Early Days of Group Homes
Although the last of the state developmental centers for people with intellectual and/or developmental disabilities would not close down until 2005, their populations had been diminishing for decades. Some of the impetus for deinstitutionalization derived from the Scandinavian principle of "normalization," translated into English in 1969 and then introduced in the U.S. by the influential scholar Wolf Wolfensberger.
"How do you take people that had been institutionalized and find places for them to be in control of their lives?"
A deinstitutionalization project at Indiana University in the early seventies worked with residents of Muscatatuck State Hospital and Training Center. (Interestingly, Wolfensberger had worked there as a staff psychologist in the late fifties. "My experience at Muscatatuck bonded me to a commitment to mentally retarded people for the rest of my life," he recalled.) In anticipation of their eventual release, a halfway house approach provided individuals with life experience in Bloomington a few days per week. For then graduate student Vicki Pappas, this early 1970s project entailed “grappling with the issues of, how do you take people that --some had been institutionalized almost all their lives-- and find places for them to be in control of their lives, to live natural lives, to do things that they were good at and wanted to do?”
Family care programs had been the first of Indiana’s community residential services. Starting in 1955, “they were operated completely through the state hospitals,” explains former state official Randy Krieble. “And there were social workers that made visits and established and hired and trained caregivers, householders, kind of like an adult foster care model.” Then local ARCs (Associations for Retarded Citizens) in the state developed group homes in the 1960s, smaller residential settings in ordinary communities.
Group homes were a less expensive alternative to institutional living. “When I started in Allen County, there were something like 2,500 individuals living in the Fort Wayne State Development Center, says Steve Hinkle. It was 1976 and Hinkle was President of Easter Seals Arc of Northeast Indiana. “And I think at that time $80,000 a year was spent on their annual programs.” “We anticipated that by opening a group home, we could cut that cost to about $25,000.” Hinkle points out that positive outcomes for the adults discharged went beyond the bottom line. For many, there were dramatic improvements in social well-being and other areas. “I mean, it was night and day.”
From institutions to group homes, "It was night and day."
Paul Shankland began working at the fledgling Division on Mental Retardation within the Indiana Department of Mental Health in 1972. In that decade, he says, “we were probably the prime mover in the development of group homes around the state.” Title XX of the Social Security Act provided funding for pilots of such residences. The first Community Residential Facilities/Developmental Disabilities (CRF/DDs) were authorized by the Indiana Legislature in 1978. Intermediate Care Facility/Mentally Retarded (ICF/MRs) were certified for eight persons per facility and received federal Medicaid reimbursement. Starting in 1987, the latter become Indiana’s primary funding source for group homes.
By 1989, the Indianapolis office of the Bureau of Developmental Disabilities Services would open group homes in Marion County at a rate of eight to twelve per month for three years. “That was an exciting time,” recalls Sue Beecher, then the office’s director. “There were a lot of alternatives for people. Elderly parents now could hopefully have their son or daughter placed in the community and some security that their son or daughter was being taken care of.”
The association’s attorney advised the homeowners not to show up.
It was sometimes an uphill battle to site a group home within a particular community. To prevent their development, opponents used zoning laws. “They would fight the fact that you were going to have four, six, or eight people living together who are not married,” explains Steve Hinkle. Seeking to buy a home in a northeast neighborhood of Fort Wayne, Hinkle says his agency set up a meeting with the neighborhood association. The association’s attorney advised the homeowners, who were opposed to the sale, not to show up. “Not a soul came and we couldn't change an attitude. And consequently, we didn't buy that house.” The invocation of fire regulations was also a barrier. Paul Shankland says fire marshals were insistent regarding installation of sprinkler systems, restaurant-type extinguishers, and external fire escapes for every home. Eventually, he adds, intensive advocacy efforts resulted in greater flexibility.
The concept of group homes was more promising at first than it was over time, in Shankland’s view. “Initially, that seemed like a really good idea and later on, as the for-profit folks got involved, it became much less so.” There were some not-so-good ideas, observes Sue Beecher, such as creating homes categorized as “intensive behavioral.” ”You would take eight people with very severe behaviors, put them in a home and expect miracles.” Eight people is too much for any group home, says Hinkle, but less than five or six makes the finances difficult for the group home operator.