As is often the case, the concepts of continuum and least restrictive environments led to somewhat contradictory outcomes – on the one hand, the development of many more positive alternatives for individuals, and at the same time, limiting choice by preconceived notions of which people qualified for or were ready for those alternatives.

The 1962 language of the Executive Director of the New York State ARC, though harsh to our ears today, captures the essence of this thinking: "If after these were set up [small residential centers in the community for people considered trainable and educable] we had a residue of so-called custodial or medical cases, for whom there is no prognosis for even quasi-independent living, but who will need care all through their lives, perhaps we could borrow a page from Connecticut and other communities where small hospital-life facilities are being created… for this type of care."

Conditions in Institution
Photo courtesy William Bronston, M.D.