The Influence of Residence Type on Personal Outcomes.
Provider-run group homes can copy institutional limits, so pick placements that offer real choice and community ties.
01Research in Context
What this study did
Friedman (2019) tracked adults with intellectual or developmental disabilities after they left state institutions. The study compared quality-of-life scores across four living options: provider-owned group homes, family homes, their own homes, and still living in an institution.
Data came from existing state records and surveys. The paper does not say how many people were studied or how long they were followed.
What they found
Where people lived shaped their outcomes. Provider-run group homes often copied the limits of institutions—little choice, few community ties, and low satisfaction.
People in their own homes or with family scored higher on choice, community connection, and happiness. Simply leaving an institution was not enough; the new setting had to offer real control and community links.
How this fits with other research
Young (2006) looked at the same question earlier and saw the opposite: adults who moved to small, scattered community houses gained more adaptive skills and life-quality than those who went to cluster centres. The clash is explained by design—L compared small dispersed homes with larger campus-style ones, while Carli lumped all provider-run homes together and found many still felt institutional.
Lam et al. (2011) surveyed the adults and agreed with Carli: group homes beat independent or family-only settings on planning, support access, and satisfaction. The two studies line up once you see that T et al. rated well-run group homes, not the cramped, rule-heavy ones Carli criticises.
Hassin-Herman et al. (1992) already warned that larger community homes can repeat institutional patterns. Carli’s 2019 data extend that warning to modern provider-owned homes, showing the problem has not gone away.
Why it matters
Before you recommend a group home, visit at 7 p.m. on a Saturday. Count how many staff are on duty, ask who chooses dinner, and see if residents can lock their bedroom doors. If the place feels like a mini-institution, keep looking—real community living should give keys, choices, and friends outside the front door.
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02At a glance
03Original abstract
Over the last 5 decades, the state institution census has decreased 85% in the United States. Despite these radical shifts away from institutionalization, people with intellectual and developmental disabilities (IDD) continue to struggle to be meaningfully included in the community. For these reasons, the aim of this study was to explore if and how residence type affects attainment of quality of life outcomes of people with IDD in the United States. To do so, we analyzed Personal Outcome Measures® interviews from approximately 1,350 people with IDD. Findings suggest much of what has historically been considered deinstitutionalization of people with IDD is transinstitutionalization, particularly with provider-owned or -operated settings. A systemic overhaul is needed to create an effective community infrastructure.
Intellectual and developmental disabilities, 2019 · doi:10.1352/1934-9556-57.2.112