Speaking out for People with
 Intellectual and Developmental Disabilities

IL-ADD Releases Cost Analysis

The Illinois League of Advocates for the Developmentally Disabled (IL-ADD) has challenged the myth that all persons with intellectual and developmental disabilities (I/DD) can be served for less cost in smaller, unlicensed settings.

On October 13, they released a summary and  detailed cost analysis that considered the actual cost of care for an individual in a state Intermeciate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) as compared to what that same individual would cost in a smaller setting. The analysis considered three care scenarios for BRB in a Home and Community-Based Services waiver setting (called "CILAs" in Illlinois).

BRB is a current resident of a state-operated ICFs/MR. BRB is 41 years old, 6' tall, 190 lbs, and healthy. He has a pervasive developmental disorder with borderline intellectual functioning. He is being treated for obsessive/compulsive behaviors which presently involve consuming huge amounts of fluid; interruptions of is O/C behaviors can bring violent responses. He also has a history of life-threatening PICA, however this has been completely extinguished in his present state-operated ICF/IID setting. He is prone to unpredictable explosive physical aggression toward peers, staff and property. He has been expelled from community-based programs.

While very challenging, BRB is not the most challenging among his peers at his ICF/IID; he cannot be dismissed as a uniquely expensive case. For example, he does not present severe medical conditions, seizure activities, sexual aggression, fire-starting, or (at this time) PICA.

Cost Comparison Findings (Summary)

Some closure advocates claim that people can be served in the community for "on average $55,000" per year. In fact, BRB's care would cost:

Scenario #1: A one-person CILA with one-on-one staff: $183,016
Even in this "best case scenario," guardians and many professionals in the field would judge these services to be inadequate and dangerous. Isolation, unsafe staffing levels (1:1, no back up), 911 calls, behavior intervention and psychotropic medication adminstration by low-wage staff, and greatly reduced professional support (as compared to the state ICF/MR) remain problems.
Scenario #2: Four-person CILA (assuming that BRB improved during Scenario #1): $146,701.
Guardians and professionals would have the same concerns as Scenario #1. Additionally, the assumption that BRB would improve under Scenario #1 (rather than deteriorate or place other housemates at risk, which is more likely), is not reastic because BRB depend on a high level of structure and his behaviors deteriorate with less.

Scenario #3: Professional and staff supports in a four-person CILA minimally comparable to state ICF/IID supports: $270,000 (more than his cost of care at the state-operated ICFs/IID). Even at this cost, some of the same concerns persist, namely, isolation, lack of structure, and high risk of 911 police intervention.

Cover Letter

Cost Analysis