The 1970s: Continued Institutional Investments
Court Orders, Community Living for All, the Emergence of Family Support.
The 1970s began with statements and actions from a variety of sources that reinforced the views of the 1960s. By the end of the decade, however, a new perspective had emerged. The decade began with statements about which groups of people belonged in institutions.
Court cases and policy debates confirmed the rights of people to treatment in the least restrictive environment. The debate centered on who qualified for what level of restriction. The decade closed with growing agreement that no one needs an institution. Advocacy efforts focused on establishing and guaranteeing rights, and securing more and more resources for community living alternatives.
Federal funding programs continued to encourage institutional developments and community alternatives. Support to families began to be recognized as an important element of community support.
In 1970, the President's Committee took the stance that publicly operated residential facilities should offer services to individuals who have the most significant disabilities and require highly specialized programs.
"Less severely retarded persons may profit by short-term residential services for the amelioration or modification of specific problems such as emotional instability, asocial behavior, physical disabilities, or for specialized educational and training programs." And further, that "a high percentage of the [residents] are capable of being integrated into community living situations, when supportive generic services are available."
In the spirit of the PCMR, the statement was a guideline for policymakers not a final policy statement on residential services.
The phrase "high percentage who are capable of being integrated" was not reflected in President Nixon's Executive Order 1176 in 1974.
The President reaffirmed a national goal of returning one-third of the 200,000 persons with developmental disabilities residing in institutions to community settings.
The National Association for Retarded Children (NARC) made clearer the need for community residential services. In 1972, the NARC urged state governments to establish small, community-based, home-like residential facilities. It further recommended that such residential facilities "take absolute precedence over further capital investments in existing or new large scale institutions."
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.
Photo from PCMR Report
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.
Meanwhile, the ICFs/MR (Intermediate Care Facilities for Individuals with Mental Retardation) program emerged. (It is now known as ICF/IID, which stands for Intermediate Care Facilities for Individuals with Intellectual Disabilities.)
Photo courtesy
William Bronston, M.D.
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.
Photo courtesy William Bronston, M.D.
Despite these investments, the Center on Human Policy reported in 1981 that serious violations of the ICF standards existed in all of the institutions in a federally- mandated survey at 44 ICF/MR-certified institutions in 23 states.
Burton Blatt published a ten year follow-up to Christmas in Purgatory and reported that publicly funded institutions remained grossly substandard.
Some states, however, chose to apply ICF/MR standards to smaller residences (between 4 and 15 beds) so that Medicaid funding could be used for community programs.
These investments, along with other efforts, laid the groundwork for making Medicaid funds far more available in the 1980s for community alternatives.
"Aversive Conditioning"
Gunnar and Rosemary Dybwad speak passionately about the wrongness of aversives.
Meanwhile, a series of court cases in the 1970s established the right of people to treatment and habilitation in the least restrictive environment.
Wyatt v Stickney in Alabama, then Welsch v Likins in Minnesota and United States v Solomon in Maryland resulted in federal district court decisions that established the right to treatment in the least restrictive environment.
In 1975, Geraldo Rivera exposed conditions in Willowbrook State School and the Willowbrook decision (New York ARC v Carey) escalated the language to include "and the most normal living condition possible."
The decision was based on the Eight Amendment right to be free from cruel and unusual punishment. Willowbrook closed in September 1987.
The Legacy of Wyatt
Willowbrook Exposé
The Pennhurst Decision and the Plymouth Decree
Two decisions in the latter part of the decade came down clearly that institutions were no longer needed. The Pennhurst decision (Pennsylvania ARC v Pennhurst School and State Hospital) went even further and stated that keeping people with developmental disabilities isolated from society in institutions is a violation of their Fourteenth Amendment right to equal protection. Pennhurst closed in 1988.
The Plymouth Decree (Michigan ARC v Smith) resulted in all parties agreeing that all individuals with developmental disabilities can and should live in the more normalized environments of the community and do not require institutionalization. The Plymouth Decree was a commitment to the development of a comprehensive system of appropriate, less restrictive habilitation training and support services. Plymouth Regional Center closed in 1984.
Pennhurst (Photo courtesy Jim Conroy)
Photos: Pennhurst Over the Years
Photos: Pennhurst 2014 Visit
(146 images, courtesy Thomas Neuville)
These decisions flowed from the growing arguments about the possibilities of supporting people with needs that challenge support providers to live in the community. The court decisions required public funds to be used to develop community alternatives for that group of people it has been argued would always require an institution.
The research from the Pennhurst closure particularly gave added support to the development of small, community living arrangements that were able to support people with severe disabilities well in the community.
These experiences began to undermine the arguments of those who appeared to support community alternatives but in fact supported continued institutionalization for some, if not many, people.
For instance, in 1974 the National Association of Superintendents of Public Residential Facilities for the Mentally Retarded said it "thoroughly supports the recent emphasis upon community programming… [and] it does express concern over the manner in which this goal is being realized… All too often 'community back wards' and 'closeting' are being substituted for institutional 'warehousing'."
