Compliance and quality in residential life. Rhetoric and realities in today's ICF/MR: control out of control.

Contrasts between the rhetoric of quality assurance and the realities of poor quality in today's ICFs/MR were explored. Comparative studies have shown that ICFs/MR provide the poorest quality of life for persons with mental retardation. The ICF/MR operational model was described here as paper-oriented, failure-based, and insensitive to the effects of its own practices.

Rules: the new institutions.

Despite the pervasive philosophy of normalization and the more recent emphasis on "quality assurance," service provision in today's Medicaid-funded residential environment has become more regulation-oriented and less person-oriented. In this article, this argument was presented in the context of rule-governed versus contingency-shaped behavior of caregivers. The culpable process was identified as the coercive enforcement of inaccurate rules, which precludes responsive staff action and generates adverse consequences.