Predictors of Use of Nursing Homes and State Institutions for Persons with DD

Predictors of Use of Nursing Homes and State Institutions for Persons with DD (2004). Rizzolo, M.K. 

This RRTCADD research brief explains the wide variation in states' use of nursing homes and state institutions compared to community residential options for individuals with developmental disabilities. It also compares the health characteristics of nursing home residents with and without developmental disabilities.

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Since the 1970 s most states have aggressively reduced their reliance on institutional settings for persons with developmental disabilities (DD) in favor of smaller, community-based options. However, in 2000, 47,372 persons with developmental disabilities were receiving residential support in state institutions and 34,452 persons with developmental disabilities were served in private institutions. That same year, 32,790 persons with developmental disabilities resided in nursing facilities.

  • States vary greatly in the extent to which they use nursing homes and state institutions for persons with DD.
  • In 2000, eight percent of individuals receiving out-of-home residential services were in nursing homes. Percentages ranged from less than one percent of Kansas DD residential system, to 24% of Georgia's.
  • Eleven percent of individuals in out-of- home placements in 2000 were in state institutions. Percentages ranged from zero percent (in AK, DC, HI, ME, NH, RI, VT, and WV) to 32% of New Jersey's system.

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Why Do Some States Use Nursing Homes and State Institutions for Persons with DD More than Other States?

The study found that use of nursing homes and state institutions for persons with developmental disabilities in 2000 was related to a state s political culture. Political culture is defined as the "attitudes, values, beliefs, and orientations that individuals in a society hold regarding their political system. (Riley, 2004). States can be traditionalistic, individualistic, or moralistic. Traditionalistic states have a desire to maintain the status quo; they typically resist change. Individualistic states are often driven by pragmatic concerns, such as getting and staying elected. Moralistic states support programs if they promote the good of the community. Sharkansky's (1969) index was used. More traditionalistic states had higher scores on the index, while more moralistic states scored lower. Each state s score on the index is shown on the following table.

Moralistic States Use Nursing Homes and State Institutions Less than Other States for Persons with DD

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The study found that:
  • Moralistic states used institutions and nursing homes less than individualistic and traditionalistic states.
  • States who spent more on the HCBS Waiver used state institutions less.
  • State wealth was also associated with use of state institutions wealthy states could afford to fund dual systems of care.

Characteristics of Persons with DD in Nursing Homes
The study also examined data on advanced age, Alzheimer's, severe immobility, incontinence, and tube feeding for persons with and without developmental disabilities in nursing homes. This data was obtained from the Minimum Data Set for persons in nursing homes from July to December 2000.

Persons with DD in nursing homes:
  • Were younger than the general nursing home population (64 years vs. 80 years)
  • Were less likely to be diagnosed with Alzheimer s (6% vs. 13%)
  • Had higher rates of incontinence (48% vs. 42%)
  • Used feeding tubes more (12% vs. 7%)


Mary Kay Rizzolo, PhD
[email protected]
Rehabilitation Research and Training Center on Aging with Developmental Disabilities
Department of Disability & Human Development
College of Applied Health Sciences University of Illinois at Chicago
(312) 413-1860 or toll free (800) 996-8845
Website: www.uic.edu/orgs/rrtcamr

Funding was provided through the Rehabilitation Research and Training Center on Aging with Developmental Disabilities, National Institute on Disability and Rehabilitation Research (Grant # H133B031134) and the State of the States in Developmental Disabilities Project, University of Colorado http://www.cu.edu/ColemanInstitute/stateofthestates/. Special thanks to Sherri Larson, PhD, at the University of Minnesota for analysis of the MDS data.

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