No more than four people live in a CIRSI home, which are staffed 24 hours a day. Skill building includes cooking, cleaning, fitness, budgeting, socialization and more.

“Everybody has a service plan with measurable goals,” said Executive Director Jeff Vance. “We’re funded through Medicaid with government oversight, but we’re a private non-profit business.”

In addition to residential services and day programs, CIRSI offers respite care, assistance to those who live in their own homes, payee services and financial help making modifications to a home and/or vehicle.

CIRSI operates on an $8 million annual budget and is a United Way agency.

CIRSI’s Special Olympics coach, Leslee Brown, left, shows Rene Estrada, right, the proper technique for the shot put. Rene participated in this event in the district meet.

“Medicaid is by far our largest funding source, but it does not pay for purchasing housing or updating housing. That falls on the renter,” Vance said. “The people we rent to don’t have a lot of financial resources. Most just have social security, so we have to keep rents low. What we use our United Way funding for is housing.”

Jeff, who has served as executive director since 2001, said he and several fellow employees have spent decades at CIRSI.

Anne Vance, director of administrative services and “jack of all trades,” started nearly 43 years ago.

“I figured out very quickly, although I had no experience, I enjoyed working with people and found out that this was something I was really good at, and have been here ever since,” Anne said. “I am not the same person I was 43 years ago. The individuals we work with have changed me. There’s a bit of understanding and kindness that goes with this job and what we do. That’s what keeps me here.”

Office Administrator Linda Hinmon echoed a similar sentiment.

Laurie Kelley and Tim Cunningham play a friendly game of Old Maid at one of CIRSI’s day programs, The Marshalltown Opportunity Center. This day program operates a morning and an afternoon session Monday through Friday where individuals have opportunities for social interaction and community involvement.

“We all grew up CIRSI. It was very small when we started,” Hinmon said. “I think we only served 20-30 individuals.”

In March 1974, a group of parents and community members applied for a $28,000 grant to begin residential services. That September, the first house opened at 107 N. Fourth St. with William Hitchings serving as executive director. By December 1975, William Bowman had become executive director, and the agency had 20 children and adult clients.

Expansion came in May 1979 when it became a United Way agency. Then in December 1982, a house was opened in Iowa Falls. A Special Olympics program followed in June 1984 and in December Rod Von Krog became executive director. July 1987 marked the start of in-home and respite care being offered, followed by services launching in Grinnell that October.

An Adult Day Program was started in September 1989, for one person. The program grew and was named the Special Focus Program, later renamed Adult Day Services.

November 1998 saw services expand into Tama/Toledo when three men began sharing a home. In November 2012, CIRSI’s office and Adult Day Services program moved to its current location. In July 2013, it opened the Tama Opportunity Center and started providing Day Habitation services in the Tama/Toledo area, followed by a Grinnell Opportunity Center that October.

The CIRSI administrative office is located at 111 E. Linn St. in Marshalltown.

The approach to housing has evolved over the years.

“Our homes used to be licensed by the Iowa Department of Inspections and Appeals as ‘residential care facilities.’ We no longer operate any residential care facilities,” Jeff said. “All of our homes are overseen by the Department of Health and Human Services through Home and Community Based Services certification, where a house is viewed as a home, not a facility.”

He added that while the definition of intellectual disability has remained fairly constant, there has been an increased understanding of dual diagnosis (also having a mental health issue), plus a greater grasp of autism.

“Autism and that whole spectrum has really grown,” he said. “The people we work with are a lot more diverse now. When we started, it was just individuals that had a hard and fast diagnosis of intellectual disability. That’s really not the case anymore. Like anything, that has presented some challenges, but a lot of rewards too.”

In January 2016, the State of Iowa implemented the Medicaid Modernization project, and that April, DHS transitioned most Iowa Medicaid members to a managed care program called IA Health Link.

“Managed Care was a big change,” Jeff added. “You have a third party intermediary that dispenses the money, that had started with the state, then goes to managed care, then filters down to us…I think the biggest downside over the years has been that the level of government oversight has steadily increased and become much more prescriptive in terms of how we go about implementing our services.”

Technological changes have been impactful, from digital filing and record keeping to virtual training of staff.

While there’s a tendency for people working in direct care and social work to “burn out” easily, Jeff said CIRSI’s turnover rate is lower than the industry standard.

“By nature, this business has a lot of turnover. The hours are difficult and most people would obviously prefer to work eight to five, Monday through Friday,” he said. “Our funding is capped. We have no ability to determine pay. We’ve really tried to develop a culture that is employee-friendly and flexible.”

Building relationships with clients — some who reside in a CIRSI home or participate in a program most of their adult lives — is what makes the job fulfilling.

“I can think of two or three individuals that I worked with — direct care — when I first started, and they’re still here with CIRSI,” said Director of Program Services Kelly Smith. “Seeing them advance and live in their own apartment for a while, live independently, that’s really cool to see.”

Anne added that when it comes to the hiring process, character is just as important as education and job experience.

“In interviews I tell them, I can teach you paperwork. What I can’t teach you is to care. You’ve got to bring that,” she said. “Staff that care are the most successful staff.”

To learn more about CIRSI, visit: www.cirsi.org.