I’m adding to my earlier comment after reading through all of the comments shared here. I keep seeing concerns about isolation repeated, even as residents and families describe growing independence, friendships, and more choices in daily life. Some professional comments read as though they know better than residents and families what our lives are like and what we need, discounting experiences that don’t fit their idea of inclusion. Transparently, I’m also quite concerned about potential conflicts of interest involving some of the people and organizations submitting comments here.

My daughter Anna lives a big and beautiful life, and she needs substantial support every day. She wants to shop, go to church, see friends and family, and spend time in the wider community. She also wants a home where she can enjoy ordinary life without having to leave for every activity. Leaving home requires planning, accessible transportation, physical effort, and energy. It is hard and taxing for her, and those realities should matter in a discussion about her choices.

I understand the concern that onsite services could become a substitute for access to the wider community. Anna needs meaningful access to both, with support for the choices she makes. Having people visit her and having activities close to home can add to that life without replacing her opportunities to go elsewhere.

I see a double standard when ordinary neighborhood amenities are treated as desirable for people without disabilities but as evidence of isolation when people with disabilities choose them. A gym close to home can spare Anna an exhausting trip for something she wants to do. It does not mean she has given up shopping, church, or friends elsewhere. The question should be whether she can choose and receive the support to act on that choice, including when she wants something different from the people around her.

Some of the recent comments argue for autonomy while giving little weight to what residents and future residents have actually said they want. Needing help with daily life, communication, or telling one's story does not make that person's preferences less real. Anna has already explained her choice in her own comment. Her need for substantial support should not make her decision easier for someone else to dismiss.

Of course families are advocating for people they love. They are also describing specific experiences. Current residents and their families have described choosing activities, meals, transportation, relationships, and time at home. Future residents are explaining why they chose Vanguard Landing and what they want their lives to include. Those are different kinds of evidence, and both deserve consideration alongside the operating records. A positive account should be examined for what it actually tells us about a person's life.

Several comments accept Vanguard Landing as a choice for people who can pay privately while opposing waiver-funded services there. Anna cannot personally pay for the substantial daily support she needs. Without access to her waiver-funded services there, her ability to live in the home she chose would depend on whether her family could pay for all of that support. Whatever the intention, that would make this housing choice depend on family wealth and exclude people who need Medicaid to make the same choice. I do not see how that advances inclusion.

Vanguard Landing's detailed response to the site-review findings also deserves consideration on its substance. DMAS' posted reaffirmation did not address those counterpoints individually. Standing by the original observations does not, by itself, resolve the specific corrections raised or establish whether the conclusions reflect residents' lives today.

I want her to have meaningful options, the help she needs to use them, and the same respect for her preferences that people without disabilities expect for theirs. Please consider the full record and approve waiver-funded services at Vanguard Landing so she can receive support in the home she chose.