Changes in populations of residential settings for persons with intellectual and developmental disabilities over a 30-year period, 1977-2007.
Deinstitutionalization is nearly complete—plan for small community homes as the new default.
01Research in Context
What this study did
Moss et al. (2008) counted where adults with intellectual or developmental disabilities lived every year from 1977 to 2007.
They used the same national IDD database each year so the numbers could be fairly compared.
The team looked only at residential settings that got public funds.
What they found
Big state institutions lost 70 percent of their residents.
Tiny community homes with six or fewer people grew from 20,000 to 316,000.
By 2007 only 14 percent of recipients still lived in large facilities.
How this fits with other research
Cohen-Almeida et al. (2000) saw the same move in a Scottish cohort. Half the adults left hospitals or parents’ homes for community placements between the 1970s and 1990s.
Lerman et al. (1995) tested what happens after the move. Adults with ID gained only small adaptive-skill boosts that stopped after six months.
Lakin et al. (2009) added that the 1999 Olmstead court ruling did not speed things up. A few slow states still hold most of the remaining public-institution beds.
Wolfensberger (2011) predicts the trend will finish the job: large institutions will close completely as small, individualized homes keep growing.
Why it matters
If you write transition plans, know that the system has already shifted under your feet. Most new referrals will land in small community homes, not large centers. Use that fact when you teach families what to expect. Track regional data like McGeown et al. (2013) so you can spot local gaps and push for fair placement speed.
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02At a glance
03Original abstract
In 1976 the Administration on Developmental Disabilities (ADD) commissioned the first national survey of institutional and community services for persons with intellectual and developmental disabilities. That study had an effective date of June 30, 1977. Prior studies conducted by the U.S. Census Bureau between 1923 and 1946 and by the National Institute on Mental Health between 1947 and 1968 had gathered data on public and private institutions but did not include smaller, “community” residential settings. By the early 1970s, there was substantial interest not only in the populations of public and private institutions, which still housed the vast majority of residential services recipients with intellectual and developmental disabilities, but also increasingly in the growing number of community residential settings being developed as alternatives to institutions.The 1977 study identified a total of 9,303 community residential settings (places with 15 or fewer residents). These settings made up 84.5% of all residential settings, although they housed only 16.3% of all residents. The 1977 study was replicated in 1982 with funding from the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). In June 1982, community residential settings made up 89.0% of all residential settings and housed 26.1% of all residents. Since 1982, there has been rapid expansion of the total number of residential settings for persons with intellectual and developmental disabilities (now estimated at 168,000 in June 2007), growing sophistication of state information systems, and higher expectations of more frequent and timely data reports. These changes have contributed to states' participation in a voluntary annual residential services reporting system in which all states have participated since 1984. The most recent data collection in this series (effective date June 30, 2007) marks 30 years since the original ADD-sponsored national study of institutional and community residential services.Figure 1 shows the changing patterns of use of residential settings of different sizes at decade intervals during the 30-year period between June 1977 and June 2007. As the figure shows, there has been a rapid decrease (70%) in the number of people with intellectual and developmental disabilities living in public and private institutional settings of 16 or more residents, from 207,356 in June 1977 to 62,496 in June 2007. There has also been an even more rapid increase in the number of persons with intellectual and developmental disabilities receiving residential supports in homes of 6 or fewer persons, from 20,400 to about 316,300. In June 1977, persons in institutions made up 84% of the 247,780 persons with intellectual and developmental disabilities receiving residential services; in 2007, 14% of 437,707 residential service recipients were in institutions. In each of the 10-year periods shown in Figure 1, the total number of persons in public and private institutions decreased between 31.9% and 33.9%.Table 1 shows changes in states' use of residential settings of different sizes for persons with intellectual and developmental disabilities. In 1977, only four states (California, Hawaii, Maine, Vermont) had more than 25% of all residential service recipients in places with 6 or fewer residents and 44 had more than 70% in places with 16 or more residents. In 2007, 36 states housed 70% or more of their residential service recipients in places of 6 or fewer residents. In 2007, a majority of states housed less than 10% of residential service recipients in places of 16 or fewer residents. (Source: Prouty, R., & Lakin, K. C. (Eds.). (2008). Residential services for persons with developmental disabilities: Status and trends through 2007. Minneapolis: University of Minnesota, Research and Training Center on Community Living.)
Intellectual and developmental disabilities, 2008 · doi:10.1352/2008.46:257-260