Deinstitutionalization: Speeding Closure of State Institutions
Author: National Council on Disability
Published: 23 Oct 2012 - Updated: 5 Jul 2026
Publication Type: Instructive / Helpful
Table of Contents:
Synopsis - Definition - Introduction - Main - FAQ's - Insights, Updates - Related Content
Synopsis: This report presents an online toolkit and companion paper released by the National Council on Disability (NCD), an independent federal agency, to help advocates and policymakers close state-run institutions and support people with intellectual, developmental, and other disabilities as they move into community living. Grounded in the 1999 Supreme Court Olmstead decision, which held that the unjustified institutional isolation of people with disabilities is unlawful discrimination under the Americans with Disabilities Act, the work draws on interviews, focus groups, and two field case studies in Oregon and Georgia to offer practical planning strategies and responses to common arguments against closure. The material is useful for families, self-advocates, and public officials seeking evidence-based guidance on the fiscal and civil rights case for community-based services over institutional care.*
At a Glance
- 1 - Ten states and the District of Columbia operate no large state institutions, serving people with disabilities in the community regardless of severity.
- 2 - Operating large state institutions can cost three to six times more than inclusive community housing, according to NCD members.
- 3 - The project studied Oregon, which has closed all state institutions, and Georgia, which began the process under an Olmstead settlement with the U.S. Department of Justice.
- Topic Definition: Deinstitutionalization
Deinstitutionalization is the policy and practice of closing large, state-run residential institutions and moving people with intellectual, developmental, psychiatric, or other disabilities into community-based housing and support services. Rooted in civil rights principles affirmed by the U.S. Supreme Court's Olmstead ruling, it aims to end the unjustified segregation of disabled people, redirect funding toward inclusive services, and give individuals greater self-direction and participation in everyday community life.
Introduction
Deinstitutionalization: Closing State Institutions
On Tuesday, October 23rd, the National Council on Disability (NCD), an independent federal agency, released its latest policy project "Deinstitutionalization: Unfinished Business" which includes an online toolkit and companion paper to provide advocates and policymakers with the tools they need to facilitate closures of state-run institutions and meet the needs of people with intellectual, developmental and other disabilities as they transition into the community.
The toolkit and accompanying paper acknowledges numerous federal and state reforms that have occurred since June 22, 1999 when the United States Supreme Court ruled in the landmark Olmstead decision that the unjustified institutional isolation of people with disabilities is unlawful discrimination under the Americans with Disabilities Act (ADA) of 1990.
Main Content
With the launch of the of "De-institutionalization: Unfinished Business" online toolkit and companion paper, NCD seeks to provide advocates and policymakers with information they need to develop a workable plan for closing institutions, strategies for implementing the plan, and tips to debunk myths and counter arguments that have been used against closing institutions, in order to support Americans with disabilities and their families in the quest to lead to a richer, more integrated life in the community.
"In my home state of Oregon, all adults with developmental and intellectual disabilities live in the community because we have no institutions. Not one person with a disability has asked that we reopen our large state institutions," said Sara Gelser, National Council on Disability Member and Oregon State Representative. "There is simply no good reason to maintain institutions in the 21st century. They deprive individuals with disabilities of their civil rights while diverting sorely needed resources from essential community based services for people with disabilities."
"Operating large state institutions, which cost three to six times the price tag of inclusive housing is both a fiscal and moral tragedy," said Gary Blumenthal, NCD member. "Strengthening self-direction and community living serves Americans with disabilities and our communities at large. A more inclusive, fiscally sound future requires our state and local communities to use every limited tax dollar in the most effective ways possible. That means continuing the trend to move people with disabilities out of state-run institutions and into their own homes. NCD hopes this toolkit will be useful in facilitating this necessary social and economic shift."
How was "De-institutionalization: Unfinished Business" prepared?
In addition to conducting interviews and focus groups, NCD facilitated two case studies in the field: Oregon, which has closed all state institutions, and Georgia, which has just begun the process as part of its Olmstead settlement agreement with the U.S. Department of Justice.
Key findings:
- The cost to provide services to people in the outdated mode of institutional settings far exceeds the cost to provide services in the community, and research consistently demonstrates that people with intellectual and/or developmental disabilities (ID/DD) achieve better outcomes in community settings.
- Ten states and the District of Columbia have no large state institutions and provide care in the community to people with intellectual disabilities and/or developmental disabilities (ID/DD) regardless of the severity of their disabilities.
- Other states continue to maintain facilities and deliver services in institutions, despite most families' preference for community-based services.
"De-institutionalization: Unfinished Business" is dedicated to the memory of Susan M. Daniels, who was an extraordinary leader and advocate for equal opportunity, full participation, and the economic empowerment of people with disabilities worldwide. The "Deinstitutionalization: Unfinished Business" paper and toolkit is available on NCD's website.
Why Advocates Fear a Return to Disability Institutions: Federal moves on special education, civil commitment and disability rights have advocates warning of a shift back toward institutional care in the U.S.
Frequently Asked Questions
NOTE: Researched FAQ's by Disabled World (DW)
When did deinstitutionalization begin in the United States?
Efforts gained momentum through the mid-20th century, but the movement accelerated after the 1999 Olmstead decision affirmed that unjustified institutional isolation of people with disabilities violates the Americans with Disabilities Act.
What is the Olmstead decision?
Olmstead v. L.C. is a 1999 U.S. Supreme Court ruling that found the unnecessary segregation of people with disabilities in institutions to be unlawful discrimination, requiring states to provide services in the most integrated setting appropriate.
What is the difference between institutional and community-based care?
Institutional care houses people with disabilities in large state-run facilities, while community-based care supports them in their own homes or neighborhood settings with individualized services, greater independence, and inclusion in everyday life.
What are common concerns raised against closing institutions?
Critics often cite worries about safety, availability of community services, and support for people with severe disabilities, though evidence from states without institutions shows community settings can meet these needs effectively.
Who benefits from deinstitutionalization?
People with intellectual and developmental disabilities, their families, and taxpayers benefit, since community living tends to produce better personal outcomes and lower costs than large institutional settings.
Insights, Analysis, and Developments
Editorial Note: The report frames deinstitutionalization not as an abstract policy debate but as a question with measurable answers, weighing tax dollars, documented outcomes, and the lived preferences of families who overwhelmingly favor community-based support. By pairing case studies from a state that finished the work with one just beginning it, NCD gives readers a realistic picture of both the obstacles and the payoff, making this a resource that speaks to advocates, budget-conscious officials, and disabled people alike who want institutions replaced by homes rather than merely reformed.*Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by National Council on Disability and published on 23 Oct 2012, this content may have been edited for style, clarity, or brevity.
* Editorial additions by Ian C. Langtree.