Programs and Services Received by Persons With Mental Retardation in Three Models of Small Community Residences

Programs and services received by a national sample of 336 persons with mental retardation in 181 foster homes, non-Intermediate Care Facility for the Mentally Retarded (ICF-MR) group homes, and ICF-MR-certified group homes of 6 or fewer residents are described. In the previous 12 months 85 % of residents had been visited at least twice by a case manager, 99 % had seen a physician, and 95 % had visited a dentist. In all, 95 % of 750 residents of the 181 sampled facilities had day time vocational or developmental programs away from the resi-dence, but supported or competitive jobs were held by only 5 % of the adults below age 65. Specialized services (e.g., those services provided by medical specialists, therapists, counselors, and psychologists) uti-lization was considerably higher for residents of ICF-MR-certified group homes as were the per resident costs of care. Multiple regression analysis found living in an ICF-MR to be a better predictor of hours of specialized services received than the physical, sensory, intellectual, or functional characteristics of residents. Since 1967, the United States as a whole and each of its individual states have pursued policies of decreasing the number of people with mental retardation (MR) living in state institutions, while increasing their opportunities to live in community residential settings. The steady growth of community settings of 15 or fewer residents has continued since 1967 when such facilities housed about 1 in 10 persons in state-licensed or state-operated residential facilities for persons with mental retardation until 1989 when they housed a majority (51.4%) of residents of mental retardation facilities (Lakin, White, Prouty, & Bruininks, 1991). Over the past decade, the biggest changes in residential populations have been among the very largest and smallest facilities. Specifically between 1977 and 1987, people living in facilities with more than 300 residents decreased from 143,000 to 69,000 (Amado, Lakin, & Menke