A/72/128 subjected to extreme levels of institution-like control in privately operated rooming houses or “halfway” houses. 16. Orphanages housing abandoned children similarly institutionalize and isolate children with disabilities. One study found that 45 per cent of children living in Russian State institutions had impairments. 15 17. Forced institutionalization often occurs as an indirect result of other violations of the right to adequate housing. When States fail to provide necessary forms of support for living in the community, or when persons with disabilities or their families simply have no means to afford housing, persons with disabilities may be forced to live in institutions because of a lack of housing options. 16 Legislative protection of legal capacity and supportive decision-making can be rendered ineffective in the context of housing decisions when there is no support or affordable housing available for living in the community. 18. In other circumstances, living in an institutional setting or remaining with family may be a decision made by a parent, guardian or family member on behalf of a person with a disability. Institutions that are originally presented as optional may subsequently deny residents the right to leave. Years of living in segregated settings have devastating effects on the autonomy of residents and their ability to exercise independent agency, making it difficult for them to trust or imagine a positive community-based alternative. 19. Deinstitutionalization without adequate housing and community support can have devastating consequences. In Gauteng Province, South Africa, more than 1,300 persons with psychosocial and intellectual disabilities were transferred owing to government budget cuts from a private hospital to the care of an array of non-governmental organizations, most of which lacked the capacity, oversight and resources necessary to address the needs of those transferred. This led to widespread ill-treatment and the death of more than 70 persons. 17 3. Homelessness 20. Homelessness disproportionately affects persons with disabilities. In a vicious circle, disability often leads to homelessness and homelessness, in turn, creates or exacerbates impairments and additional barriers linked to stigma and isolation. Of the homeless adults in shelters in the United States of America, 43 per cent have a disability. 18 Persons with psychosocial and intellectual disabilities are particularly vulnerable to homelessness and its effects. 21. The Special Rapporteur has proposed a new rights-based framework under which homelessness is understood as a deprivation of housing (both physical and social) but also as a socially constructed group identity that is linked to stigmatization and discrimination, much of which is rooted in perc eptions about persons with disabilities. As a result, in most places, that population suffers severe isolation and neglect. Homelessness and related violations of the right to life often __________________ 15 16 17 18 8/23 Human Rights Watch, “Children with disabilities living in special homes in Russia: what life is like and what needs to change”, 15 September 2014. Available from www.hrw.org/report/2014/ 09/15/abandoned-state/violence-neglect-and-isolation-children-disabilities-russian. A/HRC/28/37, para. 25. See communication from South Africa, available from www.ohchr.org/EN/Issues/Housing/Pages/Communications.aspx; Malegapuru W. Makgoba, “The report into the circumstances surrounding the deaths of mentally ill patients: Gauteng Province” (Pretoria, South Africa, Office of the Health Ombud, 2017). National Council on Disability, “The state of housing in America in the 21st century: a disability perspective” (Washington, D.C., 19 January 2010), p. 10. Available from www.ncd.gov/ publications/2010/Jan192010. 17-11724