Outcomes in different residential settings for people with intellectual disability: a systematic review.

The team looked at 68 studies about where adults with intellectual disability live.

They compared community homes (small houses, apartments) with congregate settings (large institutions, nursing homes).

They checked ten outcome areas like health, behavior, social life, and daily skills.

Community homes won in seven out of ten areas.

Adults in smaller, community settings had better health, more friends, and stronger daily living skills.

But the study also found big differences within each type of setting—some community homes still had poor outcomes.

Cameranesi et al. (2022) followed adults with profound ID for six months after they moved from institutions to community homes. They saw large gains in every quality-of-life area, backing up this review's main finding.

Hsieh et al. (2009) adds a twist: even inside nursing homes, smaller units with better social ties predicted lower death rates over ten years. This shows size and personalization matter even when the label says "institution."

Matson et al. (2009) seems to clash—it reports that community-dwelling adults with ID still have tiny social networks and low employment. The difference is focus: this review looks at where people live, while L et al. looks at what they do once they are in the community. Both can be true—community housing is better, but extra support is still needed for work and friendships.

When you plan placement or fight for funding, lead with the evidence: smaller, community-based homes usually produce better lives. Yet don’t stop at the address—check staffing ratios, individual goals, and community ties. Use tools like the ISL manual from Van Hanegem et al. (2014) to audit quality once the move happens.