Current and emerging trends for residential supports for persons with intellectual and developmental disabilities and the impact of managed care initiatives

Abstract

An important aspect of medical support for people with intellectual and developmental disabilities (IDD) is implementation of medical recommendations, and good practice requires an understanding of the kind of homes adults return to after the office visit or acute care. In the past 50 years, the nation has completely altered its residential models in this area. Where institutions were once common, now they are nearly extinct. Now, as then, most adults who have the label live with relatives. But for some who need non-family residential supports, small, community based, family-like homes are the norm. They are generally staffed in three shifts, and the staff are paraprofessionals with poor to mediocre pay and generally high turnover rates. This chapter explains the changes of the past generation, describes the characteristics of the modern residential support system in the United States, and reports on a national expert opinion survey about the future of residential options for people with IDD. The chapter suggests that modern medical best practice for people with IDD must include knowing about the person’s living situation, as well as vigilance about general well-being.