For decades, the default answer for adults with intellectual and developmental disabilities who needed daily support was an institution. A facility. A place built around managing people rather than knowing them.
That has changed, and the data backs it up. In-home care has become the most common way adults with IDD receive support in the United States, and the research on outcomes makes a strong case for why that shift happened.
This is not just a feel-good talking point. It is a documented trend with real numbers behind it, and real differences in quality of life for the people living it.
In This Guide
The Shift Away From Institutional Care
There were an estimated 2.28 million adults with intellectual or developmental disabilities in the United States as of the most recent national count, and the way most of them receive support has fundamentally changed. Medicaid Home and Community Based Services, commonly called HCBS, are now the most common pathway for adults with IDD to access support.
The Numbers Behind the Shift
A 2025 analysis of national Medicaid data found that 63.1% of the 1,519,852 adults with IDD enrollment received some form of HCBS in a single year, with home-based services being one of the three most used categories alongside case management and non-medical transportation. That is not a niche option anymore. It is the mainstream path.
The number of people known to state IDD agencies and receiving services also increased 21% between 2013 and 2020, reflecting a steady national movement toward community-based models rather than facility-based ones.
What the Research Actually Shows
It is one thing to say in-home care is more common. It is another to ask whether it actually produces better outcomes. Researchers have looked into this directly, and the findings are worth paying attention to.
Comparing Formerly Institutionalized and Never Institutionalized Adults
A peer-reviewed study published in 2023 used propensity score matching to compare outcomes between adults with IDD who had previously lived in an institution for a year or more and those who had never been institutionalized. The research found that former institution residents were significantly more likely to end up in congregate, group-based living arrangements later in life and significantly less likely to live independently or with family, even years after leaving the institution.
The researchers noted that many former institution residents remained disadvantaged relative to their peers, living what the study described as a more service-focused life, with greater reliance on housemates and paid staff for companionship rather than community connections they built themselves.
In plain terms: starting in an institutional setting tends to have a lasting effect on someone’s path toward independence, even after they leave. That is exactly the pattern in-home and community-based care is designed to avoid from the start.
The Official Federal Position
The President’s Committee for People with Intellectual and Developmental Disabilities addressed this directly in its 2024 report to the President, stating plainly that institutionalization can lead to loss of independence and decreased quality of life, while home and community based supports enable people with I/DD to live at home, decrease institutionalization, and promote wellbeing through continued community living.
That is not an advocacy talking point. That is the federal government’s own committee, made up primarily of individuals with intellectual and developmental disabilities themselves for the first time in its 58-year history, stating the evidence plainly.
In-Home Care vs. Institutional Care: A Side-by-Side Look
| Factor | In-Home Care | Institutional Care |
|---|---|---|
| Living environment | Person’s own home or family home | Shared facility setting |
| Daily routine | Built around the individual’s preferences | Built around facility schedule |
| Community access | Regular participation in local activities | Limited, often supervised in groups |
| Relationship building | Natural friendships and family closeness | Reliance on staff and housemates for companionship |
| Long-term independence outcomes | Higher likelihood of continued independent living | Lower likelihood, even years after leaving |
| Funding pathway in Ohio | Medicaid HCBS waiver (IO Waiver) | Medicaid institutional care |
| Family involvement | Ongoing and central to the care plan | Often more limited |
This is not a perfect picture for every single person. Some individuals with very high medical needs may require a higher level of clinical care than an in-home model alone can provide. But for the large majority of adults with IDD whose support needs center on daily living tasks, community participation, and personal care, the evidence consistently points toward in-home and community-based models producing better long-term outcomes.
What This Looks Like in Practice
Statistics tell part of the story. Real life fills in the rest.
Take someone like Jon, one of the individuals we support at Steps 2 Better Living. Before connecting with us, Jon had struggled to find support that actually worked around what he wanted his life to look like. Once his in-home support plan was built around his actual goals, cooking for himself, holding down a job, staying connected to his community, things shifted. He eventually took the trip to Las Vegas he had been dreaming about for years. That is not something that tends to happen inside a facility schedule.
Or consider Sarah, who came to us after working with a larger agency that treated her more like a case file than a person. The biggest difference she noticed with in-home support was simple. People actually listened, and they kept listening, visit after visit. That consistency is exactly what the research describes as the protective factor against the isolation that institutional and facility-based settings can create.
These are not isolated stories. They are the practical, everyday version of what the national data shows at scale.
The Caregiver Side of the Equation
In-home care does not just affect the individual receiving support. It changes the experience for family caregivers too, and the data here matters for a different reason.
Roughly 35 million family members in the United States provide unpaid care to an adult with a disability or chronic illness. Research using validated caregiver burden scales has found that close to 40% of family caregivers report being in high-burden caregiving situations, and burden increases directly with the number of care hours provided.
This is part of why professional in-home support matters so much. It is not just about the individual living more independently. It is about giving family caregivers room to be family again, rather than full-time, unpaid care coordinators carrying the weight alone.
How Cincinnati Families Can Access In-Home Care
In Ohio, in-home care for adults with IDD is primarily funded through the Individual Options (IO) Medicaid waiver, administered locally through Hamilton County Developmental Disabilities Services (HCDDS).
The path typically starts with an eligibility assessment through HCDDS, followed by a functional assessment that determines what level of in-home support is appropriate. Once approved, families choose which provider delivers that care.
At Steps 2 Better Living, we provide home personal care and related in-home support services for adults with developmental and intellectual disabilities across Cincinnati and Hamilton County. We build every plan around the individual, not a template. You can learn more about our approach before deciding if we are the right fit.
Frequently Asked Questions
Is in-home care always better than facility-based care?
For most adults with IDD whose needs center on daily living support and community participation, research consistently shows better long-term independence outcomes with in-home and community-based care. Individuals with very complex medical needs may require additional clinical support alongside in-home services.
How common is in-home care for adults with IDD now?
National Medicaid data shows that the majority of adults with IDD receiving Medicaid services now access some form of Home and Community Based Services, with home-based services being one of the most utilized categories nationally.
Does in-home care cost families anything?
For individuals enrolled in Ohio’s Medicaid waiver programs, in-home personal care services are typically funded through the waiver itself rather than billed directly to the family.
What if my family member previously lived in a facility?
Transitioning from institutional to in-home care is absolutely possible, and many individuals who make that transition see meaningful improvements in independence and community connection over time. It often requires a thoughtful, gradual support plan, which is something we can help build together.
Let’s Talk About What Independence Could Look Like
If you are weighing in-home care options for a family member in Cincinnati, we would be glad to talk through what that could look like for your specific situation.
Submit a referral here or call us at 513-873-4788. We will listen first.
Sources
- medRxiv — Medicaid Home and Community Based Services Are Vital for Adults with Intellectual and Developmental Disabilities, 2025
- President’s Committee for People with Intellectual Disabilities — Report to the President, 2024
- Residential Information Systems Project (RISP), University of Minnesota
- PMC — Current Services and Outcomes of Formerly-Institutionalised and Never-Institutionalised US Adults with Intellectual and Developmental Disabilities, 2023
- Family Caregiver Alliance — Caregiver Statistics: Demographics
