Improve quality in nursing homes or institute community placement? Implementation of OBRA for individuals with mental retardation.
Adults with ID gain adaptive skills in community homes and lose them in nursing homes.
01Research in Context
What this study did
The team tracked adults with intellectual disability who left nursing homes for community houses.
They compared skill growth between movers and stayers after OBRA rules took effect.
A quasi-experimental design let them follow real-world placements without random assignment.
What they found
Movers gained daily-living skills; stayers lost ground.
Community living produced clear, positive adaptive change.
How this fits with other research
Pilowsky et al. (1998) ran a near-identical study the same year and saw the same skill boost, a clean conceptual replication.
Young (2006) followed Australian movers for eight years and still saw medium gains, showing the benefit lasts.
Spreat et al. (2005) looked at cost and found community homes cheaper yet slightly fewer job slots—an extension, not a clash.
Why it matters
You can tell funders and families that moving out of nursing homes lifts skills without extra cost.
Use these data when you write transition plans or fight institutional bias in service authorization.
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02At a glance
03Original abstract
A matched sample longitudinal design was used to compare the outcomes for individuals with mental retardation who were either retained in nursing homes or transferred to community based living arrangements. Persons who moved from nursing homes to community residences experienced increased performance in adaptive behavior skills, whereas persons who remained in nursing homes regressed. Individual habilitation plans became nearly universal in both environments, but those plans prepared in the community were more focused on vocational type goals. Hours of service also increased in both environments, with the greatest increases being observed in habilitation training. Nursing services dropped to near-zero levels in community-based programs.
Research in developmental disabilities, 1998 · doi:10.1016/s0891-4222(98)00023-7