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Then in 1973, the NARC released "The Right to Choose – Achieving Residential Alternatives in the Community." The guide defined community residential services and provided communities with a format for developing a plan, getting funding, and implementing their plans.

A community-based residential service is some type of housing, other than the individual's natural home, usually designed for not more than 12 persons having similar needs in terms of age, independence and/or ability.

The residential service should:

  • Provide a home environment with supervision and guidance as needed;
  • Afford living experiences appropriate to the functioning level and learning needs of the individual;
  • Be located within the mainstream of community life; and
  • Provide access to necessary supportive, habilitative and rehabilitative programs based on a developmental model of programming.
Children on front steps
Photo courtesy
William Bronston, M.D.

Meanwhile, the ICFs/MR program emerged.

During the 1970s, billions of federal dollars were spent turning older state institutions and developmental centers into newer ICFs/MR. The ICFs/MR program essentially created financial incentives for keeping people in large state facilities and diverted funds that could have been used for community programs.

By the end of the decade, the federal ICFs/MR program was subsidizing the costs of institutionalization for the vast majority of people with developmental disabilities living in public institutions and nursing homes. By 1984, annual payments reached between $3 and $4 billion per year.

The program made federal funds readily available for institutionalization and required states to use scarce resources to construct and renovate facilities so they met ICFs/MR standards. As allowed under the program, some states used IFCs/MR funds for private institutions, rather than investing in community alternatives.

Nursery
Photo courtesy William Bronston, M.D.