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. Recommendations, including the establishment of local control, a less-direct relation between funding and rule compliance, and alternate forms of program evaluation and monitoring, were made.