Relationship of institution size to quality of care: a review of the literature.

The existing empirical literature on the relationship of institution size and quality of care was reviewed. Quality of care was discussed along four dimensions: (a) resident-care practices, (b) behavioral functioning, (c) discharge rates, and (d) extent of parental and community involvement. Care has been found to be generally more adequate in smaller institutions. However, considerable variation in quality of care has been reported among small community-based facilities. Little evidence was found that the behavioral functioning of residents is different in institutions of different sizes. There are essentially no data on discharge rates of institutions of different sizes. There is some evidence suggesting that parental and community involvement may be enhanced in community-based facilities.