Cost Evaluation of Community Residential Alternatives for Developmentally Disabled Adults (cost-Effectiveness, Mental Retardation)

Abstract

The dissertation was a cost analysis of three small community-based alternatives and a large intermediate care facility (ICFDD) for developmentally disabled adults. The purposes of the investigation were: (a) to compare the costs of home-like alternatives to the ICFDD, (b) to address the methodological deficits of previous research by incorporating controls for selection bias, accounting costs from multiple revenue sources, and accounting costs at the individual level, and (c) to compare the cost-efficiency of the alternatives and the ICFDD.

The sample consisted of 16 developmentally disabled adults that had moved from the ICFDD to one of three alternatives: (a) community residential alternative group home (CRA), (b) home individualized program (HIP), and (c) independent or semi-independent apartments (APT). There were three single group pretest-posttest comparisons in which the ICFDD was contrasted with the alternatives; the alternatives were not compared to each other. Each comparison involved assessment of: (a) annual per-resident costs, (b) sources of revenue, (c) personnel and capital expenditures, and (d) cost-efficiency in providing "normalized" settings. Dollar values were present valued to 1985.

Annual costs for the CRA and HIP samples ($21,156 and $22,423, respectively) were nearly twice the cost of ICFDD living. In contrast, the cost of supporting individuals in apartments ($11,550) was similar to their ICFDD costs. A diverse base of funding support was identified, especially for individuals living in the apartment settings.

The CRA, HIP, and apartment programs received similar ratings on the "normalization" scale; ratings for the ICFDD were substantially lower. Annual per resident cost and scale scores for the ICFDD and alternatives suggested the superior efficiency of the more expensive alternatives in providing quality living settings.