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An Insurance Scheme for Residential Services. Of very considerable importance for future programming in the field of mental retardation would, of course, be Cooke's proposal outlined in an earlier chapter in this book for the extension of our social security system to cover residential and other service costs of the seriously mentally handicapped dependent of a participant in the social security system. As Miller (1968) recently stated in another context: "... the market approach has wide implications because it is supported on the basis of efficiency as well as on desirability of consumers' choice. To what extent does one try to make it possible for those individuals who are involved to make decisions which affect them?"

However, there are some problems which must be considered. First, such a measure might make it too easy to use residential rather than non-residential services, and would thus contribute further towards he unsound imbalance between the two. Second, parents might place heir children into residences hundreds of miles away or out of state, even though equally adequate local residences may be available. This would mean that public funds were used to support probably unsuitable and even harmful practices. Third, unless such systems were subordinated to very strict control on either the state or the local level, planning of services would become virtually impossible. The need of and/or for various types of services might become so unpredictable that no economical or longrange plan could be maintained, and nursing home entrepreneurs might choose to locate their services in haphazard or inappropriate patterns. Finally, such entrepreneurs might have very little incentive for habilitation programs or the utilization of sheltered work settings. Indeed, the scheme might actually inhibit the development of habilitational programming in residential settings, since habilitation would be likely to threaten the entrepreneur's livelihood.

In any case, Cooke has injected new and challenging thoughts into the problem of service delivery in the field of mental retardation. His proposal undoubtedly should be given extensive further study before it is implemented, and such study should encompass a controlled research demonstration in one or a few states, provided that rigid safeguards can be furnished in the form of administration and regulation.

One of the inscrutable incongruences in the provision of care at public expense, not just in the field of mental retardation but in many other fields as well, is that while funds for expensive residential care are readily available, it is most difficult and in some circumstances indeed quite impossible to get public funding when opportune circumstances make it possible to provide for the same individual not only equal but superior care in a private home on a boarding or foster care basis. As Wolfensberger said: "It is indeed ironic that many children have ended up in the high-cost and low-love setting of an institution because the medium love of relatively low cost foster parents was judged as being insufficient by an agency."

A somewhat similar situation exists in regard to adoption of mentally retarded children. Admittedly this is not an easy task, and the utmost care must be exercised to protect both the interests of the retarded child, as well as those of prospective adoptive parents. Still, there are people who are able, willing, and indeed desirous to undertake the task of raising a handicapped child, and with the real and expected expansion of supportive services in the community the feasibility of such an undertaking has been very considerably increased. Yet, institutions still admit many infants with mongolism for long-term (and all too often life-time) care involving an expenditure conservatively estimated at something like $100,000 to $150,000. A mere fraction of this cost, such as $30,000, would support a small adoption service staffed by two senior social workers and a secretary for 1 year. If this staff would be able to find in a year's time just one adoptive home for a child otherwise placed in the institution, the total investment in the agency would already have been justified. Therefore, it is highly desirable that states, perhaps with some federal assistance, initiate more aggressive action in this area.

Where Does the Money Come From, and Where Does It Go? Lack of money has been a major stumbling block in the past, but equally serious has been poor utilization of funds that have been available. Indeed, there is no question that the all-too-ready availability of hundreds of millions of dollars for construction purposes without preventive and follow-up services in the community has been most detrimental, as has been premature allocation of money for large-scale programming, construction, etc., when appropriation of a much smaller sum for well-controlled and evaluated community services would have been far more desirable.

As touched upon by Wolfensberger, there exists an "American illusion" that money is the answer to most problems. In other words, if one spends enough money on a defined problem, it will eventually be conquered. This illusion is sadly evident in the attitudes of many defenders of our institutional system. In essence, they cannot conceive of an alternative concept or model -- be it residential or even nonresidential. Thus, we hear calls for more institutions, as well as more money for existing institutions, and unfortunately many states are taking this route, often without clear priorities assigned to different categories and alternatives of service.