16 hours/day)?

If the lead agency answers yes to any of the above questions, continue to Step 2.

Step 2: Break the needs into categories

The lead agency must clearly label needs in the following categories.

A. Skill-building needs (training)

Examples include:

· Learn daily routines.

· Manage money.

· Navigate the community.

· Develop cooking and cleaning skills.

· Self-manage medication.

· Regulate behavior/manage self.

The service that meets these needs is IHS with training (limited to 6 hours per day).

B. Supportive assistance (support)

Examples include:

· Help with routines the person has already learned.

· Help with completing household tasks.

· Cueing and prompting.

· Support with community participation.

The service that meets these needs is IHS without training.

C. ADL/IADL assistance

Examples include:

· Bathing.

· Dressing.

· Eating.

· Toileting.

· Transfers.

· Cleaning.

· Laundry.

· Meal preparation.

· Medication administration or setup.

Service options that meet these needs include:

· Community First Services and Supports (CFSS).

· Homemaker – ADLs.

D. Supervision/safety/overnight needs

Examples include:

· Wandering/elopement risk.

· Seizure monitoring.

· Behavioral escalation monitoring.

· Nighttime support needs.

Service options that meet these needs include:

· Night supervision.

· 24-hour emergency assistance.

· Assistive technology.

Step 3: Build a blended service mix based on needs

The lead agency must blend services based on the person’s needs.

Example

The person needs 14 hours/day of support. They may receive services as follows.

Need type	Service	Hours
Skill-building	IHS with training	4–6 hours
Supportive assistance	IHS without training	4–5 hours
ADL help	CFSS	2–3 hours
Supervision	Night supervision	2–4 hours

The person has the following daily schedule.

Service	Hours
CFSS	7 to 10 a.m.
IHS without training	10 a.m. to noon
IHS with training	Noon to 2 p.m.
IHS without training	4 to 6 p.m.
IHS with training	6 to 8 p.m.
Night supervision	10 p.m. to 1 a.m.