Group Home for Autism (April 2016)

I have a particular autistic kid in mind: nonverbal, reasoning-impaired, but healthy and able bodied. Keeping him in a suburban home is like keeping a high-energy dog in an apartment. He destroys things and there's no way to give him the workout he needs. He hurts himself constantly, but only to a degree he can stand. (He hits himself in the head about 100 times a day, probably each time hard enough to cause a mild concussion, and has been doing it for many years.) Every punishment you can think of is either ineffective, inhumane, teaches him new ways to be bad, or he likes the punishment, often multiple of the above, so it's difficult to give him negative feedback. And he's insensitive to negative feedback even when he recognizes it as negative. Recently he started on medication (2mg Abilify daily), which remarkably immediately eliminated the head banging, at the expense of sleeping more and eating less and generally being less forceful. On the upside, he is quite cautious about doing things he doesn't know he can do, and he generally does not hurt others. He'll never be able to live independently.

This is a design exercise in making a group home for kids like him: age 18 to 50, able bodied, want exercise, not a threat to themselves or others, unable to live independently. There are lots of special needs kids in the US, all different, but you could group them in various ways. I'm guessing there are between 10,000 and 1,000,000 kids like him in the US. Kids that can live independently are in a different category, so are ones who need constant medical supervision, and so are ones that don't want any exercise.

Ideal environment

Any group home has similarities to a prison or a zoo or a nursery school, so I'm comparing to them for staffing etc. It has to be very hard to escape. It should be hard for him to harm things. He's not being punished, but he still needs supervision, even when he's free to choose his own activity. Having some organized activities make supervision easier, because it prevents boredom which leads to mischief. You also have to supervise the supervision, to guarantee he isn't abused. Not only would that hurt him, it would teach him to abuse others. Bad bad bad.

First off, he should have a safe environment and room to run around. He'd be in an environment where there's nothing important he can destroy: plastic plates and windows (he smashes glass), wood or brick walls (he puts holes in drywall). He'd have lots of room to explore and run and bike, no neighbors, no cars (for the safety of him and the cars), and no way to get unfindably lost. He likes throwing things away, in particular he likes throwing rocks into water, so a beach or river or lake is a must. For him drowning isn't an issue, he only does what he knows he can do and he can swim fine. So, a property something like a summer camp.

Second, he should be given useful familiar work, and group trips. He is glad to empty the dishwasher, empty the garbage, any sort of throwing things away. He's learned to do it right. When he's doing such things he needs minimal supervision, he does them, he doesn't do other mischief. But he can only tolerate so much work before he needs a break. He'll go on walks or bike rides for hours too, and he goes to the store and pushes the cart. He can even get along with a group on vacation, though more than about three hours in a row is pushing his tolerance.

Third, someone should work with him one-on-one for two hours a day trying to teach him new tasks or skills. He doesn't learn easily, but he does learn a little sometimes.

Fourth, somewhere to hang out, fidget, nap, or watch a movie. He is sedentary maybe three hours a day.

Fifth, food. Gotta keep them fed. And eating is a good organized activity.

There also have to be bathrooms (have to supervise him or he soaks the toilet paper roll), clean clothes and places to put dirty clothes (have to supervise that or he immediately wets the clean clothes and puts them in the dirty clothes place), somewhere to sleep at night. Some nights he's always getting up and trying to eat or take a shower or run around outside. Feeding him often calms him down. Most nights he sleeps straight through.

Achievable environment

What's this environment take? They need:

How much does staff cost? 2*1 + (1/2)*3 + (1/3)*6 + (1/3)*3 + (1/2)*2 + (1/5)*9 = 9.3 hours of supervision per kid per day. Prisons estimate that a 24-hour-a-day-seven-day-a-week job takes 5 staff, once you include weekends and days off and staff meetings and training. So that's 9.3*5/24 = 1.9 staff per kid. The internet says that home health aides make $17,410 to $30,160 per year on average, varying by state, so that's $33,000 to $57,000 per kid in staff salaries. Food costs about $4000 per person per year. On top of that there are nurses, administrators, cooks, repairmen, etc. And building supplies, utilities, clothes, material costs. The home should be big enough that things average out ... at least 8 kids, up to a couple hundred. More kids allow bigger grounds and a wider variety of activities. But more kids also increase the risk of abusers having access to each kid. Assume these other costs total another 50%, that comes to $49,000 to $86,000 per year, with the cheap end in Texas, Louisiana, Arkansas, Mississippi, Alabama, Georgia, Tennessee, South Carolina, North Carolina, and oddly West Virginia, Ohio, and Idaho. A large grounds with water (ocean, river, lake) wants something away from urban areas, where land is cheap. Which is (not coincidentally) where health care is cheap, because housing is cheap. It makes sense for expensive places to pay to send their kids to homes in less expensive places, maybe even different states, even if is is paid for by the state.

Parents will want to visit and sometimes participate. If they insist on expensive privileges for their kids, kick their kids out, this is a cost-bound enterprise and we need to limit costs. In particular, only those two hours of one-on-one teaching new skills, and it has to be the regular staff doing the teaching.

The staff has to do things when they're not working: sleep, shop, eat out, schools, library. A large home (or several small homes) could support a small community. High school and college students may also volunteer as staff, maybe as part of their coursework. There may even be a slight degree of tourism. There have to be places for these extra people to stay.

If the organized activities produce something useful, like growing crops or raising chickens, all the better. The kids should certainly take part in bussing tables and folding clothes and cleaning up their surroundings. I do not expect the kids' productivity to come anywhere close to offsetting their costs. Kids who can actually contribute to society shouldn't be in these homes, they should be helped to fit into society.

Can it have horses, cows, cats, dogs, pigs, sheep, goats, chickens? Sure, why not. Caring for them and playing with them gives some of the kids chores and freetime activities. On the other hand, the kid I know is allergic to cats, so some of the sleeping areas have to be cat free, and all the indoor common areas have to be animal free (different kids are allergic to different things). Growing corn, vegetables, pumpkins, berry bushes, and orchards sound good too. And keep a couple snakes and turtles and bunnies in pens. I didn't have much luck with frogs in pens when I was a nature director; they quickly got sick and died. Fishtanks have seemed more trouble than they are worth to me, but others have had different experiences. This place would be big enough to have a concrete swimming pool full of farmed fish being raised for food.

Conclusions

I don't know whether homes like this exist. I don't think they do. What these kids are doing instead, I don't know. Probably living with their parents or siblings. Note, that saddles the family with enough work that it would be two fulltime jobs if someone else were doing it. Maybe they are living in tiny group homes in suburbs where they are heavily medicated so they don't feel the need to exercise. I've heard several quotes of $125,000 per year per kid in group homes when the state is paying for it. I've seen daycamps, where they sit around a large room with a one-on-one aide trying to keep them solving jigsaw puzzles all day. Maybe they are living on the streets, homeless. I think a home like I describe here would do everyone more good:

  1. Lower taxes
  2. More (though lower paying) jobs
  3. Kids are more active and productive

A likely reason this won't work is physical and sexual abuse. A large percent of residents in group homes are abused. This isn't due to the staff. It's due to the other residents.