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. 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. 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.
He's been on half a dozen of medications. The only one that worked was Abilify: at 2mg daily it immediately stopped the head banging and made him able to lose focus on things he couldn't have. However the headbanging and fits resumed after two months back at normal levels. Increasing up to 10mg didn't help, but reducing back down did make fits and headbanging worse for about two months. After years we very slowly stopped all medication. Fits were worse for about four months, then returned to normal. So Abilify didn't really help either, it was just addictive. Once he had surgery and was put out for that. Afterward he was heavily medicated, including morphine. He started banging his head (though weakly) as soon as he was conscious, and the morphine made him itch, he was more bothered by that than by the pain from the surgery. So medication is not the answer.
This is a design exercise in making a group home for kids like him: age 18 to 50, able bodied, want exercise, only a moderate threat to themselves and 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 100,000 kids like him in the US. Kids that can live independently are in a different category, so are ones who need constant medical supervision, so are ones that have fighting skills, and so are ones that don't want any exercise.
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), padded or carpeted or wood plank walls (he puts holes in drywall and prefers beams when he bangs his head). He'd have lots of room to explore and run and bike, no close neighbors, few 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. A storm grate to drop rocks in is a must. He can tread water, but can't purposely swim long distances. He avoids going into water deep enough where he can't stand. So, a property something like a summer camp is good.
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 for hours too, and sometimes he goes to the store and pushes the cart. Though sometimes he goes to the store and throws fits and breaks things. He can sometimes even get along with a group on vacation, though more than about three hours in a row is pushing his tolerance, and all recent vacations have prompted long fits.
Third, someone should work with him one-on-one for two hours a day trying to teach him new tasks or skills. They don't have to be contiguous 2 hours, and they probably consist of alternating trying things and fidgit breaks. 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 soaks the clean clothes and puts them in the dirty clothes place), somewhere to sleep at night. He should really have his own bathroom. 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.
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.
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:
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.
Update July 2020. He needs his own bedroom and bathroom. He needs a fully padded room, no windows, with a mattress covering the floor, where the door can be easily held shut from outside. Right now his bedroom is that padded room, but it would be better for it to be a smaller room, and have windows in the bedroom. All windows and walls he has access to have to be unbreakable by his fists and feet and head. (Drawn curtains happen to be an effective way to keep him from hitting windows.) Hitting showers hard daily tends to crack tile, which causes mold and dryrot. Perhaps a padded shower, with a shower curtain surrounding the shower two inches from the walls?
He sometimes hurts other people now as well as himself. Going to stores is out, he often destroys merchandise or breaks storefront windows. Bicycles are out because he'll accidentally run into other people. Swings and walks and throwing pebbles into water is still in. Cooking is in, except flames and heat and sharp knives need to be supervised. Any liquids in the kitchen and bathroom will be dumped as soon as you turn your back, so they need to be in locked cabinets (or some other building) unless you want to puppyguard them 24 hours a day. This suggests a small kitchen where he lives, with an electric stove with a master switch he can't get to, where he can fix himself toast or fruit, and a larger kitchen elsewhere that he isn't allowed into that cooks main meals for everyone. Maybe he eats in a central cafeteria or maybe the food is taken to him.
You should have the house compensate for direct supervision as much as possible. For example, rather than physically restraining him, get him in the padded room and keep the door locked until he's calm (you need a better door and better lock than typical residential bedroom doors). Rather than guarding the walls and windows, have walls stronger than drywall and windows stronger than sheet glass. Rather than puppyguarding the soy sauce all hours of the day, have locked cabinets to store it. Rather than negotiating who will use the bathroom, give each resident their own bathroom. Have two swings. Some of his acting up is performance art, so give him private space with remote video monitoring him so there's nobody to perform to.
I don't think a hundred residents in a small area will work. A yelling kid can be heard all around, and there'd be constant yelling. Some residents are aggressively abusive, and the chances of that go up with the number of residents. But there are still advantages to scale. A compromise is about 4 houses on a single street with about 4 residents each, plus a central cafeteria / common house in the middle. Staff can easily go from one house to another.
Supervision:
The bits I do know add up to 10/4 + 2 + 2 + 3/2 + 7/3 = 10.33 hours of paid staff a day. Pretty much the same as before. So this still seems feasible for under $100K/year. It assumes the buildings are preexisting and already paid for. If a new home were to start up, someone should donate the buildings.
Make an effort to make all the residencies different. Have some shared bedrooms, some shared bathrooms, some houses with 6 well behaved residents some with 2 poorly behaved ones. (On a poorly behaved 0..10 scale where 10 is the worst, the kid I'm describing ranks around 8. My impression from visiting group homes is that the average resident ranks around 4.) Some bedrooms well isolated from the others. Common rooms of different sizes. Some have TVs, some have internet, some don't. 4 residents per house on average. Have the rooms all different sizes and different layouts. This gives you more flexibility for rearranging later. Don't stuff in as many residents as you can get away with, keep spare bedrooms. Don't run with minimum staff, run at about 50% over minimum. You want to maintain good quality of life for the residents and the staff while keeping costs down. If $60K/year is the minimum cost feasible if you skimp on staff (it feels like it is), keep the costs under $100K/year per resident. Charge some residents more than others. Having a group of homes like this allows the peak staff needed to be closer to the average staff needed, which keeps costs down for everyone, because you always have to pay for peak staff whether you need it or not.
Update August 2020. Just as I wouldn't want this kid in the same house as someone worse than him (worse means someone actively seeking to abuse other residents), other kids better than him wouldn't want him as a housemate (he does beat up the house and make lots of noise). So his housemates will be about equivalent to him. They wouldn't like each other, and may well attack each other when they are forced to interact. Which means housemates won't work. But keeping him in his own house is too expensive.
A compromise would be four standalone houses, or standalone wings connected only by hallways, around a common atrium. Perhaps have a shared basement for staff and cars and laundry. His standalone house needs a bedroom, a padded room, a shower, a big room with the swing (could be an unheated Florida room), a kitchenette in some corner, that's it. Real meals would be prepared in elsewhere. Maybe he would go to a common area to eat, maybe meals would be taken to him. Laundry would be done elsewhere. Common areas also need a padded room.
The staff required for that is exactly the same as my previous estimates. The difference is that often he'd be the only one in his standalone house/wing, remotely monitored from next door or from the basement or such. It's fine to not have anyone looking directly at him. He doesn't like people looking at him anyhow.
It's still a good idea to have four or so of these complexes close to one another, so extra staff can come running when needed.
For example, you could have four tiny houses for four residents, and a common area with laundry and a dining and staff. The little houses would have closed-loop video in all rooms so residents can be monitored without staff in the room looking at them. Staff has keys to the houses, and takes him on walks etc as the schedule demands. Interior walls would be plywood, with gym pads over them. Ceilings would be plywood. Don't know about the floors, probably boards like summer camp cabins. My daughter recommends staining the plywood rather than painting it. There should be unbreakable somewhat insulated windows, I don't know how to do that, two-sheet transparent polycarbonate (often used for shower doors) would probably work if nobody else has solved this problem. I hear there high-impact glass is used in Miami to withstand tree branches thrown at them by hurricanes.
Here's a floorplan for one of the tiny houses. A main room with a swing and kitchenette, a bedroom, a padded room, a bathroom, that's it. 18' x 36' interior. 8' ceilings. There should be windows, I didn't mark where they are. I drew all the walls 6 inches thick, the doors 2.5 feet wide, and the counters 2 feet deep. Since the roof is peaked, there is a ladder in the bedroom up to a loft that goes over everything but the bedroom. The loft would be used mostly for storage, but it's also an interesting-shaped place. The swing mount is attached to the rafters; the loft is inside the rafters. The closets have curtains rather than doors. The padded room is well isolated, so residents in other tiny houses will not be bothered much by fits in the padded room.
This might seem excessively nice, but keep in mind that the main cost is staffing. The cost of staffing exceeds the cost of building the little house within two or three years. So if you can save on staffing by building a better house, you should.