The Call
She was in her late fifties. She had been caring for her daughter for twenty-one years. Her daughter was non-verbal, non-ambulatory, cognitively bright but locked inside a body that could not walk or speak or feed itself. She had been on the APD iBudget Waiver pre-enrollment list for more than a decade. She had recently transitioned to the ICMC program. And she was calling Audubon Gardens Group because she had heard we did physical therapy.
We do not do physical therapy.
We are a licensed residential care home. We provide 24-hour nursing care for adults with intellectual and developmental disabilities in small, homelike settings at The Garden at Bennett and The Garden at Ibis. We do not offer PT, OT, or speech therapy on our premises. Someone along the way had misdirected her.
That should have been the end of the call. But it wasn't, because within a few minutes of speaking with her, we realized that the misunderstanding about physical therapy was not the important misunderstanding. She was surrounded by misunderstandings about the system itself. About what services existed. About what "respite" meant. About what her transition to ICMC actually gave her access to. About the surgery she had coming up in a few months, and the fact that she had a formal path to bring her daughter into a care setting on an expedited basis that no one had told her about.
She is not the only mother having this call this week. She is not the only mother who has never had this call, either. In a system full of no's and delays and disappointments, the difference between a family getting help and a family staying stuck is very often just the vocabulary.
This is a guide to that vocabulary.
The First Word: "Respite"
When most families use the word "respite," they mean something like: I need a break. An afternoon to myself. A few hours where someone else is watching my loved one so I can rest, or run errands, or breathe.
That is not what "respite" means in the Florida IDD service system.
Under APD, respite means temporary residential placement. Your loved one goes to a licensed group home. They stay overnight. They may stay for days, weeks, or months, depending on your circumstances. It is used when a caregiver has a scheduled surgery, needs to travel, needs to work, or otherwise cannot provide care in the home for a defined stretch of time. It is not a break during the day. It is temporary out-of-home placement.
What families usually want when they use the word "respite" is one of two other things.
Adult Day Training (ADT) is a daytime program, structured somewhat like school. Your loved one is picked up in the morning, participates in structured activities and therapies through the day, and is dropped off in the afternoon. Under both APD and ICMC, ADT is a covered service. If what you actually need is your loved one occupied and cared for during your workday, ADT is the service to ask for by name.
Personal Supports is in-home care provided by a caregiver who comes to your house. They assist with bathing, dressing, feeding, transferring, and companionship. They can also take your loved one out into the community for a few hours. If what you actually want is help in the home, or a companion who can take your loved one somewhere for the afternoon, Personal Supports is the service to ask for by name.
The mother who called us thought she was asking for one thing. She was actually asking for three different things, and she did not know they had different names, different codes, and different requests attached to them. When her care coordinator told her certain services were not covered, it may not have been because those services were unavailable. It may have been because she had asked in a way the system did not recognize.
The Second Word: "Personal Supports" (And the Age-18 Shift)
Here is a technical detail that matters more than it should, because most families and even many providers do not know it.
Under APD, Respite is a discrete billable service line, but it is authorized only for consumers under 18 years old. Once the consumer turns 18, temporary out-of-home care is not billed under Respite anymore. It is billed under Personal Supports.
Same care. Same home. Same nurses. Different billing code.
What this means practically: if you have an adult child and you go to your Waiver Support Coordinator asking for respite, and the WSC has been working primarily with pediatric consumers, you may hear something like "respite isn't available for adults." That is not quite true. The service is available. It has a different name on the authorization. It is billed under Personal Supports.
This is the kind of technical distinction that decides whether a family gets to yes. It should not be. But it is. And when families and coordinators and providers all know it, the system moves. When one of them does not, the family waits.
The Third Word: "Crisis Placement"
When the mother called us, she was facing a surgery that would leave her unable to lift or care for her daughter for several months. She had been on the APD pre-enrollment list for more than a decade. She assumed her only option was to wait longer, or to piece together in-home coverage from whatever ICMC would authorize, or to arrange temporary respite in a group home while she recovered.
She did not know about crisis placement.
Under APD, Crisis Placement is a formal process by which an individual on the pre-enrollment list can be moved onto the actual iBudget Waiver on an expedited basis when their family faces a documented crisis. A primary caregiver facing significant surgery is one such crisis. A primary caregiver in decline, whether from age or illness, is another. The death or incapacitation of a primary caregiver is another still.
Crisis Placement is not automatic. It requires documentation. It requires an application through APD. It requires that whoever is requesting it, whether the family, a support coordinator, or a provider, knows that it exists and knows how to build the packet.
For families who have been on the pre-enrollment list for years, waiting for a crisis they hoped would never come, crisis placement is often the fastest legitimate path off the list and into services.
If your loved one is on the pre-enrollment list, and the family member currently providing care is aging, or ill, or facing a scheduled procedure that will limit their ability to provide care, this is a conversation to have with your Waiver Support Coordinator or with a trusted provider now. Not after the surgery. Now.
The Fourth Understanding: What ICMC Actually Covers
The mother who called us had recently transitioned to ICMC after more than a decade on the APD pre-enrollment list. She had understood, correctly, that ICMC was a faster path to some form of help. She had understood, less correctly, that ICMC essentially paid her a caregiver stipend and did not cover things like Adult Day Training, in-home companion services, or group home placement.
That is not true.
ICMC is required to offer the same core home and community-based services families would access under the APD iBudget Waiver. That includes Personal Supports, Adult Day Training, respite in the residential-placement sense, companion services, and residential group home placement. The delivery structure is different. Under ICMC, the case manager works for Florida Community Care, the health plan administering the program, rather than for APD directly. But the services themselves are comparable.
If your ICMC care coordinator tells you a service is not available, that is worth pushing on. Ask again. Name the service. Ask what the process is to request an increase in the budget to cover it. If your care coordinator is new to ICMC, or if they have not had a family push for that particular service before, they may not know it is authorizable until they check.
For families weighing the ICMC-versus-iBudget decision, one more thing is worth knowing. Enrolling in ICMC does remove you from the APD pre-enrollment list. But you have up to one year in ICMC to switch back to the iBudget Waiver if you choose to. And because the pre-enrollment list is prioritized by current need level rather than by time waited, switching back does not restart the clock. You do not lose your standing.
That is a real safety net. It is worth knowing about before you make the decision, and it is worth knowing about after you have made it.
What the Mother Needed
By the end of the call, we had spent almost an hour together. Not because we were selling her anything. Because she had never had someone actually walk her through the vocabulary of the system she had been trying to navigate for two decades.
She now knew that if she needed her daughter in a residential setting during and after her surgery, that was respite, and we could talk about how to plan for it. She now knew that if what she wanted was someone in the home during the day so she could rest, that was Personal Supports, and she could ask her care coordinator for a companion to take her daughter out into the community a few days a week. She now knew that her surgery might qualify her for crisis placement, which could move her daughter onto the actual iBudget Waiver on an expedited basis. She now knew she had up to a year to switch back from ICMC to APD if the ICMC path did not work for her.
None of that was new to the system. All of it was new to her.
We invited her to visit. Not because we needed her daughter to be a resident, but because families who tour our homes learn things about the system they did not know before, and that knowledge stays with them even if they never place their loved one with us. Her daughter loved being around people. She was going to bring her along.
An Invitation
If you are a Florida family caring for an adult with intellectual and developmental disabilities, and you find yourself confused about what services you can access, what the words mean, or what your care coordinator should be asking for on your behalf, you are not alone. The system is genuinely difficult to navigate. Even providers and coordinators sometimes disagree about what is possible.
At Audubon Gardens Group, we take these calls every week. Sometimes the family is looking for placement. Sometimes they are looking for information. Either is welcome. If you would benefit from a conversation, or from a tour of our homes at The Garden at Bennett or The Garden at Ibis, we would be honored to sit down with you.
Reach out. There are more paths available to your family than the system will tell you about on its own.
Frequently Asked Questions
What is the difference between respite and Adult Day Training under APD?
Respite means temporary residential placement. Your loved one stays overnight in a licensed group home for a defined period, whether that is days, weeks, or months. Adult Day Training (ADT) is a structured daytime program, similar in format to school, that runs during the day and returns your loved one home at the end. If you need overnight care, ask for respite. If you need daytime coverage, ask for ADT.
Under APD, how is respite billed once my adult child turns 18?
As a discrete billable service, Respite under APD is authorized only for consumers under 18. Once the consumer is 18 or older, temporary residential care is billed under Personal Supports. The service is still available. It is simply authorized under a different code. This distinction matters, because a family that asks for Respite by name for an adult may hear that the service is unavailable when, in fact, it can be authorized under Personal Supports.
What is crisis placement, and who qualifies?
Crisis Placement is a formal APD process that moves an individual off the pre-enrollment list and onto the iBudget Waiver on an expedited basis when their family faces a documented crisis. Examples include a primary caregiver facing significant surgery, a caregiver in decline due to age or illness, or the death or incapacitation of a caregiver. It requires an application and supporting documentation. If you believe your family may qualify, talk to your Waiver Support Coordinator or a trusted provider about whether to begin the request now.
Does ICMC offer the same services as the APD iBudget Waiver?
ICMC is required to offer the same core home and community-based services as the APD iBudget Waiver, including Personal Supports, Adult Day Training, respite, companion services, and residential group home placement. The delivery structure and case management look different, but the underlying services are comparable. If your ICMC care coordinator tells you a service is not available, it is worth asking again by name and asking what the process is to authorize it.
Can I switch from ICMC back to APD if I change my mind?
Yes. You have up to one year in ICMC to switch back to the APD iBudget Waiver. Because the APD pre-enrollment list is prioritized by current need level rather than by time waited, switching back does not restart your position on the list.
Related Articles
- What Is a Waiver Support Coordinator — and How Do You Choose One?
- How to Build a Robust Funding Packet That Gets Approved
- Florida Community Cares: A New Alternative to the iBudget Waiver?
About Audubon Gardens Group
Audubon Gardens Group operates two licensed 24-hour nursing residential care homes in Orlando, Florida — The Garden at Bennett and The Garden at Ibis. We serve medically acute and complex adults with intellectual and developmental disabilities under Florida's APD iBudget Waiver and Florida Community Cares (ICMC) programs.
Joshua Wilson is a co-owner of Audubon Gardens Group and writes on residential care, APD services, and the practical realities of navigating Florida's IDD service system.
Frequently Asked Questions
What is the difference between respite and Adult Day Training under APD?
Respite means temporary residential placement. Your loved one stays overnight in a licensed group home for a defined period, whether that is days, weeks, or months. Adult Day Training (ADT) is a structured daytime program, similar in format to school, that runs during the day and returns your loved one home at the end. If you need overnight care, ask for respite. If you need daytime coverage, ask for ADT.
Under APD, how is respite billed once my adult child turns 18?
As a discrete billable service, Respite under APD is authorized only for consumers under 18. Once the consumer is 18 or older, temporary residential care is billed under Personal Supports. The service is still available. It is simply authorized under a different code.
What is crisis placement, and who qualifies?
Crisis Placement is a formal APD process that moves an individual off the pre-enrollment list and onto the iBudget Waiver on an expedited basis when their family faces a documented crisis. Examples include a primary caregiver facing significant surgery, a caregiver in decline due to age or illness, or the death or incapacitation of a caregiver.
Does ICMC offer the same services as the APD iBudget Waiver?
ICMC is required to offer the same core home and community-based services as the APD iBudget Waiver, including Personal Supports, Adult Day Training, respite, companion services, and residential group home placement. The delivery structure and case management look different, but the underlying services are comparable.
Can I switch from ICMC back to APD if I change my mind?
Yes. You have up to one year in ICMC to switch back to the APD iBudget Waiver. Because the APD pre-enrollment list is prioritized by current need level rather than by time waited, switching back does not restart your position on the list.