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Residential Services for Persons with Mental Retardation and Related Conditions: Status and Trends Through 1993

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Residential Services for Persons with Mental Retardation and Related Conditions: Status and Trends Through 1993 - Residential Services for Persons with Mental Retardation and Related Conditions: Status and Trends Through 1993 Report #42 ... Troy Mangan Ellen M. Blake Robert W. Prouty K. Charlie Lakin ... Research and Training Center on Residential Services and Community Living Institute on Community Integration (UAP) College of Education University of Minnesota 212 Pattee Hall, 150 Pillsbury Drive SE Minneapolis, MN 55455-0223 June 1994 Ull' .• Preparation of this report was supported by a grant from the Administration on Developmental Disabilities (Grant No. 90DD0302/01) with supplemental support from the Health Care Financing Administration, both of the U.S. Department of Health and Human Services. The contents of this report do not necessarily reflect an official position of any agency. - - - ACKNOWLEDGMENTS This report is based on statistics gathered and analyzed as part of the National Residential Information Systems Project. The authors wish to thank Rita Stone, our Project Officer, and the Administration on Developmental Disabilities (ADD) for ongoing support of this project and its various activities. We also tremendously appreciate the supplemental support received from the Health Care Financing Administration and the Centers for Disease Control over the past 2 years for project activities. - Cheryl Morgan and Noelle Knapp prepared all text, tables and figures used in the report. Brian Burwell of SysteMetrics/McGraw-Hill provided core ICF-MR and HCBS expenditure data from his ongoing analysis of HCFA expenditure data. As always, we are extremely grateful to our many state respondents who provided the data used in this and other reports of the National Residential Information Systems Project. Clearly neither this report nor the other project reports would be possible without their knowledge and generous assistance. These individuals - are listed in Appendix A. - .,... The recommended citation for this report is: Mangan, T., Blake, E.M., Prouty, R.W., & Lakin, K.C. (1994). Residential SelVices for Persons with Mental Retardation and Related Conditions: Status and Trends Through 1993. Minneapolis: University of Minnesota Research and Training Center on Residential Services and Community Living, Institute on Community Integration (UAP). Additional copies of this report may be obtained postage-paid for $8.00 per copy from the Publications Office, - Institute on Community Integration, 109 Pattee Hall, 150 Pillsbury Drive SE, Minneapolis, MN 55455, (612) 624-4512. Please make checks payable to the University of Minnesota. - The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, creed, color, sex, national origin, or disability. - .. ..... ... TABLE OF CONTENTS .. LIST OF TABLES • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 111 LIST OF FIGURES ............................................................... iv .. EXECUTIVE SUMMARY .......................................................... v INTRODUCTION ............................................................... xiii METHOT10LOGY ......................................................... xiv CHAPTER 1 State-Operated Residential Services ........................................ 1 PART 1: STATE-OPERATED RESIDENTIAL SERVICES ......................... 1 Number of State-Operated Residential Facilities . 1 Residents of State-Operated Facilities . 3 Populations per 100,000 of the General Population ..................... 3 Change in Average Daily Population; 1980-1993 ........................ 6 •• Movement of Residents in Large State Residential Facilities . 6 Admissions . 6 Discharges . 6 ... Deaths ................................................. 6 Net Change ............................................. 6 Expenditures for Care in State-Operated Residential Facilities ............. 9 .. PART 2: LONGITUDINAL TRENDS IN LARGE STATE-OPERATED RESIDENTIAL FACILITIES, 1950-1992 .................................. 11 Average Daily Population of Persons with Mental Retardation and Related Conditions in Large State MR!DD and Psychiatric Facilities ...................... 11 Average Daily Population of Persons with Mental Retardation and Related Conditions in Large State MR!DD and Psychiatric Facilities per 100,000 of the General Population . 13 Movement Patterns i~ Large State Mental Retardation/Developmental Disabilities .... (MR/DD) Residential Facilities . 14 Annual Per Resident Expenditures in Large State-Operated MR!DD Residential Facilities . 16 PART 3: LARGE STATE MR!DD FACILITY CLOSURES, 1960-1996 ................ 18 ... Total Lareg State MR!DD Facility Closures . 18 Closures and Projected Closures by States ........................... 19 Large State MR!DD Residential Facilities Operating and Closing, ... 1960-1996 ............................................. 19 CHAPTER 2 All Residential Services Directly Provided or Licensed by States for Persons with Mental Retardation and Related Conditions . 29 PART 1: TOTAL STATE RESIDENTIAL SERVICE SYSTEMS ..................... 29 Number of Residential Settings .......................................... 29 Number of Persons Receiving Residential Services . 29 Relative Size of Residential Settings . 32 Average residential settings size ............................. 32 Percentage living in small residential settings . 32 Number of Residential Service Recipients Per 100,000 General Population . 36 .. , "'" Persons Presently Not Receiving Residential Services on Waiting Lists for Residential Services . 36 PART 2: RESIDENTIAL SETTINGS BY TYPE ................................. 40 "Congregate Care" Settings and Residents ................................. 40 "Family Foster Care" Settings and Residents ................................ 40 "Own Home" Settings and Residents ...................................... 41 PART 3: CHANGING PATTERNS IN RESIDENTIAL SERVICE SYSTEMS: 1977-1993 .......................................................... 45 Changing Patterns in Residential Settings .................................. 45 Changes in Numbers of Residential Service Recipients ........................ 45 CHAPTER 3 Medicaid ICF-MR and Related Medicaid Program ............................ 49 • PART 1: BACKGROUND OF ICF-MR AND RELATED MEDICAID PROGRAMS ..... 49 Federal Involvement Prior to ICFs-MR ................................... 49 Establishment of the ICF-MR Program ................................... 49 Small Community ICF-MR Group Homes ................................. 51 - 1988 ICF-MR Regulations ............................................. 51 Medicaid Home and Community Based Services (HCBS) . 52 Community Supported Living Arrangements Programs . 52 Nursing Home Restrictions . 53 PART 2: UTILIZATION OF ICFs-MR AND RELATED MEDICAID PROGRAMS ..... 54 ICF-MR Program Utilization on June 30, 1993 .............................. 54 .. Number of facilities . 54 Number of residents ..................................... 56 Changing state utilization patterns ........................... 56 Nonstate ICF-MR Utilization ........................................... 56 Large nonstate ICFs-MR .................................. 56 Small nonstate ICFs-MR .................................. 60 State ICF-MR Utilization .............................................. 60 Large state ICFs-MR ..................................... 60 Small state ICFs-MR ..................................... 61 Large and Small Certified Facilities . 62 Expenditures for I CF-MR Services . 65 Interstate Variations in ICF-MR Expenditures .............................. 67 Per capita cost variations . 67 Variations due to disproportionate placements ................. 67 Variations due to differences in per recipient expenditures ........ 67 Medicaid HCBS Recipients . 65 Expenditures for HCBS Recipients . 68 Per capita cost variations . 68 Variations due to disproportionate placements . 68 Variations due to differences in per recipient expenditures ........ 71 HCBS Recipients and Residents of Small ICFs-MR .......................... 71 - ICF-MR and HCBS Recipients and Expenditures ............................ 74 Variations in State Financial Benefit for Combined ICF-MR and HCBS Programs ... 76 Indexed Utilization Rates .............................................. 78 - Residential Arrangement of HCBS Recipients .............................. 83 Persons with Mental Retardation and Related Conditions in Generic Medicaid Nursing Homes ............................................... 84 REFERENCES AND DATA SOURCES .............................................. 86 APPENDIX A: KEY STATE CONTACTS ............................................ 90 ii - LIST OF TABLES •• Table 1.1 Number of State-Operated Residential Facilities on June 30, 1993 by State . 2 Table 1.2 Persons with Mental Retardation and Related Conditions Living in State-Operated ... MR!DD and Psychiatric Facilities on June 30, 1993 .................................. 4 Table 1.3 Persons with Mental Retardation and Related Conditions Living in State-Operated MR!DD and Psychiatric Facilities per 100,000 of the General Population on June 30, 1993 by State ................................................................... 5 .. Table 1.4 Changes in the Average Daily Population of Persons with Mental Retardation and Related Conditions Living in Large State MRIDD by State, 1980-1993 ................... 7 Table 1.5 Movement of Persons with Mental Retardation and Related
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