By Carli Friedman, CQL Director of Research
Social determinants of health are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (United States Office of Disease Prevention and Health Promotion, n.d., n.p.). Where someone lives, including both the housing itself and the wider neighborhood, can serve to either hinder or promote health – it is a social determinant of health (World Health Organization, 2006). For example, when people live in segregated communities they have poorer health (United States Office of Disease Prevention and Health Promotion, n.d.).
The purpose of this study conducted by CQL | The Council on Quality and Leadership was to examine the relationship between people with intellectual and developmental disabilities (IDD) choosing where and with whom to live in the community, and emergency department utilization – one metric of people’s health. To do so, we analyzed Personal Outcome Measures® data, and emergency department utilization data from a random sample of 251 people with IDD who lived in home and community-based settings.
According to our findings, controlling for all participant demographics, people with IDD who chose where and with whom to live in the community had a 74% decrease in emergency department visits compared to people with IDD who did not choose where and with whom to live (see figure).
The Impact of Choosing Where and With Whom to Live on Emergency Department Visits
We believe this finding about the benefit of choosing where and with whom to live in the community on emergency department utilization is likely because people with IDD tend to choose individual and family homes which are associated with better outcomes (Friedman, 2019, 2020), and because of the benefits of choice and self-determination more broadly. Yet, despite these benefits, people with IDD across the United States often have a lack of choices when it comes to housing. Organizational supports should ensure people are able to choose where and with whom to live; doing so will not only improve people’s health, but also their quality of life.
- Friedman, C. (2019). The influence of residence type on personal outcomes. Intellectual and Developmental Disabilities, 57(2), 112-126. https://doi.org/10.1352/1934-9556-57.2.112
- Friedman, C. (2020). There’s no place like home: A national study of how people with intellectual and/or developmental disabilities and their families choose where to live. The Arc of the United States and CQL | The Council on Quality and Leadership.
- United States Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Author. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
- World Health Organization. (2006). Commission on social determinants of health (Ref. WHO/EIP/EQH/01/2006). Author.
This article is a summary of the following journal manuscript: Friedman, C. (2021). Choosing home: The impact of choosing where to live on people with intellectual and developmental disabilities’ emergency department utilization. Inclusion, 9(2), 92-103. https://doi.org/10.1352/2326-6988-9.2.92