Reviews of research on deinstitutionalization show that investigators have focused primarily on adaptive behavior changes of "movers," while paying minimal attention to "stayers." Analysis of their research also revealed some methodological problems. We assessed 150 movers and 150 stayers in 1994, before deinstitutionalization began in 1997. We matched samples on seven distinctive variables, which were again assessed at similar intervals of 3, 15, and 27 months after movement. Movers made significant gains in independence and household skills, while stayers incurred losses in social skills and cognitive competencies. Teaching domestic skills and high autonomy were the best predictors of final self-care and multicognitive competencies, after controlling for initial baseline scores.

In previous studies of the mortality of deinstitutionalized persons with disabilities in California and Pennsylvania, investigators failed to employ a prospective controlled research design. We identified a sample of 150 "movers" scheduled for placement from an institution and a matched sample of 150 institutional "stayers." The matching and other risk variables were measured in 1994. Visits to all residences occurred between 1997 and mid-2000 at specified intervals after movers left the institution. Logistic regression analyses identified the 1994 preclosure risk variables of age, low self-care, medical conditions, and epilepsy/seizure disorders as the best ones for explaining all deaths. Adding mover/stayer status and community/institutional placement to the analyses did not enhance the model. Nursing home placements emerged as a postclosure risk variable.