Since 1923, statistics have been gathered on the number and characteristics of persons with intellectual and developmental disabilities living in state institutions with 16 or more residents. After reaching their peak average daily population of 194,650 people in 1967, state institution populations decreased to 34,670 people by June 30, 2008 (see Table 1).
This article reports on changes in the number and characteristics of persons living in state institutions between 1977 and 2008 and state-by-state changes between 1998 and 2008. Between 1977 and 1996, the number of people in state institutions declined from 151,112 to 58,320. By 1996, the residents were older, increasingly likely to have severe or profound levels of intellectual disability, and need help or supervision with basic activities of daily living (Lakin, Prouty, Braddock, & Anderson, 1997). Between 1997 and 2008, populations of all ages in state institutions continued to decline, with the most dramatic declines being those younger than 40 years (see Figure 1). By 2008, two thirds of state institution residents were older than 40 years (including 19,651 who were 40–62 years and 3,721 who were 63 years or older). State institution residents were also increasingly male (increasing from 57% in 1977 and 1987 to 60% in 1998 and 64% in 2008).
Although the proportion of residents with severe or profound levels of intellectual disability increased from 73% in 1977 to 82% in 1998, it declined to 69% in 2008. Similarly, the proportion of individuals needing supervision or assistance with walking, toileting, communicating, eating, and/or dressing declined between 1998 and 2008, with the biggest change being a decrease from 70% to 59% in the proportion needing supervision or assistance with dressing.
Between 1977 and 2008, the proportion of residents with behavioral or psychiatric disorders (the latter assessed only since 1998) increased steadily (see Figure 2). The proportion of residents with behavior disorders requiring special staff attention increased from 25% in 1977 to 41% in 1987, 41% in 1998, and 53% in 2008. The proportion of residents with a psychiatric disorder requiring psychiatric attention rose from 34% in 1998 to 55% in 2008. After decreasing from 27% to 17% between 1977 and 1998, the proportion of residents with mild or moderate levels of intellectual disability nearly doubled from 17% to 31% between 1998 and 2008.
States operating large facilities between 1998 and 2008 varied substantially in the extent to which their population characteristics were consistent with national trends (see Table 2). Overall, the number of people living in state institutions decreased by 33% between 1998 and 2008, and 48 facilities closed completely. By 2008, 9 states reported not operating any state institutions for persons with intellectual and developmental disabilities. During this time, state institution populations decreased in all states and by 50% or more in 12 states.
Nationally, between 1998 and 2008, the proportion of state institution residents ages 40 years and older increased 18% overall and increased in all but five states. The proportion of residents with severe or profound levels of intellectual disability decreased by 16% overall between 1998 and 2008 and by more than 50% in four states. The proportion of state institution residents with behavioral disorders increased 27% between 1998 and 2008, with six states reporting increases of 96% or more and only three states reporting decreases. The proportion of state institution residents reported to have a psychiatric disorder increased 59% between 1998 and 2008, with only four states reporting decreases. Although the proportion of persons with psychiatric disorders increased dramatically, the estimated number of people with psychiatric disorders in state residential facilities increased only from 17,659 to 18,917 individuals. The estimated number of people with mild or no intellectual disability also increased (from 4,016 in 1998 to 6,204 in 2008). Because of the decreasing overall populations of state institutions, these were the only categories with more estimated residents in 2008 than in 1998.
Table 1 and Figures 1 and 2 show the national trends between 1977 and 2008 in total number of state institution residents, the proportion of residents 40 years and older, the proportion of residents with severe or profound intellectual disability, and the proportions with behavioral and psychiatric disorders. Table 2 presents state trends between 1998 and 2008 for the same characteristics. In the United States and in each state, the number of people living in state institutions continued to decrease. In 2008, persons 40 years and older made up more than two thirds of all state institutions' residents and a majority of residents in more than 80% of states. This compares with one third of residents being 40 years or older in 1987. Between 1998 and 2008, the proportion of residents who were male, 21 years or younger, with mild or moderate intellectual disability, and with psychiatric or behavior disorders increased, whereas the proportion requiring assistance or supervision with various activities of daily living decreased.
(Sources: Lakin, K. C., Prouty, B., Braddock, D., & Anderson, L. (1997). State institution populations smaller, older, more impaired. Mental Retardation, 35, 231–232; Prouty, R., & Lakin, K. C. (Eds.). (1999). Residential services for persons with developmental disabilities: Status and trends through 1998. Minneapolis: University of Minnesota, Research and Training Center on Community Living; Salmi, P., Larson, S. A., & Lakin, K. C. (Eds.). (2009). Residential services for persons with developmental disabilities: Status and trends through 2008. Minneapolis: University of Minnesota, Research and Training Center on Community Living.)
Edited by K. Charlie Lakin and David Braddock