Robert Prouty

State Institutions: Thirty Years of Depopulation and Closure

Over the past 30 years, a number of social, political, and economic forces have influenced public policy decisions regarding residential services for persons with mental retardation and other developmental disabilities (MR/DD). One of the most striking outcomes of these forces has been a steady decrease of persons with MR/DD residing in state institutions. In this paper we show the changes over the past 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closures as a result of social policy.

Growth in residential services in Australia and the United States: 1997-2002*

The most significant factors increasing demand for services and supports for people with intellectual disability are growth in national population and changes in the demographic structure of the population, particularly aging (Lakin & Stancliffe, 2005). In addition to the increasing proportion of elderly adults in the general population, specific examples of important demographic change include the effects of increased life expectancy of people with intellectual disability (Bittles et al., 2002; Yang, Rasmussen, & Friedman, 2002), and related survival rates of low and very low birth-weight infants; and the aging of family caregivers with whom many adults with intellectual disability currently live. This paper deals with growth in residential services in Australia and the United States (US) for people with intellectual disability, as it relates to one of these factors: national population growth. In a climate of substantial unmet need (Australian Institute of Health and Welfare [AIHW], 2002; Prouty, Smith, & Lakin, 2004), real growth in residential services is required if unmet need for these services is to be addressed. As national population increases, so too does the population of people with intellectual disability, resulting in an increased absolute level of demand for intellectual disability services even if the proportion of people receiving services remains unchanged. Real growth in residential services requires that the rate of growth in residential provision is faster than the growth rate for national population. To identify the extent of real growth in residential services (known as accommodation support services in Australia) we compared annual changes in service provision with growth of national population in Australia and the United States since 1997. These data are shown in Figs. 1 and 2 respectively. Australian data (Fig. 1) are shown only to 2002, because the method of data collection changed thereafter from the previous annual snapshot-data collections, so that 2003 data are not comparable to earlier data. Note that the slopes of all the lines in Figs. 1 and 2 are directly comparable to one another because all the y-axes have a data range of 20% of the minimum value for that axis. Population data show the national population on June 30 of each year. US residential service data (Fig. 2) are a snapshot (point census) from June 30 each year. Australian residential service data (Fig. 1) are also from a snapshot day during the year. Both national data sets exclude respite places.

Change in residential placements for persons with intellectual and developmental disabilities in the USA in the last two decades

The past two decades, defined by available statistics as between 1982 and 2001, saw a remarkable change in the ways that residential supports are provided to persons with intellectual and developmental disabilities (IDD) in the USA. In this article, residential supports refer to services provided to people living in settings other than a home they share with family members. There have been a number of quantifiable interrelated aspects to changes in residential supports in the USA in the past two decades. These have included: (a) a major shift from institutional services to services in relatively small community settings; (b) an operational transformation from state governments being the primary provider of services to state governments being largely a purchaser of services; (c) a dramatic shift from state financing of community services to federal–state cost-sharing of community service expenditures; and (d) a substantial proportional growth in the total number of people with IDD receiving services. This article briefly summarises these trends. The sources of statistics cited are described in a note at the end of the article.