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Background: Deinstitutionalization research shows better services and outcomes relative to institutional life but has not compared formerly institutionalised and never-institutionalised service users. Methods: We used propensity score matching (PSM) to match formerly institutionalised and never-institutionalised participants on six personal characteristics. Data came from the 2018 to 2019 National Core Indicators In-Person Survey. We excluded current institution residents, and states with 25% + of missing data on former institutionalisation. Results: Overall, 15.5% of participants in the 29-state full sample had lived in an institution for 1 year or more. Findings from the PSM sample showed that former-institution residents were more likely to use congregate living arrangements and less likely to live with family. They experienced more loneliness, less support-related choice, and had a consistent pattern of disability service-focused social connections. Conclusions: Many former institution residents remain disadvantaged relative to matched peers. There is a need to identify factors to enhance services and outcomes following deinstitutionalization.

Direct support professionals (DSPs) and frontline supervisors (FLSs) have critical roles in home and community-based services for people with intellectual and developmental disabilities. Low wages and high levels of responsibility created a long-term crisis in recruitment and retention and are exacerbated by the COVID-19 pandemic. A national sample of DSPs and FLSs were compared on demographics and work-related circumstances using data from the third Direct Support Workforce COVID-19 Survey. Significant differences were found in demographics, hours worked, wages, wage augmentations, and quality of work-life. Policy recommendations to address the worsening workforce crisis are provided.

The purpose of this study is to lay a foundation for illustrating the importance of longitudinal data collection by sharing the results of the Independent Monitoring for Quality (IM4Q) program in Pennsylvania designed to collect data over time on the quality of services for adults with intellectual and developmental disabilities. In this article, we report on the history and characteristics of the IM4Q program, describe the key variables of interest, and highlight the trends in the key variables over 3 years of data collection (2013, 2016, and 2019). The descriptive results indicate mixed trends for the three areas of focus: comparable rates of people employed in community-based settings, less support-related choice, and better everyday choice-making outcomes.

Background: Requiring adults with intellectual and developmental disabilities to go on community outings with co-residents and staff is contrary to community-living policy's focus on person centredness and choice of activities/companions. Method: We analysed 2018-19 National Core Indicators data from 36 US states concerning 7968 adults living in staffed, non-family, multi-client settings. The focus outcome was being able to stay home if you want when others in your home go out. Results: The 42.0% of participants who could stay home were more likely to go out with friends, family or alone, and less likely to go out with staff. Those who could stay home participated in a similar variety of community activities and went out more often to shop or for errands. Conclusions: Individuals who could stay home likely had more choice about where, when and with whom they went out. Strategies for greater person-centredness are proposed.

As youth with intellectual and developmental disabilities (IDD) are transitioning from the school systems and special education supports, many of them are moving into the adult service system (e.g., Vocational Rehabilitation, Home and Community‐Based Services). Thus, in addition to adolescence being a source of many psychological and behavioral needs, the change in service systems often leads to uncertainty and anxiety. Psychotropic medications tend to be used to treat challenging behavior and psychological conditions (e.g., depression, anxiety, psychosis). This study used National Core Indicators‐In‐Person Survey 2020–2021 data to explore the prevalence of psychotropic medication use among two groups of people with IDD: disability service users of transition age (18–25 years) and disability service users of adult age (26–45 years) and the role of residential settings (where one lives) as related to psychotropic medication use. The results indicated that adults (aged 26–45 years) are more likely to be prescribed psychotropic medications. This appears to be driven by the larger number of transition‐aged adults who still live with family, where prescription rates are much lower. Psychotropic drug use is an important issue due to its potential to lead to unintended negative consequences that affect health, social inclusion, and self‐determination if not carefully and effectively administered. [ABSTRACT FROM AUTHOR]

This document is a table that lists the names and affiliations of individuals who participated in a conference on intellectual and developmental disabilities (IDD). The conference focused on addressing disparities faced by individuals with IDD from underserved racial, ethnic, linguistic, and cultural communities. The participants discussed various methodological issues in research, practice, and policy, and emphasized the importance of including diverse perspectives and co-creating research with individuals with IDD. The table is part of a special issue of the journal Intellectual and Developmental Disabilities that provides recommendations for future research. [Extracted from the article]

BACKGROUND: The onset of the COVID-19 pandemic forced an immediate change to the delivery of employment supports and services for jobseekers and workers with intellectual and developmental disabilities (IDD) across the United States. OBJECTIVE: This study examines how employment consultants and employment program managers adjusted the delivery of their supports to continue to provide services to jobseekers and employees with IDD during the pandemic. METHOD: A total of 11 employment consultants and employment program managers from 10 states participated in semi-structured interviews about the effects of the pandemic on their provision of employment services and on the people they support. The data were analyzed thematically. RESULTS: Four overarching themes regarding changes in support delivery were identified: 1) Immediate needs at pandemic onset; 2) Preparing for jobs; 3) Finding jobs; and 4) Keeping jobs. CONCLUSION: The adaptations and innovations made to employment services during the pandemic, especially regarding remote services, offer new and innovative approaches to helping people with IDD find and keep employment beyond the pandemic. [ABSTRACT FROM AUTHOR]

BACKGROUND: Community-based employment is a key step for many adults with intellectual and developmental disabilities (IDD), a group prone to high unemployment, poverty, and dependency. It is also important in order to avoid poverty and progress toward economically stable and independent lifestyles. Increases in community-based employment for individuals with IDD meet the expectations of the HCBS final rule as well as state-wide transition planning requirements and other compliance indicators. OBJECTIVE: The current study explores changes in employment over time before and after the final rule was issued and other initiatives (e.g., Employment First policy) were adopted. This method provides an important way to detect if the effort is impacting service users with IDD as intended. By comparing three waves of data from the state of Pennsylvania (2013, 2016, and 2019), we can gain insight into changes in employment rates over time among HCBS service users with IDD in light of policy initiatives. METHODS: We used three waves of IM4Q data to compare the growth in employment among 9,486 individual service users with IDD in the state of Pennsylvania. Repeated measures regression using generalized estimating equations (GEEs) was used to examine employment in an integrated setting in the community over time after controlling for age, support needs, residence type, and community type. RESULTS: Controlling for the effects of demographic and environmental characteristics, there was a significant increase in community-based employment among IDD service users in Pennsylvania between 2013 and 2019. Other variables were also associated with employment. CONCLUSION: This study was the first to our knowledge to consider changes in community-based employment across three waves of data for individuals with IDD. The data wave collection periods in Pennsylvania coincided with significant policy changes relevant to service users with IDD. These changes in policy may be effective and warrant both continued exploration of its effects and ways to maximize policy to further integrate adults with IDD into the community. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado, Indiana, Minnesota, and Mississippi). We linked residents' care times to their measures of health and functioning from Minimum Data Set assessments. Major variables were unit- and resident-specific minutes of care per day, process measures (physical restraints, range of motion, toileting program, and training in activities of daily living [ADLs]), outcome measures (ADL decline, mobility decline, and worsening behavior between the time study and 90-day follow-up), and covariates such as unit type and resident health status. We used multilevel analysis to examine staffing and quality relationships. Results: Residents with toileting programs, range of motion or ADL training, and restraints received significantly more care from unlicensed but not from licensed staff. However, functional outcomes were not significantly related to care received from licensed or unlicensed staff, except for ADL decline, which was greatest for residents receiving more unlicensed minutes of care. Unit staffing level (licensed and unlicensed) was unrelated to any of the care processes or outcome measures, although higher overall staffing was associated with more time devoted to direct resident care. Implications: Future research into nursing home quality should focus on organization and delivery rather than simply the amount of care available. (Contains 5 tables.)

Purpose: Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. Design and Methods: We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. Results: Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. Implications: Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment--but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations. (Contains 1 figure and 4 tables.)

Purpose: This study reviews staffing standards from the 50 states and the District of Columbia to determine if these standards are related to nursing home staffing levels. Design and Methods: Rules and regulations for states' nursing home staffing standards were obtained for the 50 states and the District of Columbia. Nurse staffing data were obtained from the Centers for Medicare and Medicaid Services On-Line Survey, Certification, and Reporting (known as OSCAR) database. The minimum hours per resident day (HPRD) staffing standards for each state were categorized according to the following: no state-specific HPRD standard (adheres only to federal staffing guidelines); low HPRD standard ([is less than or equal to] 2.5 HPRD); and high HPRD standard (> 2.5 HPRD). A series of hierarchical linear models examined the relationships between state staffing standards and actual facility staffing (total, licensed, and certified nurse aide HPRD), using a number of covariates. Results: The variance in facility staffing was much greater within than between states. Facilities in states with high staffing standards had somewhat higher staffing than states with no standards or low standards, whereas facility staffing in states with low standards was not significantly different from that in states with no standards. Other factors, such as resident acuity and average state Medicaid rate, also were related to staffing. Implications: State staffing standards may not be effective policy tools because they are only one of many factors that affect facility staffing levels. Setting a low minimum HPRD standard may fail to raise staffing, or it may even have a dampening effect on staffing rates in facilities. Key Words: Staffing levels, Quality of care, Nursing home, State standards, Policy

BACKGROUND: Rates of integrated employment among people with IDD receiving services are low and have remained essentially unchanged for the past ten years. National Core Indicators© (NCI) data provide an important window on the employment and employment outcomes of people with IDD receiving services. OBJECTIVE: To use NCI data to describe the employment status of individuals supported by state IDD agencies, to compare outcomes of those in and those not in integrated employment, and to propose policy suggestions to increase the numbers if individuals with IDD receiving services in integrated employment. METHODS: NCI data from 2012-13 were analyzed to look at the demographics, outcomes and employment status of NCI respondents. RESULTS: The data highlighted in this article illustrate the employment, employment support, employment type, wages, hours and selected employment outcomes of individuals with IDD who receive public services. CONCLUSIONS: Improving the level of participation of people with IDD in integrated employment and the quality of employment outcomes in terms of choice of job, individual or group supports, rate of pay and type of work must continue to be a priority for states. [ABSTRACT FROM AUTHOR]

In 2014, the Centers for Medicare & Medicaid Services (CMS) launched the Home and Community-Based Services (HCBS) Final Rule intended to improve the quality of HCBS for people with disabilities. The Rule focuses on improving outcomes through person-centered services and supports. These outcomes include privacy and dignity. This study reviewed state compliance with the Final Rule by examining statewide transition plans and investigating the Final Rule’s impact on privacy outcomes of adults with intellectual and developmental disabilities (IDD). We compared cross-sectional National Core Indicators® (NCI®) Adult Consumer Survey (ACS) 2012 to 2013 and Adult In-Person Survey (IPS) 2018 to 2019 data. Privacy (people letting them know before entering their home; being alone with friends/visitors at home) increased after Final Rule implementation. Individuals in the 2018 to 2019 group had 36% and 29% higher odds of being asked for permission to enter their home and of being alone with friends/guests, respectively. Age, gender, severity of ID, and several co-occurring conditions were also predictive of improvement in privacy. [ABSTRACT FROM AUTHOR]