Comparison of States’ Use of Large State Institutions
States have reduced the number of residents in state institutions to varying degrees. As of 2008, 86 percent of the nation’s institutional population resided in 18 states, with Texas housing almost one in seven (14%) of all institutional residents (table 5).
Table 5: Distribution of Residents in Large State Institutions as of June 30, 2009
|
State |
Population |
Percentage of Total |
Cumulative Percentage |
|---|---|---|---|
|
1. Texas |
4,541 |
14% |
14% |
|
2. New Jersey |
2,785 |
8% |
22% |
|
3. Illinois |
2,254 |
7% |
29% |
|
4. California |
2,252 |
7% |
36% |
|
5. New York |
2,056 |
6% |
42% |
|
6. North Carolina |
1,593 |
5% |
47% |
|
7. Ohio |
1,429 |
4% |
51% |
|
8. Mississippi |
1,336 |
4% |
55% |
|
9. Virginia |
1,259 |
4% |
59% |
|
10. Pennsylvania |
1,230 |
4% |
63% |
|
11. Louisiana |
1,165 |
4% |
67% |
|
12. Florida |
1,094 |
3% |
70% |
|
13. Arkansas |
1,078 |
3% |
73% |
|
14. Washington |
926 |
3% |
76% |
|
15. Massachusetts |
893 |
3% |
79% |
|
16. Georgia |
849 |
3% |
81% |
|
17. South Carolina |
810 |
2% |
84% |
|
18. Connecticut |
723 |
2% |
86% |
Table 6 presents data on the number of residents of large state institutions and the percentage of all residential service recipients who are served in large public institutions. This metric shows how much the state relies on large public institutions to provide services, but it does not adjust for the proportion of the ID/DD population that receives residential services. For example, states that have relatively few people in institutions but provide little residential care will rank high on this metric. However, the issue is not that these states are using institutions more than other states, but rather that they provide less care overall.
Table 6: States Ranked by Public Institution Residents as a Percentage of Total Residential Service Recipients, 2009
|
State |
Total Residential Service Recipients |
Residents in ID/DD Settings with 16+ |
Public Institution Residents as a Percentage of Total Residential Service Recipients |
||
|---|---|---|---|---|---|
|
Number |
Number |
Rank |
Percentage |
Rank |
|
|
Alaska |
1,062 |
0 |
1 |
0.0 |
1 |
|
District of Columbia |
1,280 |
0 |
1 |
0.0 |
1 |
|
Hawaii |
1,114 |
0 |
1 |
0.0 |
1 |
|
Maine |
2,910 |
0 |
1 |
0.0 |
1 |
|
Michigan |
14,607 |
0 |
1 |
0.0 |
1 |
|
New Hampshire |
1,795 |
0 |
1 |
0.0 |
1 |
|
New Mexico |
2,158 |
0 |
1 |
0.0 |
1 |
|
Rhode Island |
2,237 |
0 |
1 |
0.0 |
1 |
|
Vermont |
1,554 |
0 |
1 |
0.0 |
1 |
|
West Virginia |
1,947 |
0 |
1 |
0.0 |
1 |
|
Oregon |
5,664 |
0 |
1 |
0.0 |
1 |
|
Minnesota |
14,157 |
22 |
12 |
0.2 |
12 |
|
Idaho |
43,731 |
74 |
16 |
0.2 |
13 |
|
Indiana |
9,257 |
134 |
22 |
1.4 |
14 |
|
Maryland |
7,438 |
129 |
21 |
1.7 |
15 |
|
Colorado |
5,227 |
103 |
18 |
2.0 |
16 |
|
Arizona |
4,111 |
123 |
20 |
3.0 |
17 |
|
Nevada |
1,544 |
47 |
13 |
3.0 |
18 |
|
Montana |
1,893 |
64 |
14 |
3.4 |
19 |
|
Wisconsin |
11,341 |
441 |
31 |
3.9 |
20 |
|
California |
55,436 |
2,252 |
48 |
4.1 |
21 |
|
Kentucky |
4,097 |
170 |
24 |
4.1 |
22 |
Table 6: States Ranked by Public Institution Residents as a Percentage of Total Residential Service Recipients, 2009 (continued)
|
State |
Total Residential Service Recipients |
Residents in ID/DD Settings with 16+ |
Public Institution Residents as a Percentage of Total Residential Service Recipients |
|||
|---|---|---|---|---|---|---|
|
Number |
Number |
Rank |
Percentage |
Rank |
||
|
New York |
46,568 |
2,056 |
47 |
4.4 |
23 |
|
|
Pennsylvania |
24,095 |
1,230 |
42 |
5.1 |
24 |
|
|
Alabama |
3,549 |
192 |
26 |
5.4 |
25 |
|
|
Iowa |
8,994 |
528 |
32 |
5.9 |
26 |
|
|
North Dakota |
2,062 |
123 |
19 |
6.0 |
27 |
|
|
Nebraska |
3,013 |
184 |
15 |
6.1 |
28 |
|
|
Kansas |
5,761 |
353 |
29 |
6.1 |
29 |
|
|
South Dakota |
2,307 |
146 |
23 |
6.3 |
30 |
|
|
Ohio |
22,521 |
1,429 |
45 |
6.3 |
31 |
|
|
Wyoming |
1,271 |
82 |
17 |
6.5 |
32 |
|
|
Oklahoma |
4,404 |
289 |
28 |
6.6 |
33 |
|
|
Utah |
3,303 |
222 |
27 |
6.7 |
34 |
|
|
Delaware |
1,028 |
72 |
15 |
7.0 |
35 |
|
|
Florida |
15,339 |
1,094 |
40 |
7.1 |
36 |
|
|
Massachusetts |
12,235 |
893 |
37 |
7.3 |
37 |
|
|
Tennessee |
5,370 |
421 |
30 |
7.8 |
38 |
|
|
Connecticut |
7,001 |
723 |
34 |
10.3 |
39 |
|
|
Illinois |
21,311 |
2,254 |
49 |
10.6 |
40 |
|
|
Missouri |
6,511 |
695 |
33 |
10.7 |
41 |
|
|
Washington |
7,168 |
926 |
38 |
12.9 |
42 |
|
|
North Carolina |
12,261 |
1,593 |
46 |
13.0 |
43 |
|
|
Georgia |
5,961 |
849 |
36 |
14.2 |
44 |
|
|
Louisiana |
7,332 |
1,165 |
41 |
15.9 |
45 |
|
|
South Carolina |
4,885 |
810 |
35 |
16.6 |
46 |
|
|
Virginia |
7,411 |
1,259 |
43 |
17.0 |
47 |
|
|
Texas |
25,640 |
4,541 |
51 |
17.7 |
48 |
|
|
New Jersey |
13,389 |
2,785 |
50 |
20.8 |
49 |
|
|
Arkansas |
3,863 |
1,078 |
39 |
27.9 |
50 |
|
|
Mississippi |
3,379 |
1,336 |
44 |
39.5 |
51 |
|
|
U.S. Total |
443,134 |
32,909 |
|
|
|
|
Source: Lakin et al., 2010
Table 7 presents the number of institution residents per 100,000 people in the state. This metric adjusts for the size of the state, which is a good proxy for the number of people with ID/DD in the state.
Table 7: States Ranked by the Number of Institution Residents per 100,000 Total Population
|
State |
Institution Residents per 100,000 population |
Percentage Change in Average Daily Population, 1980–2009 |
||
|---|---|---|---|---|
|
Number |
Rank |
Percentage Change |
Rank |
|
|
Alaska |
0 |
1 |
-100 |
1 |
|
District of Columbia |
0 |
1 |
-100 |
1 |
|
Hawaii |
0 |
1 |
-100 |
1 |
|
Maine |
0 |
1 |
-100 |
1 |
|
Michigan |
0 |
1 |
-100 |
1 |
|
New Hampshire |
0 |
1 |
-100 |
1 |
|
New Mexico |
0 |
1 |
-100 |
1 |
|
Rhode Island |
0 |
1 |
-100 |
1 |
|
Vermont |
0 |
1 |
-100 |
1 |
|
West Virginia |
0 |
1 |
-100 |
1 |
|
Oregon |
0 |
1 |
-100 |
1 |
|
Minnesota |
0.4 |
12 |
-98.8 |
12 |
|
Nevada |
1.8 |
13 |
-67.6 |
39 |
|
Arizona |
1.9 |
14 |
-81.4 |
23 |
|
Colorado |
2 |
15 |
-92.4 |
15 |
|
Indiana |
2.1 |
16 |
-94.6 |
13 |
|
Maryland |
2.31 |
17 |
-93 |
14 |
|
Kentucky |
3.9 |
18 |
-81 |
24 |
|
Alabama |
4.1 |
19 |
-88.3 |
17 |
|
Idaho |
4.8 |
20 |
-79.2 |
27 |
|
Florida |
5.9 |
21 |
-72.3 |
35 |
|
California |
6.1 |
22 |
-72.9 |
33 |
|
Montana |
6.6 |
23 |
-79.7 |
26 |
|
Tennessee |
6.7 |
24 |
-76.7 |
30 |
|
Wisconsin |
7.8 |
25 |
-79.2 |
28 |
|
Oklahoma |
7.8 |
26 |
-84.1 |
20 |
|
Utah |
8 |
27 |
-72 |
36 |
Table 7: States Ranked by the Number of Institution Residents per 100,000 Total Population (Continued
|
State |
Institution Residents per 100,000 Population |
Percentage Change in Average Daily Population, 1980–2009 |
||
|---|---|---|---|---|
|
Number |
Rank |
Percentage change |
Rank |
|
|
Delaware |
8.1 |
28 |
-85.9 |
19 |
|
Georgia |
8.6 |
29 |
-63.9 |
42 |
|
Pennsylvania |
9.8 |
30 |
-83 |
21 |
|
Nebraska |
10.2 |
31 |
-68.3 |
38 |
|
New York |
10.5 |
32 |
-86.2 |
18 |
|
US Total |
10.7 |
|
-74.4 |
|
|
Missouri |
11.6 |
33 |
-63.8 |
43 |
|
Ohio |
12.4 |
34 |
-71.2 |
37 |
|
Kansas |
12.5 |
35 |
-73.4 |
32 |
|
Massachusetts |
13.5 |
36 |
-80.1 |
25 |
|
Washington |
13.9 |
37 |
-58 |
46 |
|
Wyoming |
15.1 |
38 |
-82.2 |
22 |
|
Virginia |
16 |
39 |
-64.3 |
41 |
|
North Carolina |
17 |
40 |
-47.5 |
49 |
|
Illinois |
17.5 |
41 |
-64.4 |
40 |
|
Iowa |
17.6 |
42 |
-56.1 |
47 |
|
South Carolina |
17.8 |
43 |
-72.9 |
34 |
|
South Dakota |
18 |
44 |
-77.4 |
29 |
|
Texas |
18.32 |
45 |
-55.1 |
48 |
|
North Dakota |
19 |
46 |
-88.4 |
16 |
|
Connecticut |
20.5 |
47 |
-74.8 |
31 |
|
Louisiana |
25.9 |
48 |
-63 |
44 |
|
New Jersey |
32 |
49 |
-60.9 |
45 |
|
Arkansas |
37.3 |
50 |
-30.1 |
50 |
|
Mississippi |
45.3 |
51 |
-20.3 |
51 |
Source: Lakin et al., 2010
Cost of Institutional Care
The average daily expenditures per resident in fiscal year 2008 for public residential settings with 16 or more residents varied significantly across states. The weighted per diem average of $539 ($196,710 per year) represents expenditures ranging from a low of $285 per day (104,025 per year) in Arkansas to a high of $1,030 ($375,950 per year) in Tennessee (Lakin et al., 2010). Adjusted for inflation, these costs have nearly doubled since 1988, owing in large part to the decreasing numbers of residents sharing the fixed costs of maintaining the institutions (Lakin et al., 2010).
Table 8 presents data on the average cost of care in large state institutions. Many factors account for the variation in costs, so a higher cost should not be construed as necessarily indicating better or worse care than a lower cost.
Table 8: States Ranked by Average Cost of Care in Large State Institutions
|
State |
Average Cost per Day |
Average Cost Per Year |
|---|---|---|
|
Arkansas |
$285 |
$104,025 |
|
South Carolina |
$310 |
$113,150 |
|
Mississippi |
$318 |
$116,070 |
|
Illinois |
$395 |
$144,175 |
|
Texas |
$398 |
$145,270 |
|
Florida |
$404 |
$147,460 |
|
Kansas |
$408 |
$148,920 |
|
Arizona |
$416 |
$151,840 |
|
Ohio |
$419 |
$152,935 |
|
Missouri |
$437 |
$159,505 |
|
South Dakota |
$458 |
$167,170 |
|
Utah |
$463 |
$168,995 |
|
Maryland |
$466 |
$170,090 |
|
Georgia |
$472 |
$172,280 |
|
Louisiana |
$473 |
$172,645 |
|
North Carolina |
$481 |
$175,565 |
|
Virginia |
$496 |
$181,040 |
|
Nevada |
$501 |
$182,865 |
|
North Dakota |
$514 |
$187,610 |
|
Oklahoma |
$525 |
$191,625 |
|
Alabama |
$535 |
$195,275 |
|
Indiana |
$538 |
$196,370 |
|
Washington |
$569 |
$207,685 |
|
Colorado |
$580 |
$211,700 |
Table 8: States Ranked by Average Cost of Care in Large State Institutions (continued)
|
State |
Average Cost per Day |
Average Cost Per Year |
|---|---|---|
|
Iowa |
$595 |
$217,175 |
|
Pennsylvania |
$603 |
$220,095 |
|
Nebraska |
$608 |
$221,920 |
|
Wyoming |
$645 |
$235,425 |
|
Massachusetts |
$675 |
$246,375 |
|
New Jersey |
$685 |
$250,025 |
|
Kentucky |
$687 |
$250,755 |
|
Montana |
$690 |
$251,850 |
|
California |
$701 |
$255,865 |
|
Wisconsin |
$701 |
$255,865 |
|
Idaho |
$802 |
$292,730 |
|
Delaware |
$853 |
$311,345 |
|
Minnesota |
$906 |
$330,690 |
|
Connecticut |
$922 |
$336,530 |
|
New York |
$925 |
$337,625 |
|
Tennessee |
$1,030 |
$375,950 |
Source: Lakin et al., 2010. States with no large state institutions are not included in the table.
For a comparison of the costs of institutional and community-based care, see Section 6 of the Deinstitutionalization Toolkit.
Additional resources are available in the Institutions topic area in the Deinstitutionalization Toolkit. These external documents may be accessed for a more “inDepth” review of the topic area.
References
Fortune, J., and K. J. Auerbach. (2009). Virginia SIS Comparisons for SEVTC and Comprehensive Community Waiver Populations. Human Services Research Institute, Information Brief. Accessed March 30, 2011.http://www.arcofva.org/docs/0910_sis_comp.pdf
Lakin, K. C., R. Doljanac, S. Y. Byun, and R. Stancliffe. (2006). Medicaid Home and Community-Based Services for Persons with Intellectual and Developmental Disabilities: Background and Findings from Consumer Interviews and the Medicaid Statistical Information Systems. Prepared for the Centers for Medicare and Medicaid Services. Accessed March 30, 2011. http://rtc.umn.edu/docs/HCBSFinalrprt.pdf
Lakin, K. C., S. Larson, P. Salmi, and A. Webster. (2010). Residential Services for Persons with Developmental Disabilities: Status and Trends through 2009. Research and Training Center on Community Living Institute on Community Integration/UCEDD, College of Education and Human Development, University of Minnesota. Accessed July 21, 2011.http://rtc.umn.edu/docs/risp2009.pdf