Ownership Type and Quality of Care in Residential Facilities for the Developmentally Disabled

Following the closure of large state hospitals, which in official parlance are classified as “Intermediate Care Facilities for Individuals with Intellectual Disabilities” (ICF-IIDs), many individuals with intellectual and developmental disabilities have resided in smaller, community-based ICF-IIDs funded by the same Medicaid program. These facilities exhibit considerable heterogeneity, with private for-profit facilities operating alongside ones that are nonprofit or government-owned. Since the turn of the millennium, there has been no systematic assessment of whether ownership type affects the quality of care provided to the individuals residing in these homes. Using a national dataset with information on all ICF-IIDs for the years 2008-2017, we examine whether ownership type predicts differences in facility-level outcomes that at least arguably correlate with the quality of care. The two measures we regard as the least vulnerable to bias – the frequency of regulatory citations and the frequency of complaints – suggest strongly that for-profit facilities underperform both government-owned and nonprofit facilities. The other metrics examined tell a far more complex story that, unfortunately, sheds little light on quality differences per se, but underscores the need for better data and further empirical scholarship in this neglected field. In particular, the importance of reducing the susceptibility of national datasets to reporting bias, obtaining more detailed data on the characteristics of ICF-IID residents such as comorbid mental illness and (self-)injurious behaviors, and linking facility-level datasets to individual outcomes that can be tracked over time, cannot be overstated.