1 The Need for Group Homes

• Library: Group Homes: Strategies for Effective and Defensible Planning and Regulation (ABA) (2014 Ed.)

The term "group home" refers to a congregate housing arrangement for a group of unrelated people. In most cases, the residents of such a facility share a condition, characteristic, or status not typical of the general population.¹ There are numerous other names for congregate living arrangements, however, including "community residential facilities," "group living facilities," "community care homes," "nursing homes" "assisted living facilities," and others. Group homes vary in many respects. They may be permanent or transitional; they may provide varying levels of treatment for their residents; they may be owned or managed by nonprofit or for-profit entities, or even some type of governmental entity.

Group homes provide services for a variety of medical conditions and people, whether with physical or mental disabilities, or with some other characteristic that requires the supportive services of a community living arrangement. Group homes are available for people with a physical disability, such as those who use wheelchairs or other mobility-assisting devices, those who have visual impairments, and those who are hard of hearing. Group homes also provide services for people with cognitive disabilities including dementia, general learning disability, and intellectual disability. Group homes may provide services to people with medical or mental illnesses. For people with a disability without family or whose families are unable to meet their needs, group homes provide a household unit that functions similarly to a family environment.² Moreover, group homes provide services for people with AIDS or other transmittable medical conditions. Group homes further provide care, treatment, and support to recovering drug and alcohol abusers.

Whatever form it takes, the community-based group home has been described as a "preferred model for residential treatment of individuals who are either mentally ill or physically and/or developmentally disabled,"³ and scientific studies have found group homes to be an effective model for assisting people with disabilities to learn, socialize, and develop,⁴ especially when compared with institutional models for living and treatment. In addition, group living facilities serve people beyond just those with physical or cognitive disabilities: group living facilities provide housing for the elderly, for citizens returning to civil society from prison terms, for orphaned or neglected children, and other groups.

As discussed in the Introduction, this book covers aspects of providing for and regulating a variety of types of group homes serving individuals with a variety of characteristics. The fact remains, however, that group homes for people with disabilities are a significant source of controversy, with the added complexity of numerous federal and state laws offering greater protections to group homes for people with disabilities than for congregate living arrangements serving others. While most of the legal protections for group homes for people with disabilities discussed herein are inapplicable to group homes for others, housing facilities for those not within the reach of the Americans with Disabilities Act and the FHAA will also benefit from many of the practical planning and zoning strategies this book covers.

The authors further recognize that there is a growing belief in the scientific and civil rights communities that housing people with disabilities—particularly people with intellectual or psychiatric conditions—in non-congregate, independent settings is the most dignified housing alternative for such individuals, and is the option that offers the greatest likelihood of successful treatment and quality of life for residents.⁵ A less heralded benefit of this trend is a reduced amount of public scrutiny—at least in the local land use regulation and approval context—of independent living arrangements as compared with congregate living arrangements. Experience suggests, however, that the greatest source of opposition and challenge for planners and land use attorneys remains the siting of congregate living arrangements because of a continuing community bias against these types of arrangements. So while this book focuses largely on the planning and land use law issues surrounding group homes and other congregate living arrangements, the reader should be aware that movements toward independent living arrangements for people with disabilities are occurring and may present their own local regulatory challenges now or in the future.

Characteristics of Group Homes

In almost all cases, group homes provide a supportive environment for their residents, and group home operators generally seek to locate in residential areas or other neighborhoods where the residents can be comfortably and unobtrusively integrated with the neighborhood and become essentially a functional family, surrounded by a supportive community. Many group homes operate in single-family, detached houses in suburban or urban residential neighborhoods⁶ and often look much like the rest of the structures and properties in the neighborhood where they are located. In most cases, the group home is a single-family residence, and the exterior remains typical of the neighborhood where it is located.⁷ Only the use has changed—and even that arguably is no change at all when one considers that such homes function with the residents sharing the benefits and burdens of a single household just like any other "family."

A study of group homes conducted in 1983 found that nonprofit organizations operated more than half of them, while public agencies and for-profit entities operated the remainder.⁸ Many private homes, however, operate under contracts with state or local public health agencies. Even more homes used federal, state, or local grants to assist with start-up costs.⁹

Group homes today are generally small. The average occupancy level of a group home in 2011 was 8.2 residents per group housing unit. For group living units for people with intellectual disabilities,¹⁰ there were only 2.5 people per unit.¹¹ These numbers are representative of dramatic downsizing of congregate living facilities since the 1970s, when the average number of residents per group living facility exceeded 20.¹²

Group home residents, as already noted, function like most other families, with responsibilities for the same daily tasks performed by members of general society: household chores, attending work or school, shopping, and exercising.¹³ Residents in a group home setting frequently cook and share meals, recreate together, and forge relationships with one another and with members of the surrounding community.¹⁴ Some group homes have the added element of trained support staff to assist residents with daily household routines or to assist with the management of the home.¹⁵ While some group homes may have 24-hour professional staff, others may have no staff at all,¹⁶ depending on the particular needs of the group home residents and operator. The staff serve the important role of training residents in self-care and life skills, which in turn assists group home residents in becoming self-sufficient and often is an important precursor to the residents obtaining employment and becoming more active participants in the broader economy.¹⁷

People who reside in group homes come from many backgrounds. Some group home residents may be placed in group homes by a state or local government agency, or by a nonprofit agency previously responsible for the person's care. In many other instances, however, people living in group facilities in a particular neighborhood may actually be longstanding area residents, who previously lived under the care of family members who are no longer able to care for them.¹⁸ Families of those with disabilities may seek out a supportive group home living arrangement to provide long-term care and housing that the family cannot provide.

A Brief History of Treatment of Disabilities and the Group Home Concept

The group home as we know it today is a relatively recent innovation in the treatment of people with disabilities and other people who are unable to live alone. The community-based group home grew out of concerns about past methods of treating those with mental health issues and cognitive disabilities, although the group home model has been applied to groups of people beyond those populations.

For most of history, people with disabilities have been subjected to intense discrimination, which has generally marginalized them.¹⁹ In particular, the treatment of people with cognitive disabilities has varied from discriminatory to subhuman due to a widespread societal fear of mental illness and failure to comprehend the vast range of diagnosed illnesses, treatments, and most important, the differences between mental illness and cognitive disabilities. Before the mid-19th century, people with disabilities were cared for largely by family members due to a lack of government or other medical, educational, or housing facilities for people with disabilities.²⁰ People with mental illnesses were described as "idiots" and "lunatics," and were sometimes even thought to be bewitched or demonic.²¹ Those who could not fend for themselves or whose families were unable to support them were recommended for a variety of treatments, ranging from being placed in workhouses to being permanently hospitalized in institutional settings or even incarcerated. Facilities responsible for housing people with disabilities were almost never regulated by government entities, and thus conditions were often foul and unsanitary.

Homelessness was also a frequent problem among people with disabilities, especially in the early history of the United States.²² By the mid-19th century it was clear that a public solution was required to deal with the increasing problem of homeless people with mental health problems.²³ This development marked the beginning of a long period of institutionalization of...