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Source: Star-News, Wilmington, N.存倉C.Sept. 27--Wilmington resident Evelyn Rispoli is a spry 70-year-old who is a machine in the kitchen -- best known for her Spanish and Italian dishes -- and such a social butterfly that she's affectionately called the neighborhood psychologist.But just a few short years ago she was so sick that her family and friends thought it was the end for her, and they got rid of all her belongings.Rispoli was in New York when she lost her leg, underwent four surgeries and journeyed to near death, with several months slipping completely from her memory. As she came to, the prognosis was still not good. But one thing she knew was that she wanted to spend her final days in North Carolina."I wanted to die with the sun in my face," she said.Today Rispoli is instead living with the sun in her face -- evidenced by the glow of her summer tan -- in her own humble home and not inside the walls of a nursing home.She's one of nearly 350 North Carolina residents who have made the transition from facility living to a community home since 2009 under what's called the Money Follows the Person program. Among other things, the program has helped her set up a household, providing things such as curtains and lamps, since her old belongings had been discarded. She also participates in a Medicaid program that provides in-home health assistance.The program is but one of several state and federal initiatives designed to provide older adults and younger people with disabilities more options about where they live and receive services to help with day-to-day functioning.It helps find community placements for older adults and people with physical, mental and developmental disabilities who are Medicaid-eligible, are currently residing in long-term care facilities and meet various other criteria.'One traffic accident away'Too often younger people with disabilities get trapped in institutional settings because of an accident or illness, according to project director Trish Farnham."When we talk about supporting the resources, the funding, the attention, for people with disabilities to live in their community, it's important to consider that we are all potentially one traffic accident away from being directly impacted," she said. "Any of us could walk out tomorrow, experience a catastrophic accident, and find ourselves in a facility."She points to an eye-opening statistic: In North Carolina, an estimated 4,000 individuals living in nursing homes are Medicaid-eligible and younger than 65.The program, she said, is also vital to the state meeting its Olmstead commitments.In July 1999, the U.S. Supreme Court ruled in the landmark Olmstead case that two Georgia women with intellectual disabilities and mental illness were kept in state-run institutions in violation of Title II of the Americans with Disabilities Act. Nearly 15 years later, states across the country, North Carolina included, are grappling with the most effective way to provide community-based care to individuals with disabilities.North Carolina was one of several states intensely scrutinized by the Department of Justice for allegedly relying on institutional settings instead of community-based settings.A companion program called the Transition to Community Living initiative was born out of negotiations with the Department of Justice about how the state could provide more community living options to people with 儲存erious mental illness.A year into the settlement agreement with Department of Justice, the state is finding success in helping individuals with mental illness find alternative living situations to adult care homes. This is taking place against the backdrop of a shifting landscape for public health care, as the state reforms its mental health system, targeting tele-psychiatry and community-based crisis response, and considers a massive overhaul of Medicaid into a managed care system.Fostering independenceBoth Money Follows the Person, which helps a broad array of individuals with disabilities, and the Transition to Community Living initiative, which is focused on people with mental illness, are housed within the N.C. Department of Health and Human Services."This is not a one individual community problem. It's a statewide problem that will be solved with good work from the state level but from all of the communities involved and, frankly, the consumers and families," said Dave Richard, director of the DHHS Division of Mental Health, Developmental Disability, and Substance Abuse Services.Today, all individuals seeking placement in an adult care home undergo a pre-screening, and if found to have a serious mental illness, are referred to a local agency that helps them identify housing options and community supports available to them. If they choose to live in supportive housing instead of a facility, the agency develops a community integration plan."While the diversion process is still new, we have seen a significant number of individuals with serious mental illness that have made the choice to live with family, or in other small community-based settings," said Jessica Keith, DHHS' special adviser on the Americans with Disabilities Act.Darlene Webb, with Coastal Care, said 15 people have moved from adult care homes to community living this year in the southeastern North Carolina territory the local management entity covers. That includes seven from New Hanover County, two from Brunswick and one from Pender."That number might not sound that big, but a lot of these folks have lived in adult care homes for years," Webb said.That means individuals who have had so much taken care of for them have to relearn skills such as how to pay bills, manage their own medication and cook for themselves, she said."There's a lot that goes into getting someone into independent living," she said. "We've had folks that have left adult care homes prior to us getting involved and they ended up homeless. We were able to find them when they went into crisis. It's pretty powerful when someone has their apartment set up and they say, 'I used to be homeless, right over there.' "Rispoli knows all too well what it's like to lose everything. In the nursing home, she had lost hope. She had nothing. But she was introduced to Money Follows the Person, which helped her navigate finding a place to live and setting up household. She loves her new house, and the program has provided her with just the essentials she needs to make it a home."If you are confined, you're not living -- you're existing," she said, with tears in her eyes. "It made me realize life is precious. Everything is precious."Metro desk: 343-2389On Twitter: @StarNewsMollyCopyright: ___ (c)2013 the Star-News (Wilmington, N.C.) Visit the Star-News (Wilmington, N.C.) at .starnewsonline.com Distributed by MCT Information Servicesself storage