Satisfaction and sense of well being among Medicaid ICF/MR and HCBS recipients in six states.
Very small homes or family living give adults with IDD measurably higher satisfaction and less loneliness than large facilities.
01Research in Context
What this study did
Researchers asked adults with intellectual or developmental disabilities how they felt about their homes. They compared people in very small community homes, family homes, and large ICF/MR facilities across six U.S. states.
They used a survey. The team wanted to know who felt more satisfied and less lonely.
What they found
Adults in very small HCBS settings and those living with family rated their lives higher. They felt less lonely than people in ICF/MR facilities.
The difference was clear: smaller or family settings won on well-being.
How this fits with other research
Young (2006) tracked Australian adults for years. Community houses beat cluster centres on adaptive skills and choice-making. The 2009 U.S. survey now shows the same pattern for happiness and loneliness.
Irvin et al. (1998) saw adults gain skills after leaving nursing homes. Pilowsky et al. (1998) added that small, stimulating homes improved health and community ties. Moss et al. (2009) echoes these gains, but measures them with satisfaction instead of skill scores.
Friedman (2019) sounds a warning: simply moving people to provider-run group homes can copy old institutional limits. The 2009 data agree—size alone is not enough; very small or family settings are the ones that lift well-being.
Why it matters
When you write a support plan, push for the smallest viable home or keep family placement alive. Ask for houses with four or fewer residents. Add community outings and resident choice to beat loneliness. These steps turn decades of research into real-life happiness.
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02At a glance
03Original abstract
Self-reported satisfaction and sense of well-being were assessed in a sample of 1,885 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services in 6 states. Questions dealt with such topics as loneliness, feeling afraid at home and in one's neighborhood, feeling happy, feeling that staff are nice and polite, and liking one's home and work/day program. Loneliness was the most widespread problem, and there were also small percentages of people who reported negative views in other areas. Few differences were evident by HCBS and ICF/MR status. The findings document consistent benefits of residential support provided in very small settings-with choices of where and with whom to live-and to individuals living with family.
Intellectual and developmental disabilities, 2009 · doi:10.1352/1934-9556-47.2.63