** Facilities for the Mentally Retarded
To further complement the statistics on disability from the various household
surveys, Tables Z and 33 present information on persons with mental
retardation in residential facilities. These data come from the 1987
National Medical Expenditure Survey (NMES) which, in addition to its
household and nursing home components, includes persons who were residents of
or had been admitted to facilities for the mentally retarded during calendar
year 1987. (Another major source of information in this regard is the annual
survey of such facilities conducted by the University of Minnesota Affiliated
Program on Developmental Disabilities and summarized in Table 44).
Table Z shows a total of 211,712 persons resided in facilities for the
mentally retarded in 1987 according to the NMES. Of these, 38.5 percent were
in primarily large (16 beds or more) state institutions, 32.4 percent in
large non-state facilities, and 29.1 percent in small (3-15 beds) non-state
residential facilities. Of particular significance is that, unlike patterns
in the past, less than half of the residents are in state-operated
facilities; however, less than 30 percent of the total are in the small
facilities which can serve as preferred alternatives to the custodial focus
of large institutions.
As Table 33 shows, mental retardation is often placed under the rubric of
developmental disabilities which includes other conditions such as epilepsy,
autism, cerebral palsy and spina bifida. Not all persons with a
developmental disability are mentally retarded; so the two types of
conditions cannot be equated. For example, persons with the physical
limitation caused by cerebral palsy may have no mental retardation at all.
However, of the total number of persons in residential facilities for the
mentally retarded, only a small percentage, 0.7%, have one or more of these
other developmental disabilities, without mental retardation. Another 8.7
percent have neither mental retardation nor another developmental disability.
Those without either type of condition are likely to be elderly or have
mental health problems, in part because some facilities for the mentally
retarded do not just serve persons with mental retardation.
Persons who are mentally retarded often do have additional disabling
conditions, including the other developmental disabilities, impairments and
other chronic conditions, and ADL limitations. Of all residents in
facilities for the mentally retarded, 35 percent had another developmental
disability, nearly 20 percent had a visual impairment and almost 12 percent
had a hearing impairment. Fifty-eight percent had difficulty talking while
over 18 percent had other chronic physical health problems. In addition,
nearly 64 percent had difficulty performing at least one activity of daily
living such as bathing and dressing, while over one third had difficulty with
three or more ADLs. Concerning the severity of retardation, 21.4 percent had
borderline/mild, 20.9 percent moderate, 20.5 percent severe and 37.2 percent
profound.
Table P: Demographic Characteristics of Residents of Facilities for the
Mentally Retarded by Type of Facility,
United States, January 1, 1987
Other Residential Facilities
All State
Facilities Institutions 3-15 Beds 16 Beds or More
211,712 81,442 61,561 68,709
100.0% 38.5% 29.1% 32.4%
Source: Agency for Health Care Policy and Research, 1987 National
Medical Expenditure Survey, Research Findings 6.
Of significance from a policy analysis and planning perspective is how and
why these patterns vary among the different types of facilities, including
state and private, large and small, as well as changes in these relationships
which are occurring over time. For example, Medicaid, an important source of
funding for the poor, is authorized for state operated intermediate care
facilities certified for the mentally retarded (ICF-MR). In an effort to
encourage levels of care appropriate for one's degree of retardation,
Medicaid allows payment for treatment in relatively small ICF-MR residential
settings as an alternative to the custodial focus of large institutions.
However, in spite of these guidelines and the flexibility they allow, ICF-MR
facilities remain essentially large institutions, a situation which
effectively limits community care options for the poor. Nevertheless, as
shown in Table 33, there is a direct relationship between the size of the
institution and the severity of the retardation of the residents. Over 60
percent of those living in mostly large state facilities had a profound level
of retardation compared to less than 15 percent for small facilities of 3-15
beds.
A similar pattern existed in terms of capacity for independent living. For
residents of large facilities, over half of those in the mostly large state
institutions and over 30 percent in other large facilities had difficulty
with three or more ADLs, compared to only 16.8 percent for small, non-state
facilities. Contributing to this dichotomy between large and small
facilities is the deinstitutionalization movement which has encouraged
placing and serving those with relatively low levels of disability in the
community or small residential settings. These patterns also vary by state
and region of the country. For example, the placement of residents in small
facilities for the mentally retarded varied from a low of 18.5 percent in the
south to over one-third in the midwest. Differences among the individual
states are shown in Table 44.
*** Federal Benefit Programs ***
Many social service programs at the national, state and local level provide a
range of assistance for persons with disabilities. These may be within the
scope of broad, federal categorical grant programs, such as those for
children or the elderly, where there are client target groups and priority
services associated with disability.
There are also several federally funded programs geared specifically for
persons with disabilities, consisting of cash assistance, services, or both.
Data on several of the programs which focus specifically on disability appear
in Tables 34-42 and are briefly summarized as follows:
** Special Education
Nearly 4.6 million children from birth through age 21, with a range of
disabilities, received special education services during the 1988-89 school
year (see Table 34).
** Social Security Disability Insurance Benefits (SSDI)
During calendar 1989, 415,500 new SSDI awards were made to disabled workers.
At the end of that year a total of 2.9 million persons were receiving SSDI
payments averaging $555.80 per month (see Tables 35 and 36).
** Supplemental Security Income (SSI)
At the end of calendar year 1989, there were 82,765 blind and 3,071,251
disabled SSI recipients, including children and all blind and disabled
recipients who were 65 years of age and over. The average monthly benefit
was $319.76 for blind and $308.94 for disabled SSI recipients (see Tables 35
and 37).
** State Vocational Rehabilitation Programs (VR)
During federal fiscal year 1988 (10/1/87 - 9/30/88), 217,138 persons with a
disability were rehabilitated into either paid employment or independent
living (see Tables 38 and 39).
** Disabled Veterans (VA)
A total of 2.8 million disabled veterans were receiving benefits as of
September 1989 by the Department of Veterans Affairs (see Table 40).
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