I am Anna's father and a physician. Anna's life has shaped the way I care for my patients and the way I think about quality of life. I see it in concrete terms: physical function, relationships, participation in daily life, setting goals, and having a real say in what comes next.

 

When Anna joined our family as a baby, the expectations set for her were almost nonexistent. She has cerebral palsy, and we were told she was not expected to see, crawl, walk, or talk.

 

Anna is 20 now. She reads, texts her friends, and sings. After hearing an opera singer, she told me, “I can do that,” and asked for singing lessons. She is always setting a new goal for herself and working toward it. She gathers people around her and is one of the most magnetic and emotionally intelligent people we know. My wife routinely tells people that Anna needs to be her life coach.

 

For years, Anna has done the daily work of therapy. She still needs substantial physical assistance in many parts of daily life. With that support, she participates actively in her own care, tells us what she wants, and keeps working toward greater independence.

 

Now Anna is ready for the next phase of her life. She chose Vanguard Landing before there was anything there for her to visit. She wanted a home of her own, friends nearby, and more independence with the substantial support she needs. Now she asks about it every day. When she visits, she jumps right in, engages with everyone, and does not want to leave.

 

Every home in Anna's neighborhood has the same universal design and zero-entry access, so Anna will be able to visit neighbors inside their homes without first having to determine whether she can get through the door. Most of us take that kind of access for granted. Anna has to consider it before every plan she makes.

 

Her bedroom and bathroom are customized for her mobility. She is most excited to put her own coffee maker in the kitchen for her morning lattes.

 

Anna also wants to shop, go to church, see friends and family, and spend time in the wider community. Leaving home takes planning, accessible transportation, physical assistance and energy. A trip that is simple for many of us can be exhausting for her. She should have the support to go where she wants, and the option to enjoy company and activities close to home.

 

There seems to be an idea that having friends, activities, and services close to home at Vanguard Landing will keep residents from participating in the wider community. For Anna, those nearby options would make more of daily life accessible. A gym close to home could spare her a taxing trip. Friends in accessible homes nearby would give her people to visit. She would still want to shop, go to church, and see friends and family elsewhere. People without disabilities choose neighborhoods with these conveniences. I do not understand why they become evidence of isolation when the person choosing them has a disability.

 

Living in an ordinary neighborhood does not tell us how much control someone has over her day. Anna lives at home with a family who supports her goals. Even here, her choices depend on our schedules and who is available to help. Sometimes she has to come along because the person helping her has somewhere else to be. At Vanguard Landing, she could have the support to go out when she wants and to stay home when she does not. She would still need substantial physical assistance. She would have more freedom to decide how she spends her day.

 

Anna has told us what she wants throughout her life. We took her seriously when she wanted singing lessons. We take her seriously now when she tells us where she wants to live. Needing substantial physical help does not make her preferences less real or give someone who has never met her a better understanding of the life she wants.

 

Virginia law recognizes that people with disabilities are entitled to the same opportunity as anyone else to choose housing. For Anna, living alone in an apartment with sporadic drop-in care would not provide the level or continuity of support she needs. She needs substantial support every day to live as independently as possible in the home she chose.

 

People with developmental disabilities need different kinds and levels of support, and they do not all want the same life. We need a range of housing options that can support those differences and protect each person's choices.

 

The ability to access this housing choice should not depend on family wealth. Medicaid waiver-funded services would provide the support needed for daily living, helping residents live with greater independence, stability, and dignity. This investment would ensure that a person’s opportunity to live in a safe, supportive home is determined by their needs and preferences—not by whether their family can afford to pay for essential services out of pocket.

 

The accounts in this very comment period describe how isolated someone can be in an ordinary neighborhood, even within an environment that satisfies HCBS requirements on paper. They describe limited contact with neighbors and everyday choices that require staffing arrangements days in advance. Families of current Vanguard Landing residents describe growing independence, friendships, individual outings, and the ability to stay home with support when they choose.

 

We should be asking what makes those differences possible. A person can live among people without disabilities and still have very little opportunity to know them or participate in community life. A person who needs substantial assistance may have more freedom when support and opportunities are close at hand.

 

We need to judge inclusion by whether people have meaningful relationships, can pursue their own goals, and have the support to make and act on everyday choices. That requires listening to the people living in these settings. When their experiences challenge our assumptions about which environments offer the most freedom, we need to be willing to reconsider those assumptions.

 

Anna has spent almost her entire life preparing for this, setting goals and working toward them with substantial support. She chose Vanguard Landing for this next phase, and we support her choice. She should be able to use her Medicaid waiver there, and others who qualify and make the same choice should too.