THE SIZE OF COMMUNITY RESIDENTIAL FACILITIES: CURRENT GUIDELINES AND IMPLICATIONS
FOR PLANNING
I. INTRODUCTION
Welsch v. Likins (1974) was one of several events during the past two decades which
has helped give both substance and definition to reinstitutionalization efforts
within the State of Minnesota. The suit was initiated in 1972 and sought to
"...assert a due process claim compelling the
state to seek out and develop less restrictive, community-based alternatives for
the care and treatment of judicially committed mentally retarded persons" (Welsch
v. Likins, 373 F.Supp. 487 1974). The long-standing
suit culminated in a recent consent decree (Welsch-Noot, 1980) which requires the
State to reduce the overall population of mentally retarded persons residing in
state institutions by nearly one-third during the next six years.
This mandated reduction brings to focus several complex and
important issues (Developmental Disabilities Planning Office, 1981). As counties
and communities begin to plan and develop cormnunity-based placement opportunities,
fundamental questions about reinstitutionalization will arise.
One of the more immediate questions concerns the type of alternative
conrnunity living arrangements which must be developed--how many, what kind, what
size.
A. Deinstitutionalization and "Normalization"
The National Association of Superintendents of Public Residential Facilities for
the Mentally Retarded (1974) defined reinstitutionalization
as a three-fold process:
1. prevent admission of people to public residential facilities by finding and developing alternative community residential facilities;
2. return to community residential facilities all public residential
facility residents who have been prepared through programs of
habilitation and training to function in appropriate local settings;
3. establish and maintain responsive residential environments which
protect human and civil rights and which contribute to expeditious
return of the individual to normal community living whenever
possible.
The "normalization" principle is fundamental to the reinstitutionalization process.
The principle holds that, by utilizing means which are as culturally normative as possible, it is possible to establish and/or maintain personal behaviors and characteristics which are more culturally normative (Wolfensberger, 1972). The key then is to provide
DEVELOPMENTAL DISABILITIES PLANNING*Department OF ENERGY, PLANNING AND DEVELOPMENT 201 CAPITOL SQUARE BLDG. l 550 CEDAR STREET " ST. PAUL, MN 55101 l 612/296-4018
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opportunities, patterns and conditions in everyday life which are
as close as possible to the norms and patterns of mainstream
society.
The "normalization" philosophy is supported by two corollary principles: the least
restrictive doctrine (defined in several major court decisions) espouses the view that
individuals ought to "be served under conditions that maximize opportunities to live and
learn in normal settings in society; the developmental progranmling model "assumes that limitations of all retarded people are modifiable regardless of their degree of impairment" (Bruininks, Kudla, Hauber, Hill and Wieck, 1981).
B. "Normalized" Housing Options
These underlying principles seem to imply two things for the planning of residential
facilities: (1) physical integration by way of small, homelike structures; and (2)
social integration through thoughtful use of existing conrnunity resources in the areas
of training, education, leisure and employment (Bruininks et al, 1981 ; O'Brien and Poole, 1978).
Housing under the normalization principle deviates from usual patterns
and standards only to the extent that departures from the norm will bet
ter serve the needs of disabled residents. Under ideal conditions, resi- dents with handicaps
live in the same kinds of houses (size, location and design) as non-handicapped individuals(Roos, 1974).
"At least three overlapping dimensions of attitudes and philosophies can be discerned in
building design, These are (1) the role expectations, the building design, and atmosphere
impose upon prospective residents, (2) the meaning embodied in or conveyed by a building, and (3) the focus of convenience designed into the building, i.e., whether the building was designed primarily with the convenience of the residents, the community, the staff, or the architect in mind."
(Wolfensberger, 1976)
The developmental model suggests architectural designs which "...(l) facilitate and encourage the resident's interaction with the environment; (2) maximize interaction between staff and
residents; (3) foster individuality, dignity, privacy, and personal responsibility; (4)
furnish residents with living conditions which not only permit but encourage functioning
similar to that of nonhandicapped community age peers" (D. D. Project on Residential
Barriers, 1977). Various authors have suggested
that residential dwellings should approximate the atmosphere, structure
and appearance of similar, surrounding homes--any variations in design
or function should "either compensate for handicaps, and/or maximize
the likelihood of developmental growth" (D.D. Project on Residential Services, 1977;
Roos, 1974; Noakes, 1974). This implies that the scale
of support facilities should also conform to community norms.
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II. STATEMENT OF PROBLEM
The recent Welsch v. Noot consent decree (1980) has vested the State's deinstitutionalization efforts with new significance. County responsibilities to
mentally retarded citizens have become more immediate. By the terms of the
court-sanctioned agreement, future referrals to the State's eight institutional facilities
will be greatly curtailed; moreover, approximately 800 persons currently residing in
institutions will require some type of community placement between now and July of 1987.
Counties therefore must develop conmunity placement opportunities for persons coming out of state hospltals as well as those persons who might otherwise have been referred to institutional care.
A. Policy v. Practice
Under Minnesota law (Minnesota Statutes 1980, Chapters 245, 252, 256E and 393), individual counties are responsible for planning and establishing after-care services (see also, DPW Rule 185). Counties will be called upon to develop community residential alternatives that fulfill the mandate of the Welsch decree which states in part that:
"Persons shall be placed in community programs which appropriately meet their individual
needs. Placement shall be made in either a family home or a state licensed home, state licensed program, or state licensed facility except when. ..the most appropriate placement would be an independent community residence, such as an apartment."
(Welsch v. Noot, 1980, P. 8, paragraph 34)
"For those persons not returning to their homes, preference shall be given to placement
in small residential settings in which the population of mentally retarded persons does
not exceed 16 and to facilities which, although exceeding 16 in total size, have living
units of no more than 6 persons."
(Welsch v. Noot, 1980, p. 8, paragraph 25)
Although the decree indicates a preference for small residential settings, the state is "not
obligated to assure placement of any quota of residents in settings or living units of a
particular size" (Weslch v. Noot, 1980, p. 8, paragraph 25). Consequently, there are no clear indicationsof the types, numbers, and sizes of facilities counties will be required to develop. Moreover, even though the several governmental licensing, construction and program review guidelines espouse the principles of normalization, least restrictive environments and the developmental programming concept, a wide discrepancy exists in the application of those principles both between and among the various levels of government. Counties and other potential developers must somehow make sense of the various rules, standards, and regulatory guidelines.
B. Program Standards Regarding "Size"
DPW Rule 185 establishes county responsibilities for persons who are mentally retarded. Under Rule 185, the Commissioner of DPW
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must determine the need, location and program for residential facilities. The size of the
facility must "relate to the needs of the clients for services;" no facility ~or more than eight persons will be approved unless it can be clearly shown that residents will be better served in a larger facility and then only if the size of living units are for no more than six persons (12MCAR 2.185).
.
DPW Rule 34 applies to any facility or service engaged in the provision of residential or domiciliary services for mentally retarded individuals. Licensure requirements are applicable to all facilities serving more than four persons. Rule 34 facilities provide services on a 24hour basis and include group homes, child-caring institutions, board and lodging homes, boarding-care homes, nursing homes, state hospitals, institutions and regional centers. A facility may consist of one or more living units. By rule definition, resident living units must be "small enough to ensure the
development of meaningful interpersonal relationships. .."
The size of the living unit must be based upon the needs of the residents; i there can be nor
more than 16 residents per living unit (a living unit may
be a group home, foster home, ward, wing, floor, etc.~ Primary living units may not have
more than four persons to a bedroom (12MCAR 2.034).
DPW Rule 37 establishes guidelines under which the Department of Public Welfare makes "...grants to aid in the purchase, construction or remodeling of community residential facilities" for persons with mental retardation and cerebral palsy.
The "purpose of the program is to provide appropriate alternatives for such persons, "including those currently in state hospitals and nursing homes" and to allow them to "live in a home-like atmosphere near their families." One of the criteria under which grants are awarded is that facilities can house no more than 16 persons; no more than two facilities may be located together
(12MCAR 2.037).
DPW Rule 8 establishes standards for group homes and licensing procedures for specialized facilities providing care "on a 24-hour-a-day basis for a select group of not more than ten children." Rule 8 standards prescribe no more than
four children per bedroom (12MCAR 2.008).
DPW Rule 18 sets standards for the provision of semi-independent livingservices to people who are mentally retarded. Though the rule does not govern the living arrangements of clients, it affirms the normalization principle; i.e., that persons be provided "with the alternative which is least restrictive. This includes making available to the
client patterns and conditions of everyday life that are as close as possible to the
norms and patterns of the mainstream of society"
(12 MCAR 2.018 adopted May, 1981)
Supervised Living Facilities regulations promulgated by the Department of Health establish certain minimum stand ards for construction, equipment, maintenance, operation and licensure. These health standards defer to the licensure requirements of the Department of Public Welfare relative to the provision of appropriate space and arrangements for sleeping, dining, recreation and other common use activity areas; i.e., facility size is subject to DPW rule standards (7MCAR 1.391-1.401).
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Federal SNF, ICF/MR Standards require that participating facilities meet state licensure standards. Consequently, no specific facility "size" standards have been established. The Health Care Financing Administration has, however, developed some very general guidelines. An ICF/MR facility must admit only that number of individ
uals that does not exceed: its rated capacity; and its capacity to provide adequate
programming (42 CFR 442. Subpart G, Section 442.420). An ICF/MR "may not house residents of grossly different ages, developmental levels, and social needs in close physical or social proximity" unless such arrangements are "planned to promote the growth and development of all those housed together." Also, an ICF/MR may not segregate residents on the basis of physical handicaps. Residents must be integrated "with
others of comparable social and intellectual development" regardless of certain physical or neurological limitations (Subpart G, Section 442.444). Section 442.447 specifies that, unless granted a variance, bedrooms must not accommodate more than four residents.
Federal Certificate of Need pro ram regulations (42 CFR, Parts 122 and 7123 have been developed in such a way as to "give each state substantial flexibility in determining how its certificate of need program will be implemented" (Federal Register, 24, 205, 69740.
October 21, 1980). No specific "size" guidelines are prescribed. Under general federal standards, STATE HEALTH SYSTEMS AGENCIES must consider how facilities
will meet individual resident needs. The quality and extent of proposed services is a major consideration. Within the" general limitations imposed by DPW program rules and regulations, HSAS are able to exercise considerable latitude in determining the appropriate scale of proposed facilities, i.e., ascertaining how facility "size" might relate to resident care practices, facilitate individual growth and/or promote social integration. Facility size is determined by several factors: cost, resident programming needs, projected utilization, location, identified resident populations, accessibility/availability of
necessary support services.
1122 Review Need Determination and Cost Containment (Federal Capital Expenditure
Review) procedural and criteria related requirements are-similar to the minimum Federal requirements for state certificate of need reviews. 1122 regulations contain
no explicit statements regarding facility size atid/ or resident populations.
1122 reviews assure that unnecessary capital expenditures are not incurred by/or on behalf of health care facilities (42 CFR 100). These determinations are subject to applicable state
agency rules (e.g., DPW Rule 34 standards). 1122 reviewsoinclude an examination.of operational potential, cost containment flnanclal feasibility, and service quality.
HUD Section 202 program loans are directed toward housing projects which serve elderly and handicapped individuals (24 CFR 885). Departmental policies attempt to limit the size and concentration of housing for physically handicapped persons. It is HUD'S policy "to encourage housing for the physically handicapped which provides for their
continued integration in the conmnunity. ..rather than permittin9 the segregation of the
handicapped by themselves." Consequently, only Pro
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posals for "small apartment complexes of six to 24 units or congregate group homes for
occupancy of up to 12 persons" are generally approved.
HUD has a similar policy regarding housing for developmentally disabled persons.
Approvals are limited to small grow horn=: "Althowhgrow
homes for up to 12 persons per site will be permitted, facilities for six to eight persons would be preferable, if feasible, as smaller projects can provide a more normal
and home-like noninstitutional environment" (HUD Handbook 4571.1 REV, 1978).
HUD policy further maintains that all projects intended for occupancy should be designed for independent living; thereby making a wide variety of housing types possible.
"Most proposals involving the developmentally disabled have proposea group homes.
However, to be consistent with the basic objective of maximizing independence, proposals for the developmentally disabled which provide opportunities for more independent living will be encouraged. . . Housing. . .should be located in predominantly residential neighborhoods where other family housing is located. ..In all group homes, onl two-person occupancy will be permitted in each bedroom unit" HUD Handbook 1978).
Municipal Zoning Authority in Minnesota is derived from State Statute (Chapter 462). Section 462.357, subdivision 1 establishes the authority of municipalities to regulate the use of property within (and, in certain instances, adjacent to) their boundaries. Zoning authority is conferred upon municipalities in order that they might promote the "public health, safety, morals and general welfare. .."
The state has, however, established certain standards with statewide
applicability: "In order to implement the policy of this state that mentally retarded and physically handicapped persons shall not be excluded by municipal zoning ordinances from the benefits of normal residential surroundings, a state licensed group home or foster home serving six or fewer mentally retarded or physically handicapped persons shall be
considered a permitted single family, residential use of property for
the purposes of zoning" (Section 462.357, subdivision 7).
Chapter 462 states further that, "Unless otherwise provided in any town,
municipal or county zoning regulation.. .a state licensed residential
facility serving f~om seven through 16 mentally or physically handicapped persons shall
be considered a permitted multi-family residential use of property for purposes of
zoning" (Section 462.357, subdivision 8). Conditional use or special use permits may
not be imposed on such facilities if they are more restrictive than those imposed on other, similar structures, except that "additional conditions are necessary to protect the
health and safety of the residents of the residential facility. .."
Chapter 252 establishes the authority of the Commissioner of DPW to
"determine the need, location and programs of public and private residen- tial and day care
facilities and services for mentally retarded children and adults" (Section 252.28, subdivision 1). Subdivision 3 references Chapter 245: "No license or provisional license shall be granted when the issuance of the license would substantially contribute to the excessive concentration of residential facilities within any town, municipal
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ity or county of the state" (Section 245.812, subdivision 1). When determining if a license
will be issued, the commissioner must "specifically consider the population, size, land use
plan, availability of community services and the number and size of existing public and
private community residential facilities in the town, municipality, or county. . ." (Section
245.812, subdivision 2). Under Section 245.812, subdivision 3, "A licensed residential facility serving six or fewer persons or a licensed day care facility serving ten or fewer persons" must be considered a permitted single family residential use of property.
The Minnesota Housing Finance Agency administers a program which provides non-profit sponsors with up to 100% permanent mortgage financing for the development of residential group homes. The program has several objectives; among these are: providing
facilities that offer normalized life patterns; providing supervised living environments
which permit training in self-sufficiency skills; providing living conditions which respond
to residents' special needs while offering alternative life styles to institutionalization.
Projects may house from six to 16 persons (Residential Group Home Program/MHFA, 1980).
III. REVIEW OF LITERATURE
As the state continues its deinstitutionalization efforts and
counties endeavor to develop community residential opportunities, it
becomes important to establish a link between practice (implementation of Welsch/development of residential housing) and policy (normalization).
State policy statements and the Welsch decree both espouse the normalization principle and
the doctrine of least restrictive alternatives. However, how do counties incorporate those
philosophies into residential housing designs and conrnunity-based programming?
Existing program standards generally provide only very broad guidance. Under what circumstances and conditions might the design of dwelllng units contribute to the further development of residents? Does facility "size" bear any relationship to the quality of resident care? What constitutes a least restrictive, normalized environment?
A."Size" and Its Impacts
Most of what has been written about the impact of "size" is inconclusive, Facility size has
not been identified as a definitive predictor of care practices or resident behavior development (Balla, 1976; Bjaanes and Butler, 1974; McCormick, Bal la and Zigler, 1975). Research indicates that size per se is neither the source of all ills nor the solution to all problems (Raynes, 1977). ' Culturally normative environments are defined
by several considerations: social interaction, access to community resources/services,
programming, staffing patterns, geographic location, etc. (Crawforct, 1979; McCormick, Bal la and Zigler, 1975; Del linger and Shope, 1978); facility size is only one of only one of several factors.
King, Raynes and Tizard (1971) suggest that the organizational structure and the type of
institutions may be more important than size in influencing the patterns of care. They point out that even relatively small
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hospital facilities, and facilities with small living units, can exhibit
institutionally-oriented care patterns. They observe further, however, that "The history of mental institutions suggests that the larger the institutions have become, the harder it has been to eschew the obvious attractions of centralization and to maintain an appropriate
balance with the social environment 'outside'."
Wolfensberger (1972) helped popularize the idea of small, specialized community-based
residential programs as an alternative to traditional, multi-purpose institutional
arrangements. By de-emphasizing comprehensiveness and centralization, more "normal" patterns of social interaction are encouraged. Neither superior care nor social integration is
guaranteed, however, in small community settings (Balla, 1976; Baroff, 1980; Bjaanes and Butler, 1974). Inadequate cormnunity-based facilities do exist; likewise, excellent "larger" facilities are not unconrnon (Raynes, 1977).
B. "Small" v. "Large"
The literature does suggest, however, that "smaller" community residences are generally preferable to larger establishments; that normalized environments are more
readily established and maintained in smaller, communitybased residential settings.
Though small size per se is neither necessary nor sufficient to insure appropriate care, the following service attributes are more likely to prevail in smaller facilities and have been identified as being influential in producing 9ains in adaptive behavior and general developmental growth:
-individualized attention (Baroff, 1980);
-resident-oriented care practices (Balla, 1976; Baroff, 1980; King,
Raynes and Tizard, 1971; McCormick, Balla and Zigler; 1975);
-absences of security features, existence of personal effects, privacy in bathroom and bedroom areas (Balla, 1976; Baroff, 1980);
-experienced, trained direct care staff (Dellinger and Shope, 1978;Baroff, 1980).
Citing the findings of a 1979 study (Eyman, Demaine and Lei), Baroff(1980) suggests that "the apparent value of locating residential settings within rather than apart from community resources, a condition more easily achieved in small residential settinqs, is. ..reflected in behavior gains in personal and community self-sufficiency as a function of residential proximity to community services ...research appears to. ..show
that such normalization elements as proximity of the residence with the neighborhood,
appearance and internal comfort can produce real gains in adaptive behavior."
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Baroff (1980) also reviewed the findings of seven other studies. Each sought to examine the relationship between behavior and size. Six of those studies indicated some advantages in smaller settings. One showed no difference; none indicated any advantages accruing to larger settings.
"It does seem that size makes some difference. Smaller residential settings, typically serving not more than ten persons, can necessarily be more responsive to individual needs. Moreover, their location in normal community residential neighborhoods allows easy access to the range of community experiences that can enhance social, vocational, and recreational skills and can foster greater independence.
These same experiences are much more difficult to provide in the more physically isolated and autonomous settings of the larger institutions."
(Baroff, 1980, p. 116)
IV. IMPLICATIONS FOR PLANNING
__.__
Minnesota's 87 counties are charged with the responsibility for developing residential
placement opportunities for many of the State's developmentally disabled citizens; and they
must provide those opportunities within the constructs of the normalization principle-as
espoused by federal , state and sub-state regulatory guidelines. The application of that principle is inconsistent both between and among the various regulatory and licensing authorities. There are no systematic guidelines relative to facility "size."
To some extent, imprecision and lack of clarity in regulatory standards may
be unavoidable. Federal guidelines in most cases prescribe only minimum standards.
Their application is broad politically as well as geographically.
They must take into account the disparate nature of service delivery systems among the many states. Under these circumstances, lack of specificity Is understandable--though no less confounding to state and local implementing agencies. Similarly, certain state standards are broad in application as well as definition (e.g., DPbl Rule 34). The general nature of rules is not altogether unreasonable. Some programs must accommodate a wide range of
disabilities and service needs. This lack of specificity, however, places much of"the burden for determining the appropriateness of program and facility design upon
developers. It is imperative then that counties and other decision-makers recognize the consequences of various policy decisions. Already some policy-makers have indicated a need for more standardized, coherent policy statements on
"size" (see DD Residential Guidelines Task Force/Metropolitan Health Board, 1980).
The literature suggests that"size" may be an important factor in determining the degree to which normalization has been achieved; hence the development.Of individual residents.
Additional analysis will help define the relationship between facility size and
program policy objectives. Also, further analYsls of size-cost factors will prove
helpful to planners and developers as they begin to make important decisions about
the future direction of residential services.
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Facility cost is an especially important issue. Studies indicate that COM
munity care models may indeed be cost-effective alternatives to public institutional
fa~ilitiek. An analysis of national data (Wieck, 1980) indicates that the lowest per diem rates among conrnunity residential facilities were associated with the smallest homes which were family owned and operated and offered the least amount of support services. A study of "small" group homes in Minnesota (Heiner and Bock, 1978) also suggests that, smaller facilities are capable of producing "positive client changes at a better rate than larger ones; and...without significantly higher costs." The findings from the
Minnesota study are described as "preliminary". Further study of size-per diem
relationships should prove enlightening.
Planning and other development efforts should endeavor to assess all "costs".
Planners should be advised that cost and efficiency are defined in terms broader than
dollars. Although difficult to prove empirically, "...it is entirely possible that .economies of scale apply favorably to [larger facilities] relative to the meeting of basic needs but that this cost savings is at least partially offset by diseconomies relative to the provision of psychosocial. developmental services" (Regional Institute of Social Welfare,1976) .
Policy-makers will no doubt wish to consider other factors as well: person
nel/staff, location, community resources/services, the impacts of fiscal
constraints/opportunities, developments in programing models, etc.
It seems clear that, by definition, "normalization" implies small, home-like residential dwelling units. The primary focus of all residential programs must be the care and support of developmentally disabled residents rather than the convenience of developers. "Small" facilities may not be the most appropriate setting for all persons returning to communities under the mandates of the Welsch decre~ The doctrine of least restrictive alternatives does not necessarily always imply "small"-it does, however, suggest a resident oriented, gievelopmental program focus.
Where it iscktermined that larger facilities with specialized services are a more appropriate care setting, developers should direct their attention toward ensuring appropriately modeled "living units". The literature suggests that the organization and management of living units can have a profound impact upon the development of skills, adaptive behaviors and personal growth. In all cases, residential program development will require thoughtful and informed planning. Political decisions (e.g., the allocation of resources) must measure up to the philosophical considerations embodied within the Welsch decree (e.g., normalization and the riqht to a least restrictive living environment).
"Superficially, the normalization principle might seem merely to apply to the life and circumstances ofmildly handicapped people, or those not living in institutions. But it is wrong to think that living in the community can in itself be equated with being "integrated" into
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society. The question still remains of how closely the life of mentally retarded people
approaches that of "normal" members of that community. In fact, the normalization principle will have its most far-reaching consequences for retarded people presently living in hospitals and institutions. "
(Nirje, "The Normalization Principle" Changing Patterns of Residential Services for the Mentally Retarded, p. 232)
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Balla, David A., "Relationship of Institutional Size to Quality of Care: A
Review of the Literature." American Journal of Mental Deficiency, Vol. 81,
No. 2, 117-124. September 1976
Baroff, George S., "On 'Size' and the Quality of Residential Care: A Second Look", Mental Retardation, Vol. 18, No. 3, 113-117, June 1980
Bjaanes, A. T., Butler, E. W., and Kelly, B. R., "Placement Type and Client
Functional Level as Factors in Provision of Services Aimed at Increasing Adjustment" in
Reinstitutionalization and Community Adjustment of Mentally Retarded People (R. H.
Bruininks, C. E. Meyers, B. B. Sigford, K. C. Lakin, editors).
AMD Monograph No. 4 (C. Edward Meyers, series editor). Washington D. C.: American Association on Mental Deficiency, 1981 (pp 337-350).
Bjaanes, A. T., and Butler, E. W., "Environmental Variation in Community Care Facilities for Mentally Retarded Persons", American Journal of Mental Deficiency, Vol. 73,
No. 4, pp429-39, January 1974.
Bruininks, R. H., Kudla, M. J., Hauber, F. A., Hill, B. K., and Wieck, C. A.,
"Recent Growth and Status of Community Residential Alternativesn, in Deinstitutionalization and Community Adjustment of Mentally Retarded People
(R. H. Bruininks, C. E. Meyers, B. B. Sigford, K. C. Lakin, editors). AAMD Monograph No. 4 (C. Edward Meyers, series editor). Washington, D.C.: American Association on Mental Deficiency, 1981 (pp. 14-27).
Cohen, H., "Behavioral Effects of Institutional Relocation of Mentally Retaeded
Residents", American Journal of Mental Deficiency, Vol. 82, No. 1, pp 12-18, July 1977.
Crawford, J., et al, "Reinstitutionalization and Comnunity Placement: Clinical and Environmental Factors", Mental Retardation, Vol. 17, No. 2, pp59-63, April 1979.
Developmental Disabilities Planning Office, Policy Analysis Series #1: A Taxonomy of Issues Surrounding Implementation of the Welsch v. Noot Consent Decree. St. Paul: Developmental Disabilities Planning Office, State Planning Agency, April 1981,
Developmental Disabilities Project on Residential Services and Community Adjustment. Project Report to the Inter-Agency HUD and HEW Task Force on Reinstitutionalization. Minneapolis: Department of Psychoeducational Studies, University of Minnesota. 1977.
Developmental Disabilities Residential Guidelines Task Force, "Report of the
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Metropolitan Health Board of the Metropolitan Council). St. Paulz Metropolitan Health
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Dellinger, J. K., and Shope. L. J., "Selected Characteristics and Working Condi
tions of Direct Service Staff in Pennsylvania CLAS", Mental Retardation,Vol. 16, No. 1, 19-21, February 1978.
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Eyman, R. K., Demaine, G. C., and Lei, T., "Relationship Between Community
Environments and Resident Changes in Adaptive Behavior: A Path Model", American Journal of Mental Deficiency, Vol. 83, pp 330-338, 1979 (cited in Baroff,1980).
Felsenthal, D., and Scheerenberger, R. C., "Stability and Attitudes of Primary Caregivers in the Community", Mental Retardation, Vol. 16, No. 1, pp 16-18, February 1978.
King, R. D., Raynes, N. V., and Tizard, J., Patterns of Residential Care: Sociological Studies in Institutions for Handicapped Children, London: Routledae & Keaan Paul, Ltd. 1971.
"Minnesota Model Standards: The Development Testing and Evaluation of a Proactive Quality Assurance Mechanism for Facilities for the Mentally Retarded" (Final Report). Minnesota Management Model for Reinstitutionalization Project. St. Paul: Department of Public Welfare, MR Program Division,iJanuar.y 1980.
McCormick, M., Balla, D., and Zigler, E., "Resident-Care Practices in Institutions for Retarded Persons: A Cross-Institutional, Cross-Cultura" American Journal of Mental
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President's Committee on Mental Retardation, 1974.
Nirje, B., "The Normalization Principle", Changing Patterns in Residential Services for the Mentally Retarded (revised edTtlon), Washington, D.C.: President's Ccrnmittee on Mental Retardation, 1976, pp. 231-240.
Noakes, E. H., "What is the Problem? Whose Problem Is It? How Widespread Is
It?", in Proceedings of National Conference on Housing and the Handicapped,September 10-12, 1974; Houston, Texas, convened by Goodwill Industries of America (project of Division of Developmental Disabilities, Rehabilitation Services Administration, Dept. of HEW). (Cited in D.D. PrOJeCt, 1977)
O'Brien, J., Poole, C., "Planninq Spaces: A Manual for Human Service Facilities
Development", Atlanta: Georgia' Association for Retarded Education Project), June 1978.
Raynes, N. V., "How Big is Good? The Case for Cross-Cutting Retardation, Vol. 15, No. 5, pp 53-54, October 1977.
Regional Institute of Social Welfare Research, "Is Statewide Deinstitutionalization of Children's Services a Forward or Backward Social Movement?". Athens, Georgia:
University of Georgia/U.S. Dept. of Commerce, NTIS 1976. -
Roos, P., "Implications for Developing a National Program for Housing and Handicapped People", in Proceedings of National Conference on Housing and the Handicapped, September 10-12, 1974; Houston, Texas, convened by Goodwill Industries of America (project of Division of Developmental Disabilities, Rehabilitation Services Administration, Dept. of HEW). (Cited in D.D.' Project, 1977)
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Scheerenberger, R. C., and Felsenthal, D., "Conrnunity Satisfaction and Activities",
Mental Retardation, August 1977.
Schroeder. S., and Henes, C., "Assessment of progress Settings for MR Persons:
vol. 15, No. 4, pp 3-7,of Institutionalized and Deinstitutionalized Retarded Adults: A Matched-Control Comparison", Mental Retardation, Vol. 16, No. 2, pp147-8, April 1978.
"The Relationship of Client Capacity to Client Development, Client Movement and
Costs in Intermediate Care Facilities (ICF/MR) for the Mentally Retarded: Final Report" (KarlW. He.inetiWarren H. Bock, principal investigators).St. Paul: Department of Public Welfare/MR Program Division, September 1978.
Wieck, C. A., "The Cost of Public and Community Residential Care for Mentally
Retarded People in the United States," Doctoral Dissertation, University of
Minnesota. Minneapolis, 1980.
Wieck, C. A., and Kudla, M. J., (Robert H. Bruininks, team leader) "Evaluation
of Board and Care Facilities: A Report on Minnesota's Human Services", (submitted to Nancy Dittmer, Denver Research Institute); Minneapolis: University of
Minnesota, Department of Psychoeducational Studies, 1980.
Wolfensberger, W., The Principle,of Normalization in Human Services, Toronto: National Institute of Mental Retardation, 1972. (Cited in Balla, 1976;Baroff, 1980).
Wolfensberqer, W., "The Oriqin and Nature of Our Institutional Models", in
Changing Patterns in Residential Services for the Mental Retarded (R. Kagel and A. Shepard, editors). Washington, D.C.: U.S. Government Printing Office, 1976 (Cited in D. D.. Project, 1977).
CURRENT GUIDELINES
Welsch v. Likins, 373 F. Supp. 487 (1974)
U.S. District Court, District of Minnesota, Fourth Divisions February 15, 1974.
Welsch v. Likins, 550 F.2d 1122 (1977)
United States Court of Appeals, Eighth Circuit. Submitted January 13, 1977; Decided March 9, 1977.
Welsch-Noot Consent Decree; United States District Court, Di'strict of Minnesota,
Fourth Division. U.S. District Judge Earl Larson. September 15, 1980.
12 MCAR 2.185 (DPW Rule 185) County Board or Human Service Board Responsibilities to Individuals Who Are or May Be Mentally Retarded (State Register,Vol. 5, No. 33, 1263, February 16, 1981).
Policy Analysis Paper #2
April 10, 1981
Revised August 1981
Page 15
12 MCAR 2.037 (DPW Rule 37) Department of Public Welfare Rule for the Administra
tion of Grants In Aid to Residential Facilities for the Mentally
Retarded and Cerebral Palsied.
12 MCAR 2.008 (DPW Rule 8) Standards for Group Homes and Licensing
Procedures.
12 MCAR 2.018 (DPW Rule 18)--Standards for the Provision of Semi-Independent
Living Service (SILS) to People Who Are Mentally Retarded.
(Published at State Register, Vol.5, No. 47, 1,888, May 25, 1981. )
12 MCAR 2.034 (DPW Rule 34)--Standards for the Operation of Residential Facilities and Services for Persons iiho Are Mentally Retarded. (Amendments to12 IICAR 2.034: State Register, Vol. 5, No. 47, 1,889, May 25, 1981. )
7 MCAR 1.391-1.401 (Chapter Twenty-Three: MHD 391-401) Regulations for Construction, Equipment, Maintenance, Operation and Licensure of Supervised Living Facilities.
42 CFR 442 Title 42 Public Health/Chapter IV Health Care Financing Administration Part 442 -Standards for Payment for Skilled Nursing and Intermediate Care Facility Services (reference: Section 1905(c) and (d) of the Social Security Act)
42 CFR 122/42 CPR 123
Title 42 Public Health/Chapter 1, Public Health Service Health Systems Agency and State Health Planning and Development Agency Reviews; Certificate of Need Programs (Federal Register, Vol. 45, No. 205, 69740, October 21, 1980).
42 CFR 100
Title 42 Public Health/Chapter 1 - Public Health Service Subchapter 1 - Medical Care Quality and Cost Containment Part 100 Cost Containment and Quality Control (reference: Section 1122 of the Social Securfty Act (42 U.S .C. Chap 7).
24 CFR 885
Title24-Housing and Urban Development/Chapter VIII - Low Income Housing,Department of HUD Part 885 Loans for Housing for the Elderly or Handicapped (Reference: Section 202 of the Housing Act of 1959, as amended, 12 U.S. C. 1701q)
HUD Handbook 4571.1 REV, Section 202 Direct Loan Program for Housing for the
Elderly and Handicapped (Transmittal No. 5). Chapter 1, Section 1-5,
Washington, D.C.: U.S. Dept. of Housing and Urban Development. March 10, 1978.
Apartment Development Division, "Group Residences for the Developmentally Disabled", St. Paul: Minnesota Housing Finance Agency/Apartment Development Division, 1980.
Minnesota Statutues, Chapter 245 Department of Public Welfare/Public Welfare and Related Activities. see Section 245.812, Subds 1, 2, 3 and 4 (Sections 245.61 to 245.69 authorize County Boards to make grants for local mental health programs; to establish/facilitate programs in mental health, mental retardation and inebriacy. Sections 245.781 to 245.812 - "Public Welfare Licensing Act" establishes the authority of the Commissioner of DPW to license operators of day care and residential facilities. Sections 245.781 to .812 do not apply to a day care or residential facility serving fewer than five physically or mentally handicapped adults. )
Minnesota Statutes, Chapter 252 - Mentally Retarded and Epileptic; State Hospitals.
see Section 252.28, Subd. 1 and 3.(Section 252.28 references the authority of the Connnissioner of DPW to determine the need, location and program of public and private residential and day care facilities and services for mentally retarded children and adults. )
Minnesota Statutes, Sections 252A.01-.21 "Mental Retardation Protection" directs the Commissioner of the Department of Public Welfare to supervise persons with mental
retardation who are unable to fully provide for their own needs and to protect their human
and civil rights by assuring a full range of social, financial, residential and habilitative services.
Minnesota Statutes, Sections 256 E.01-.12 "Conrnunity Social Services Act" establishes a system of planning forand providing conmunity social services administered by the boards of county commissioners of each county.
Minnesota Statutes, Section 393.07 "Public Child Welfare Program Mandates that
county welfare boards administer a program of social programs and financial assistance to
children who are confronted with social, physical or emotional problems requiring such protection and assistance.
The Policy Analysis Series is published by the Minnesota Governor's Planning Council on Developmental Disabilities and the Developmental Disabilities Program, Department of Energy, Planning and Development.
Bruce Balow, Ph.D., Cotincil Chair Colleen Wieck, Ph.D., Director
The purpose of this series is to enhance communication among state and local agencies, service providers, advocates, and consumers on timely issues. We encourage reader participation by giving us feedback on your ideas and perceptions of this problem.
This paper my be cited:
Developmental Disabilities Program. Policy Analysis Series #2: The Size of Community Residential Facilities: Current Guidelines and Implications for Planning. St. Paul, MN: Developmental Disabilities Program, State Planning Agency, August 1981.
