Institutions inDetail, Part 2

Comparison of States’ Use of Large State Institutions

States have reduced the number of residents in state institutions to varying degrees. As of 2008, 86 percent of the nation’s institutional population resided in 18 states, with Texas housing almost one in seven (14%) of all institutional residents (table 5).

Table 5: Distribution of Residents in Large State Institutions as of June 30, 2009

State

Population
(as of June 30, 2009)

Percentage of Total

Cumulative Percentage

1.    Texas

4,541

14%

14%

2.    New Jersey

2,785

8%

22%

3.    Illinois

2,254

7%

29%

4.    California

2,252

7%

36%

5.    New York

2,056

6%

42%

6.    North Carolina

1,593

5%

47%

7.    Ohio

1,429

4%

51%

8.    Mississippi

1,336

4%

55%

9.    Virginia

1,259

4%

59%

10.  Pennsylvania

1,230

4%

63%

11.  Louisiana

1,165

4%

67%

12.  Florida

1,094

3%

70%

13.  Arkansas

1,078

3%

73%

14.  Washington

926

3%

76%

15.  Massachusetts

893

3%

79%

16.  Georgia

849

3%

81%

17.  South Carolina

810

2%

84%

18.  Connecticut

723

2%

86%

 Table 6 presents data on the number of residents of large state institutions and the percentage of all residential service recipients who are served in large public institutions. This metric shows how much the state relies on large public institutions to provide services, but it does not adjust for the proportion of the ID/DD population that receives residential services. For example, states that have relatively few people in institutions but provide little residential care will rank high on this metric. However, the issue is not that these states are using institutions more than other states, but rather that they provide less care overall.

Table 6: States Ranked by Public Institution Residents as a Percentage of Total Residential Service Recipients, 2009

State

Total Residential Service Recipients

Residents in ID/DD Settings with 16+

Public Institution Residents as a Percentage of Total Residential Service Recipients

Number

Number

Rank

Percentage

Rank

Alaska

1,062

0

1

0.0

1

District of Columbia

1,280

0

1

0.0

1

Hawaii

1,114

0

1

0.0

1

Maine

2,910

0

1

0.0

1

Michigan

14,607

0

1

0.0

1

New Hampshire

1,795

0

1

0.0

1

New Mexico

2,158

0

1

0.0

1

Rhode Island

2,237

0

1

0.0

1

Vermont

1,554

0

1

0.0

1

West Virginia

1,947

0

1

0.0

1

Oregon

5,664

0

1

0.0

1

Minnesota

14,157

22

12

0.2

12

Idaho

43,731

74

16

0.2

13

Indiana

9,257

134

22

1.4

14

Maryland

7,438

129

21

1.7

15

Colorado

5,227

103

18

2.0

16

Arizona

4,111

123

20

3.0

17

Nevada

1,544

47

13

3.0

18

Montana

1,893

64

14

3.4

19

Wisconsin

11,341

441

31

3.9

20

California

55,436

2,252

48

4.1

21

Kentucky

4,097

170

24

4.1

22

Table 6: States Ranked by Public Institution Residents as a Percentage of Total Residential Service Recipients, 2009 (continued)

State

Total Residential Service Recipients

Residents in ID/DD Settings with 16+

Public Institution Residents as a Percentage of Total Residential Service Recipients

Number

Number

Rank

Percentage

Rank

New York

46,568

2,056

47

4.4

23

Pennsylvania

24,095

1,230

42

5.1

24

Alabama

3,549

192

26

5.4

25

Iowa

8,994

528

32

5.9

26

North Dakota

2,062

123

19

6.0

27

Nebraska

3,013

184

15

6.1

28

Kansas

5,761

353

29

6.1

29

South Dakota

2,307

146

23

6.3

30

Ohio

22,521

1,429

45

6.3

31

Wyoming

1,271

82

17

6.5

32

Oklahoma

4,404

289

28

6.6

33

Utah

3,303

222

27

6.7

34

Delaware

1,028

72

15

7.0

35

Florida

15,339

1,094

40

7.1

36

Massachusetts

12,235

893

37

7.3

37

Tennessee

5,370

421

30

7.8

38

Connecticut

7,001

723

34

10.3

39

Illinois

21,311

2,254

49

10.6

40

Missouri

6,511

695

33

10.7

41

Washington

7,168

926

38

12.9

42

North Carolina

12,261

1,593

46

13.0

43

Georgia

5,961

849

36

14.2

44

Louisiana

7,332

1,165

41

15.9

45

South Carolina

4,885

810

35

16.6

46

Virginia

7,411

1,259

43

17.0

47

Texas

25,640

4,541

51

17.7

48

New Jersey

13,389

2,785

50

20.8

49

Arkansas

3,863

1,078

39

27.9

50

Mississippi

3,379

1,336

44

39.5

51

U.S. Total

443,134

32,909

 

 

 

Source: Lakin et al., 2010

Table 7 presents the number of institution residents per 100,000 people in the state. This metric adjusts for the size of the state, which is a good proxy for the number of people with ID/DD in the state.

Table 7: States Ranked by the Number of Institution Residents per 100,000 Total Population

State

Institution Residents per 100,000 population

Percentage Change in Average Daily Population, 1980–2009

Number

Rank

Percentage Change

Rank

Alaska

0

1

-100

1

District of Columbia

0

1

-100

1

Hawaii

0

1

-100

1

Maine

0

1

-100

1

Michigan

0

1

-100

1

New Hampshire

0

1

-100

1

New Mexico

0

1

-100

1

Rhode Island

0

1

-100

1

Vermont

0

1

-100

1

West Virginia

0

1

-100

1

Oregon

0

1

-100

1

Minnesota

0.4

12

-98.8

12

Nevada

1.8

13

-67.6

39

Arizona

1.9

14

-81.4

23

Colorado

2

15

-92.4

15

Indiana

2.1

16

-94.6

13

Maryland

2.31

17

-93

14

Kentucky

3.9

18

-81

24

Alabama

4.1

19

-88.3

17

Idaho

4.8

20

-79.2

27

Florida

5.9

21

-72.3

35

California

6.1

22

-72.9

33

Montana

6.6

23

-79.7

26

Tennessee

6.7

24

-76.7

30

Wisconsin

7.8

25

-79.2

28

Oklahoma

7.8

26

-84.1

20

Utah

8

27

-72

36

Table 7: States Ranked by the Number of Institution Residents per 100,000 Total Population (Continued

State

Institution Residents per 100,000 Population

Percentage Change in Average Daily Population, 1980–2009

Number

Rank

Percentage change

Rank

Delaware

8.1

28

-85.9

19

Georgia

8.6

29

-63.9

42

Pennsylvania

9.8

30

-83

21

Nebraska

10.2

31

-68.3

38

New York

10.5

32

-86.2

18

US Total

10.7

 

-74.4

 

Missouri

11.6

33

-63.8

43

Ohio

12.4

34

-71.2

37

Kansas

12.5

35

-73.4

32

Massachusetts

13.5

36

-80.1

25

Washington

13.9

37

-58

46

Wyoming

15.1

38

-82.2

22

Virginia

16

39

-64.3

41

North Carolina

17

40

-47.5

49

Illinois

17.5

41

-64.4

40

Iowa

17.6

42

-56.1

47

South Carolina

17.8

43

-72.9

34

South Dakota

18

44

-77.4

29

Texas

18.32

45

-55.1

48

North Dakota

19

46

-88.4

16

Connecticut

20.5

47

-74.8

31

Louisiana

25.9

48

-63

44

New Jersey

32

49

-60.9

45

Arkansas

37.3

50

-30.1

50

Mississippi

45.3

51

-20.3

51

Source: Lakin et al., 2010

Cost of Institutional Care

The average daily expenditures per resident in fiscal year 2008 for public residential settings with 16 or more residents varied significantly across states. The weighted per diem average of $539 ($196,710 per year) represents expenditures ranging from a low of $285 per day (104,025 per year) in Arkansas to a high of $1,030 ($375,950 per year) in Tennessee (Lakin et al., 2010). Adjusted for inflation, these costs have nearly doubled since 1988, owing in large part to the decreasing numbers of residents sharing the fixed costs of maintaining the institutions (Lakin et al., 2010).

Table 8 presents data on the average cost of care in large state institutions. Many factors account for the variation in costs, so a higher cost should not be construed as necessarily indicating better or worse care than a lower cost.

Table 8: States Ranked by Average Cost of Care in Large State Institutions

State

Average Cost per Day

Average Cost Per Year

Arkansas

$285

$104,025

South Carolina

$310

$113,150

Mississippi

$318

$116,070

Illinois

$395

$144,175

Texas

$398

$145,270

Florida

$404

$147,460

Kansas

$408

$148,920

Arizona

$416

$151,840

Ohio

$419

$152,935

Missouri

$437

$159,505

South Dakota

$458

$167,170

Utah

$463

$168,995

Maryland

$466

$170,090

Georgia

$472

$172,280

Louisiana

$473

$172,645

North Carolina

$481

$175,565

Virginia

$496

$181,040

Nevada

$501

$182,865

North Dakota

$514

$187,610

Oklahoma

$525

$191,625

Alabama

$535

$195,275

Indiana

$538

$196,370

Washington

$569

$207,685

Colorado

$580

$211,700

Table 8: States Ranked by Average Cost of Care in Large State Institutions (continued)

State

Average Cost per Day

Average Cost Per Year

Iowa

$595

$217,175

Pennsylvania

$603

$220,095

Nebraska

$608

$221,920

Wyoming

$645

$235,425

Massachusetts

$675

$246,375

New Jersey

$685

$250,025

Kentucky

$687

$250,755

Montana

$690

$251,850

California

$701

$255,865

Wisconsin

$701

$255,865

Idaho

$802

$292,730

Delaware

$853

$311,345

Minnesota

$906

$330,690

Connecticut

$922

$336,530

New York

$925

$337,625

Tennessee

$1,030

$375,950

Source: Lakin et al., 2010. States with no large state institutions are not included in the table.

For a comparison of the costs of institutional and community-based care, see Section 6 of the Deinstitutionalization Toolkit.

Additional resources are available in the Institutions topic area in the Deinstitutionalization Toolkit. These external documents may be accessed for a more “inDepth” review of the topic area.

References

Fortune, J., and K. J. Auerbach. (2009). Virginia SIS Comparisons for SEVTC and Comprehensive Community Waiver Populations. Human Services Research Institute, Information Brief. Accessed March 30, 2011. http://www.arcofva.org/docs/0910_sis_comp.pdf

Lakin, K. C., R. Doljanac, S. Y. Byun, and R. Stancliffe. (2006). Medicaid Home and Community-Based Services for Persons with Intellectual and Developmental Disabilities: Background and Findings from Consumer Interviews and the Medicaid Statistical Information Systems. Prepared for the Centers for Medicare and Medicaid Services. Accessed March 30, 2011. http://rtc.umn.edu/docs/HCBSFinalrprt.pdf

Lakin, K. C., S. Larson, P. Salmi, and A. Webster. (2010). Residential Services for Persons with Developmental Disabilities: Status and Trends through 2009. Research and Training Center on Community Living Institute on Community Integration/UCEDD, College of Education and Human Development, University of Minnesota. Accessed July 21, 2011. http://rtc.umn.edu/docs/risp2009.pdf

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