Changes in residential arrangements of persons with intellectual and developmental disabilities in the decade following the Olmstead Decision of 1999.
After Olmstead, states cut large institutions by one-fourth and doubled supports for people living in their own homes.
01Research in Context
What this study did
Smith et al. (2011) counted where Americans with intellectual or developmental disabilities lived. They compared 1999 and 2009, the ten years after the Olmstead court ruling. The team used state reports to track four settings: large state institutions, group homes, foster or host homes, and the person’s own home.
What they found
Institutional use dropped by about one-fourth. Own-home supports more than doubled. Group homes and foster homes also grew. The shift shows Olmstead pushed states toward community living.
How this fits with other research
Porter et al. (2008) saw the same own-home growth earlier, so Drew’s team extends that trend. Johnson et al. (2009) show the institutional drop started back in 1977; Drew shows the court decision sped it up.
Donnelly et al. (2003) looks like a contradiction. Their UK cohort found little social gain twelve years after leaving institutions. The gap is about outcome choice: Drew counts where people live; Julie counts friendship and social skills. Both can be true—placement can rise while social life still lags.
Moss et al. (2009) add a warning. Even in the community, larger provider-run homes can feel institutional. Drew gives the happy census numbers, but J et al. remind us that size and control matter for real quality.
Why it matters
You can show funders that the national move to community living is real and ongoing. When you write transition plans, push for small, person-controlled settings, not just any vacancy. Pair placement goals with social-skills programming so the move also builds friendships.
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02At a glance
03Original abstract
On June 22, 1999, the U.S. Supreme Court ruled in Olmstead v. L.C. that under the Americans with Disabilities Act (ADA), unjustifiable institutionalization of a person with a disability who, with proper support, can live in the community is discrimination. In its ruling, the Court said that institutionalization severely limits the person's ability to interact with family and friends, to work, and to make a life for him or herself. (Oregon closed its last remaining residential institution [Eastern Oregon Training Center] on October 31, 2009.)In 1999, 361,172 persons with intellectual and developmental disabilities received residential services in settings other than homes they shared with other family members. These included public or private institutions of 16 or more persons, community group homes, host or foster homes, or in their own homes or apartments. The Olmstead decision of 1999 called on states to offer services to individuals with disabilities, including persons who have intellectual and developmental disabilities, in the most integrated setting feasible. In the decade following the Olmstead decision (1999–2009) states actively reduced the number of people with intellectual and developmental disabilities residing in public or private residential facilities of 16 or more persons and increased access to more integrated community options. Between 1999 and 2009, the total number of residential service recipients increased to 436,670 (+20.9%). In 1999, 82,718 individuals with intellectual and developmental disabilities (25% of residential recipients) were living in public or private institutions compared to 59,604 (14% of service recipients) in 2009, a decrease of 27.9%.The national trend of moving away from the use of institutions to various models of supported community living (community group homes, host or foster families, or support in people's own homes) is shown in Figure 1. For definitional purposes a community group home refers to a residence owned, rented, or managed by a state or private agency to provide housing for 15 or fewer persons with intellectual and developmental disabilities staffed by individuals who are employed by the agency to provide care, instruction, supervision, and other support for the residents; a host family/foster home refers to a setting owned or rented by an individual or family in which they live and provide care and support for one or more unrelated persons with intellectual and developmental disabilities; a person's own home refers to a home owned or rented by one or more persons with intellectual and developmental disabilities as their own personal home and in which personal assistance and other supports are provided to them. Between 1999 and 2009, nearly all states reduced the use of large public or private residential facilities. In 2009, five states (DC, HI, ME, NM, VT) no longer furnished services in any public or private institution. We collected data for this article through June 2009. At that time, Oregon was downsizing their last institution, which was closed on October 31, 2009; therefore, because of the timing, the data in Table 1 does not show Oregon with no institutions, though technically they did not have any institutions in 2009.In contrast to the 27.9% reduction of people living in public and private institutions, the nation moved toward greater use of community group homes (+17.3%), support in an individual's own home (+90.2%), and services in host or foster care homes (+28.5%) (see Table 1). With the U.S. Department of Justice increasing effort to enforce Olmstead, the continuing successful efforts of states to reduce institutional populations, and the substantial and growing evidence of the relative detriments of institutional living, it seems likely that these trends will continue nationally and in each of the individual states.Sources: Lakin, K. C., Larson, S. A., Salmi, P., Scott, N., & Webster, A. (2010). Residential services for persons with developmental disabilities: Status and trends through 2009. Minneapolis: University of Minnesota, Research and Training Center on Community Living; Prouty, R. W. & Lakin, K. C. (2000). Residential services for persons with developmental disabilities: Status and trends through 1999. Minneapolis: University of Minnesota, Research and Training Center on Community Living; The Olmstead Decision Fact Sheet, Administration on Developmental Disabilities. (2000). retrieved from http://www.acf.hhs.gov/programs/add/otherpublications/olmstead.htmlPreparation of this report was supported by Grant 90D0217/01 from the Administration on Developmental Disabilities of the U.S. Department of Health and Human Services and a Cooperative Agreement with supplemental support from the National Institute on Disabilities and Rehabilitation Research, U.S. Department of Education (Grant H133B080005-09) to the University of Minnesota, Research and Training Center on Community Living.
Intellectual and developmental disabilities, 2011 · doi:10.1352/1934-9556-49.1.53