Factors associated with living in developmental centers in California.
Complex needs open the door to institutions, but nearby beds shove clients through it—so build community capacity before empty center beds beckon.
01Research in Context
What this study did
Harrington et al. (2009) ran numbers on every adult with intellectual disability in California's billing system. They asked: who ends up in the state's large developmental centers?
They fed client records into a logistic model. Client needs, age, sex, and regional supply of beds went in. Institutional placement came out.
What they found
Complex needs were the biggest driver. Younger men and areas with more center beds also raised the odds.
The model says placement is not just about the person. It is also about what the region offers.
How this fits with other research
Amaral et al. (2019) and Sutton et al. (2022) later used the same California data to predict ER trips and hospital admissions. They found the same risk flags: complex health, younger age, and certain living settings. The story extends: the same clients cycle through centers, ERs, and wards.
Kuenzel et al. (2021) looked at self-directed funding. Older adults and people in group homes were less likely to get it. Charlene's paper shows younger clients land in centers; Elizabeth shows older ones get stuck with fewer choices. Together they map a age-based service cliff.
Chou et al. (2007) saw Taiwan adding both small homes and big institutions at once. Charlene's U.S. numbers say bed supply predicts use. The papers do not clash; they warn that any vacant beds—large or small—will fill unless community options grow first.
Why it matters
If you write transition plans, do not just score support needs. Check the local bed map. A region thick with center slots will pull your client in, even with good ISP goals. Push for community capacity first—add host homes, day slots, and mobile health—then watch the risk of institutional recycle drop.
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02At a glance
03Original abstract
This study examined need, predisposing, market, and regional factors that predicted the likelihood of individuals with developmental disabilities living in state developmental centers (DCs) compared with living at home, in community care, or in intermediate care (ICFs) and other facilities. Secondary data analysis using logistic regression models was conducted for all individuals ages 21 years or older who had moderate, severe, or profound intellectual disability. Client needs were the most important factors associated with living arrangements, with those in DCs having more complex needs. Men had higher odds of living in DCs than in other settings, whereas older individuals had lower odds of living in DCs than in ICFs for persons with developmental disabilities and other facilities. Asians/Pacific Islanders, African Americans, and Hispanics were less likely to live in DCs than to live at home. The supply of residential care beds for the elderly reduced the likelihood of living in DCs, and the odds of living in a DC varied widely across regions. Controlling for need, many other factors predicted living arrangements. Policymakers need to ensure adequate resources and provider supply to reduce the need by individuals with intellectual disability to live in DCs and to transition individuals from DCs into other living arrangements.
Intellectual and developmental disabilities, 2009 · doi:10.1352/1934-9556-47.2.108