The Case for Inclusion 2019

2022 Key Findings

The Case for Inclusion 2022: Blazing Trails to Sustainability for Community Disability Services

The Case for Inclusion 2022

Download the Case for Inclusion 2022 as a PDF


Published annually since 2006, the Case for Inclusion assesses all 50 states and the District of Columbia on 80 measures that indicate how well state programs are enabling people with intellectual and developmental disabilities (IDD) to be included in the community. This year's Case for Inclusion also offers a policy blueprint for alleviating the challenges facing community IDD service providers given the confluence of a longstanding direct support workforce crisis and the COVID-19 pandemic. 

Part 1 of this year’s report leverages the best available data over four of the Case for Inclusion’s issue areas: Addressing a Workforce in Crisis, Promoting Independence, Promoting Productivity and Tracking Health, Safety & Quality of Life. Among its many findings, the Case for Inclusion 2022 finds that:

  • Nationally, the average DSP turnover rate in 2020 increased by about one percentage point to 43.6%. Meanwhile, vacancy rates for full-time direct support positions increased from 8.5% in 2019 to 12.3% in 2020—a roughly 45% increase.
  • As of 2018, 16 states and the District of Columbia had closed their last remaining large, state-run institutions. Joining the ranks of states to have fully deinstitutionalized since last time the Case for Inclusion reported these data are Montana and Tennessee.
  • 1 in 5 (21.1%) people with IDD who received employment or day supports were participating in an integrated employment service. Within the 33 states that report that they collect data on the number of people working, 19.3% of individuals participating in integrated employment services were working for pay.
  • There were 589,940 people on states’ waiting lists for home- and community-based services nationally. Nearly 4 in 5 (78%) of those waiting were concentrated in just five states.

Because this key findings report cannot cover every data point across all 80 measures contained in the Case for Inclusion’s seven main issue areas, we invite you to learn more and explore the data at

Part 2 of this report pivots to recommend solutions and opportunities for the federal and state legislative and executive branches, along with providers and other advocates, to strengthen the ability of people with IDD to live a fully inclusive life in the community. Specifically, we offer policy recommendations for the Biden administration, the 117th Congress, state governments, and providers and other stakeholders.

Finally, this year’s report includes a special “interlude,” an analysis of why it matters that the majority of direct support professionals in this country are women and workers of color. This analysis culminates into a call to action for more robust data revealing the disproportionate impacts of challenges in the direct support workforce.

You can view or download the full key findings report above, or select any of the downloadable resources below to learn more.


The Case for Inclusion 2022: Blazing Trails to Sustainability for Community Disability Services

Executive Summary: Case for Inclusion 2022

Interlude: Why It Matters that the Majority of the Nation's Disability Support Professionals are Women of Color