And even more were for six or fewer people (84%). During the same period the number of settings for 16 or more people actually declined slightly.
By 1987, just under half (46%) of the people living in residential settings were in settings for 15 or fewer people. The other half were in settings for 16 or more, mainly state institutions.
The HCB waivers stimulated the development of smaller and smaller residential settings that had ever expanding impacts over the next two decades.
By 2003, 63% of the people living in residential settings were living in settings of 6 or fewer people. Three quarters of all people in residential settings were living in settings of 15 or fewer people. This dramatic change is reflected in the numbers of people living in larger (16 or more) facilities.
This dramatic change is reflected in the numbers of people living in larger (16 or more) facilities.
Over the 20 year period, the number of people in larger facilities and nursing homes was less than half of what it had been – a drop from approximately 220,000 to approximately 107,000.
Basically, with the advent of the Home and Community Based Waiver, the incentive structure shifted. The full impact did not come until the 1990s, but began to have its effect in the 1980s.