A Welcome Home

They had been out all day; Layla handed out lunches as part of her volunteer work at Meals on Wheels, under Jones's supervision. The next day, Layla helped stuff envelopes at a community center, with Jones later asking about the experience.

Wednesday was cooking class, and Layla ringed pizza dough with pepperoni and cheese before setting the table with three other participants in the day program.

"She is part of my life now," said Jones, who has taken Layla to homecomings in Guyana, her home country, weddings and all the other social activities that she and her husband do together. "And I see her being a part of it as long as I have health and strength."

Although the concept of sponsored placements has been used in other parts of the state and across the country, there has been a spike in Northern Virginia during the past two years.

Blue Ridge Residential Services, a Lynchburg-based company, has recruited 10 caregivers since 2006 and has 12 more ready to open their homes this fall, said Richard Gilman, the company's executive director. And there appear to be many more local residents interested: Applications to Blue Ridge have tripled since October, from 10 to 30.

State officials said that the increased interest in placements in Northern Virginia is largely a result of the shortage of group homes in the region. Escalating land, labor and other costs have prevented group homes from opening fast enough to meet the region's growing population and health-care needs, officials said.

As of July 1, there was a waiting list of nearly 1,000 for group home placements in Northern Virginia, several dozen of them considered urgent.

According to the Research and Training Center for Community Living at the University of Minnesota, there are about 37,000 such approved homes across the country, about 10 percent of the available community placements nationwide. As of July 1, 2007, there were 739 placements across Virginia, nearly twice as many as in 2000. There are about 216 people living in placements in Maryland and 68 in the District, according to the center.

"Anything we can do to relieve the pressure off of our waiting lists is a positive," said Lee Price, director of intellectual disability services for the state Department of Mental Health, Mental Retardation and Substance Abuse Services. "These aren't going to be for everybody, but for hard-to-place adults and those who have been on waiting lists for a number of months or years, it's an important alternative."

Some advocates for people with mental disabilities said that the placements provide good options but sometimes do not promote the kind of independence that clients need.

"I think there's some concern that they can be isolating," said Nancy Mercer, executive director of ARC of Northern Virginia, an advocacy group. "Many with intellectual disabilities thrive in group homes, where there's more consistent interaction with their peers, relationships that can really help them grow. So they are not for everybody."

In Northern Virginia, caregivers receive an average of $67,484 a year through Medicaid, the federal-state health-care system for the disabled and poor. Caregivers work an average of 92 hours a week, and the money is appropriated for them to work with their charges on skills to help them live more independently. Medicaid does not pay for overnight care. That cost is paid through Social Security, which also covers food, rent and other living necessities for the resident. The payments are usually managed by someone other than the caregiver.