The risk of re-institutionalization: examining rates of admission to long-term care among adults with intellectual and developmental disabilities over time

Despite efforts toward community living for persons with intellectual and developmental disabilities, there is a risk of re-institutionalization through placement in long-term care facilities. To examine patterns of admission to long-term care facilities in Ontario, Canada among adults with intellectual and developmental disabilities across key demographic and clinical variables, a cohort of 50 670 adults with intellectual and developmental disabilities was identified using administrative and clinical health data. Proportions admitted to long-term care facilities between 2009 and 2013 were compared to proportions in a random sample of the general population. A greater proportion of adults with intellectual and developmental disabilities were admitted to long term care over the 4-year period (4.5 vs. 0.9%). Mental health and addiction problems as well as frailty were more strongly associated with admission among adults without intellectual and developmental disabilities. The proportion of adults with intellectual and developmental disabilities admitted annually dropped from 1.6% (2009/10) to 1% (2012/13) while it remained stable among those without disabilities (approximate to 0.3%); no change was observed in the proportion of younger adults with intellectual and developmental disabilities. A small proportion of younger adults with intellectual and developmental disabilities continue to be admitted to long-term care. Research is needed to understand factors which predict admission in this group as well as age-appropriate alternatives to long-term care.