As parents and guardians of adults with developmental disabilities who have lived, or are living, in institutions, we understand that many people with cognitive challenges function well enough to live in community homes. We also know that institutions have a role in providing services to people with severe and profound cognitive disabilities, including those who in addition have complex medical and behavioral conditions. We are becoming increasingly concerned about the desire of many professionals and organizations to completely do away with institutions and provide services only in community settings.

This concern is not ours alone. Nearly 30 states have investigative media series, state audits, and/or peer-reviewed studies showing systemic problems with community-based settings. In response to these reports, the Centers for Medicare and Medicaid Services (CMS) has been working hard for several years on objective measures for ensuring quality in Home and Community-Based Waiver...

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