A Matched Comparison Study of Cost-Effectiveness: Institutionalized and Deinstitutionalized People

Abstract

Article Descriptorsdeinstitutionalization; cost-effectiveness; community residen tial services; matched comparison; Pennhurst.Seventy people with mental retardation who had moved from a large state institution to small community living arrangements were matched with 70 people who remained at the same institution. They were matched by sex, level of retardation, years institutionalized, selfcare skills, age, and IQ. Developmental growth, opera tionally defined as adaptive behavior change using a research version of the AAMD Adaptive Behavior Scale, was measured for all people; only those people who had been deinstitutionalized demonstrated signifi cant growth. They also received more services. Subse quently, telephone surveys and other procedures were used to identify the inclusive public costs associated with the two groups. Upon comparison, the deinstitu tionalized group required less public money than the institutionalized group, although the financial burden shifted substantially from federal sources to state (and local) funding sources when people moved from the in stitution to community-based facilities. Correlates of costs in the community were explored in a preliminary way.

A Policy Analysis of Community Costs for Persons With Severe Disabilities

“…Similarly, Lakin, Hill, and Bruininks (1985) reported that Intermediate Care Facilities for People with Mental Retardation (which were dominated by large public institutions) had per diem costs that were 2.8 times higher than private facilities (which were usually community-based). Other investigators came to similar conclusions (Ashbough & Allard, 1983;Baker, Seltzer & Seltzer, 1977;Campbell & Smith, 1989;Conroy & Bradley, 1985;Intagliata, Willer & Cooley, 1979;Jones, Conroy, Feinstein & Lemanowicz, 1984;Minnesota Department of Public Welfare, 1979;Murphy & Datel, 1976;and Touche Ross and Company, 1980). A few dissenters have questioned the accuracy of these comparisons between the cost of community-based residential care and institutional care on the grounds that incomplete cost data has resulted in frequent understatement of the costs of community-based residential facilities (Braddock, 1981;Jones & Jones, 1976;Mayeda & Wai, 1975).…”

Comparative costs for institutional services and services for selected populations in the community

“…Bensberg and Smith (1984) found the average daily costs for group homes to be $8 1.86 per day or $29,878.90 per year. Jones, Conroy, Feinstein, and Lemanowicz (1984), comparing the average costs per year across group homes and institutions, calculated group home costs as $40,284 per year and institutional costs as $47,170. Greenberg, Lakin, Hill, Bruininks, and Hauber (1985) reported that in 1982 small facility models showed considerable variation in cost of care.…”