Institutions—nursing homes, psychiatric hospitals, group homes, developmental facilities, and other congregate settings—segregate disabled people from community life. Yet millions of disabled people remain institutionalized globally, often unnecessarily. This page starts with disability justice critique of institutions, explains international deinstitutionalization frameworks, then provides country-specific information about alternatives, rights, and how to transition to community living.
Institutions are fundamentally incompatible with disabled people's autonomy, dignity, and rights. This is not a matter of opinion—it's documented in international law, disability rights advocacy, academic research, and disabled people's lived experience.
Institutions are congregate residential settings where:
Examples: nursing homes, psychiatric hospitals, state developmental facilities, large group homes, residential schools, "care communities."
This differs from:
Disability justice organizations (ASAN, ADAPT, SABE, and others) have articulated why institutions violate disabled people's rights:
Institutions violate autonomy: Disabled people's right to make decisions about their own lives is core to human dignity. Institutions inherently restrict this—staff control schedules, activities, socialization, medical decisions, finances.
Institutions create dependency: Rather than supporting disabled people toward interdependence and community participation, institutions create dependence on institutional systems. Disabled people lose skills; become isolated.
Institutions prevent community participation: Disabled people in institutions don't work in regular jobs, attend regular schools, participate in community activities, maintain friendships outside institution, or have meaningful community roles.
Institutions concentrate power imbalances: Staff control everything; residents have little recourse. This creates conditions enabling abuse. Disabled people in institutions experience disproportionate abuse, neglect, and exploitation.
Institutions are expensive: Institutional care is more expensive than community support. Yet institutions remain funded while community alternatives starve. This is a policy choice, not economic necessity.
Institutions reflect and reinforce ableism: They exist because society believes disabled people cannot live in community, cannot make decisions, need "protection." Institutions encode ableist assumptions into policy and practice.
2.6 million disabled people globally live in institutional settings. Yet disability justice organizations globally argue this is not necessary—most could live in community with appropriate support.
900,000+ people in U.S. alone unnecessarily institutionalized (could live in community with support).
Trends: Deinstitutionalization occurring in some countries (Nordic countries, some EU member states, parts of North America) while institutionalization still increasing in others (parts of Eastern Europe, some Global South countries).
The international disability rights movement has established clear frameworks for moving disabled people from institutions to community living.
CRPD Article 19 establishes that disabled people have the right to live independently in the community. This is not optional—it is a human right.
Article 19 specifically requires states to:
This means: Institutions are incompatible with CRPD Article 19. States have obligation to deinstitutionalize and fund community living.
For detailed explanation of CRPD Article 19 and how countries implement it, see International Housing Rights.
Olmstead decision established that unjustified segregation of disabled people in institutions violates the Americans with Disabilities Act. The court ruled:
"Confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, personal choices, and the opportunity to engage in community activities."
While Supreme Court also allowed "reasonable limitations," Olmstead established principle that community living is the goal and institutions are not acceptable default.
Home and Community-Based Services (HCBS) Settings Rule requires that Medicaid-funded services support community living in "the most integrated setting appropriate."
Rule specifies that settings must:
Rule applies to all Medicaid HCBS waiver services. However, implementation lags—many "settings" still institutional in practice.
Disability rights organizations globally have articulated standards for ethical deinstitutionalization:
Person-centered planning: Transitions planned around individual preferences, not institutional convenience.
Funding follows person: Money follows disabled person to community setting, not stays with institution.
Community infrastructure: Community support services, housing, employment support, education access all necessary for successful transition.
Peer support and involvement: Disabled people, particularly those with lived experience of institutions, must direct transition.
No abandonment: Transitions must include support; people not discharged into homelessness.
Accountability: Institutions cannot simply close; disabled people must be successfully transitioned to community living.
Choose your country or region to see specific institutional landscapes, deinstitutionalization progress, and alternatives to institutions:
The U.S. has large institutional population (nursing homes, psychiatric hospitals, state developmental facilities, large group homes) despite Olmstead decision requiring community living.
Nursing homes: 1.3 million residents (mostly elderly; significant proportion disabled working-age adults). Settings often institutional despite regulations.
Psychiatric hospitals: 40,000-50,000 residents (varies by definition); many involuntarily committed. Lengths of stay vary from short-term stabilization to long-term.
State developmental facilities: 40,000+ people with intellectual/developmental disabilities in large congregate settings (state-operated). Many unnecessarily institutionalized despite Olmstead requirement.
Large group homes: 20+ resident facilities common; operate institutionally despite not legally defined as institutions.
Some states (Vermont, New Hampshire, others) have closed state developmental facilities and transitioned residents to community living.
Most states moving slowly or not at all. Many states use HCBS Settings Rule as excuse not to deinstitutionalize ("we are compliant"), while maintaining institutional practices.
Olmstead litigation ongoing; disability organizations using courts to force state compliance. But litigation is slow; many people institutionalized while cases proceed.
Supported living: Disabled person rents/owns own home, hires own support staff, maintains control over living arrangement and support. Most aligned with Article 19.
Supported decision-making: Disabled person works with trusted people (not paid staff) to make decisions. Being adopted in 21 U.S. states.
Host homes/family care: Disabled person lives with family (not in institution); receives support. Must be genuine choice with real autonomy.
Cooperative housing: Disabled people collectively own/manage housing; hire shared support staff; maintain control and community.
Self-directed care: Disabled person directs their own services and support; increasingly available through Medicaid.
Right to counsel: You have right to attorney in commitment/institutionalization proceedings.
Right to refuse treatment: Cannot be forced into unwanted medical treatment (with limited exceptions).
Right to due process: Institutions cannot hold you indefinitely without legal process.
Right to family contact and community access: Institutions must permit visits, community access.
Right to challenge institutionalization: You can petition court for release, challenge commitment, demand Olmstead compliance.
Disability Rights Organizations: Every state has disability rights agency (disabilityrightsflorida.org, disabilityrightsca.org, etc.; find yours at dol.gov). These organizations provide legal assistance with institutionalization challenges.
ADAPT (adapt.org) is disability-led direct action organization focused on deinstitutionalization. ADAPT members have conducted sit-ins, demonstrations, civil disobedience to force institutional closure and community living transitions. ADAPT actively challenges institutionalization and supports deinstitutionalization.
Your state disability rights organization: dol.gov directory
Centers for Independent Living: ncil.org directory
ADAPT: adapt.org
ASAN: autisticadvocacy.org
SABE: sabeusa.org
Olmstead litigation tracking: disabilityrightsus.org
Canada has been deinstitutionalizing since 1960s-70s. However, significant institutional population remains; some provinces moving faster than others.
Provincial variations: Some provinces (British Columbia, Ontario) have largely deinstitutionalized; others maintain larger institutional populations.
Nursing homes: Common; often institutional despite regulations.
Developmental services: Some provinces operating large residential facilities; others transitioned to community living.
Psychiatric hospitals: Some long-term psychiatric facilities remain; involuntary commitment possible.
Nordic model influence: Canada influenced by Nordic deinstitutionalization; many policies aligned with community living.
Implementation gaps: Laws support community living; funding and services often inadequate.
Provincial responsibility: Each province responsible for disability services; progress variable.
Similar to U.S.: supported living, self-directed care, host homes, cooperative housing increasingly available.
Canadian Human Rights Act prohibits discrimination; Article 19 right to community living applies.
Provincial human rights codes protect rights; vary by province.
Right to legal counsel and due process.
Right to challenge institutionalization through provincial courts.
Independent Living Canada: ilcan.ca
Provincial disability organizations: Search "[province] disability rights"
Canadian Human Rights Commission: chrc-ccdp.gc.ca
ADAPT Canada: adapt-canada.ca
EU member states required to implement CRPD Article 19 deinstitutionalization. Progress varies dramatically.
Nordic countries: Sweden phased out institutional care by 1970s. Norway, Denmark, Finland prioritize community living. Strong funding for community support.
Netherlands: Well-developed community living infrastructure; deinstitutionalization largely complete.
Some Western European countries: Germany, Austria, France progressing toward deinstitutionalization.
Eastern European countries: Post-2004 EU expansion; some countries still developing community infrastructure. Deinstitutionalization just beginning; concerns about "trans-institutionalization"—moving from large institutions to smaller segregated settings rather than true community integration.
Some Southern European countries: Deinstitutionalization progressing slower; funding constraints.
Movement from large institutions to small group homes/settings can maintain segregation while appearing to deinstitutionalize. True deinstitutionalization requires community integration, not just smaller congregate settings.
Contact your national disability organization for country-specific information on:
European Disability Forum: edf-feph.org
ENIL (European Network on Independent Living): enil.eu
National disability organizations: Search "[country] disability rights"
UK has significant institutional population despite decades of deinstitutionalization policy.
Care homes: 18,000+ residential care homes; many operate institutionally.
Psychiatric hospitals: Continuing Care Units and other long-term psychiatric facilities exist; involuntary commitment possible.
"Supported living": UK terminology sometimes misleading—called supported living but still congregate, staffed settings rather than individual choice.
Policy commitment: UK committed to community living; implementation lags.
Closure of large hospitals: Many large psychiatric hospitals closed; residents transitioned to community or smaller facilities.
Group homes remain: Many residents in group home settings; disability organizations argue still institutional in practice.
Genuine supported living: Individual rents/owns home, hires own support—but less common than in U.S.
Host homes: Family-based care with choice and autonomy.
Peer-supported housing: Growing; disabled people supporting each other in community.
Equality Act 2010: Protects right to community living; supports legal challenges to institutionalization.
Mental Capacity Act 2005: Protects rights of people with cognitive disabilities; limits power of others to make decisions.
Right to legal counsel and due process.
Disability Rights UK: disabilityrightsuk.org provides resources and legal assistance.
Disability Rights UK: disabilityrightsuk.org
Equality and Human Rights Commission: equalityhumanrights.com
Local council social services: Contact through local government
Australia has deinstitutionalized much of its developmental disability population through NDIS. However, institutional practices and barriers remain.
Residential aged care: 200,000+ residents; some younger disabled people in aged care settings (inappropriate but common).
NDIS Specialist Disability Accommodation (SDA): Disability-specific housing; can be community-integrated or congregate/institutional depending on implementation.
Some state-operated facilities: Some remain though numbers declining.
NDIS intent: NDIS intended to support community living through individualized funding. However, accessibility, capacity, and participant choice issues remain.
SDA concerns: Disability organizations concerned that SDA creating new forms of institutionalization disguised as "specialized housing."
NDIS-funded supported living: Participant gets funding to hire own support in own home.
Peer-supported housing: Growing; disabled people supporting each other.
Community engagement: NDIS funding can support community participation, employment, education.
Disability Discrimination Act: Protects right to community living.
NDIS rules: Theoretically support community living; implementation variable.
Right to legal counsel and due process.
Disability organizations: Contact Australian Human Rights Commission or state disability organizations.
NDIS: ndis.gov.au
Australian Human Rights Commission: humanrights.gov.au
State disability organizations: Search "[state] disability rights"
Institutional landscape and deinstitutionalization progress vary dramatically globally.
Large institutional populations: Many Global South countries have substantial institutional populations.
Deinstitutionalization beginning: Disability movements in Brazil, India, South Africa, and other countries increasingly advocating for deinstitutionalization.
Resource constraints: Community infrastructure (housing, support services, employment) often inadequate even in countries committed to deinstitutionalization.
Disability-led organizing: Disability organizations in Global South increasingly leading deinstitutionalization advocacy and peer-led community living alternatives.
Brazil: Disability organizations advocating for deinstitutionalization; some transitions occurring.
India: Disability rights movement growing; deinstitutionalization advocacy increasing.
South Africa: Disability organizations addressing institutional populations post-apartheid.
Kenya, Uganda, Ghana: Disability organizations emerging and addressing institutionalization.
New Zealand: Deinstitutionalization ongoing; Disability Rights Commissioner monitors progress.
Japan: Less deinstitutionalization than Western countries; family care models traditional.
South Korea: Disability-led movements emerging around deinstitutionalization.
UN CRPD: ohchr.org (research what deinstitutionalization obligations exist in your country)
Disabled Peoples' International: dpi.org (connect with disability movements in your country)
SABE International: sabeint.org (self-advocacy networks globally)
Regional disability forums: Connect with regional networks
Disabled people are successfully living in community with appropriate support, demonstrating that institutional placement is unnecessary for most people.
How it works: Disabled person rents or owns own home; chooses housemates if desired; hires own personal care attendants/support staff; directs support.
Advantages: Maximum autonomy and choice; integrated in community; relationships and employment possible; cost-effective.
Who it serves: Works for people with physical disabilities, sensory disabilities, many people with intellectual/developmental disabilities, psychiatric disabilities.
Barriers: Requires adequate funding for support; housing affordability; disabled person capacity to direct own care (though supported decision-making helps).
How it works: Disabled person (or representative) receives funding and directs own services and supports; hires and manages own providers.
Adoption: Increasingly available in U.S. states, Canadian provinces, some EU countries through Medicaid/disability benefits.
Advantages: Person-directed; enables choice and autonomy; often cost-effective.
Barriers: Requires administrative capacity; funding limitations; provider availability.
How it works: Disabled person works with trusted people (family, friends, disability advocates, not paid staff) to make decisions about living arrangement, support, daily life.
Adoption: Legal in 21+ U.S. states; emerging in other countries.
Advantages: Maintains autonomy and community connections; less formal than guardianship; honors disabled person's decision-making.
Barriers: Depends on availability of trusted supporters; legal recognition varies.
How it works: Disabled people collectively own, manage, or lead housing; hire shared support staff; maintain control.
Examples: Cooperatives in Scandinavia, some U.S. cities, growing globally.
Advantages: Community with peers; shared decision-making; affordability; solidarity.
Barriers: Startup capital needed; complex governance; finding disabled people wanting to live together.
When appropriate: Small family-based settings with real choice and autonomy; person not forced into arrangement.
Critical: Must be genuine choice with meaningful autonomy and community access. Can be institutional if person lacks choice or is isolated.
For information on Housing Rights including right to community living, see Housing Rights.
For Independent Living Philosophy and Centers, see Independent Living Philosophy and Centers for alternative models.
For International Housing Rights frameworks (CRPD Article 19), see International Housing Rights.
For Homelessness and Disability, see Homelessness and Disability.
Have information about deinstitutionalization efforts, community-based alternatives, or country-specific resources to contribute? Contribute to DisabilityWiki
Last updated: November 2025