Residential was my first job in HS. I went to school for Psychology and really wanted to do something in that field at the time. A mentor recommended a local residential facility I won't name, and I made the mistake of explaining I wanted to gain "experience". Something to keep in mind is that I'm 6'5, back then was about 240lbs, and my work experience included bouncing and other forms of physical security (among other things).
So this place handled behavioral issues, traumatic brain injuries, and folks with intellectual disabilities. Each of those 3 had their main "campus". And each unit had a "clever" name that was meant to encapsulate the flavor. For example, we had "Brown Hall" for the most violent folks, due to the fact that A) dried blood is brown, and B) so is feces. Another unit was called "Buttonwood" for the younger kids with ID (cute as a "button"), etc. Well, I made the mistake of saying I wanted to gain "experience". So they started me out, 0 experience in this field, in "Wildwood". Wildwood, ostensibly, was a mix of all 3 campuses, and focused on folks who needed 24/7 access to nurses and medically-trained staff. Unlike the other units (which would have nurses visit every day to administer meds), we had our own nursing substation.
As the name implies, it was "wild". Anyway, after all of my training (if memory serves it was a month/160-hours of VERY intensive training covering all sorts of topics, especially non-injurious physical restraints) they gave me a group. I had a 90lb 17-year old non-verbal with Fetal Alcohol Syndrome who could barely walk (let's call him "Teddy"), a 250lb bipolar-psychotic in his 20s ("Lebron"), and 180lb guy with Down's also in his 20s ("Willy"). The names are fake, of course.
Long story short, after a week on the actual job, I interrupted Lebron raping Teddy. Teddy and Lebron were roommates. Undisclosed to me, Lebron had a history of weird rapey/unwanted sexual behavior with other clients...but the Unit Manager thought it was a great idea to bunk him up with a 90lb non-verbal.
Now, during the day, Teddy is "Close Reach", Lebron is "Intermittent Visual-15", and Willy is "Visual Range". But at night, everyone becomes either IV-15, 30, or 45. And they would have staff do chores around the unit like vacuuming or laundry. So I put everyone to bed, everything seems fine, I start a load of laundry, come back to check on Teddy and Lebron...and see an obvious rape in progress. I step back into the hallway, and Lebron (who could be pretty fucking terrifying) angrily walks up, and slams the door in my face, like this has happened before.
I snap back into it, push the door back open and begin yelling at him to leave Teddy alone. I yell for other staff. One comes by and I tell him what happened and to watch them both, as I go to talk to our Supervisor.
I go to the Supervisor, let's call him John, and explain the situation. He has me report it to our state's child-abuse hotline thing because Teddy is 17. I go back to the room and can examine it further. All the sheets and bedding from Teddy's bed are pulled off in the direction of Lebron's...as if he literally pulled him out of bed and Teddy resisted. I'm assured everything will be handled properly as my shift ends, I clock out and go home.
I come back the next day and a detective is waiting for me, along with some corporate douchebag from the company that employed me. I learn that Lebron was arrested, a rape-kit is being processed on Teddy, and they pulled his used diapers to...check for things.
The detective is asking me what I saw, and I am answering honestly. The corporate douchebag is doing their best to undermine EVERYTHING I say. "Oh but you didn't see his erect penis?" shit like that. His back was to me and he had mounted Teddy.
After that I had a target on my back until I left. Other staff SHUNNED me. John did his best to protect me, but that meant being on my ASS about every little thing to make sure corporate/Unit Manager didn't have anything to complain about. And after everything, Lebron came back to the unit. They gave him his own room with a 1-to-1 and a dollar-store "door alarm" on his door.
Immediately after, the groups were changed, I had Teddy and another young guy who had ID and was really easy (he just wanted to color). The state paying for Teddy to stay with us ultimately relocated him to a less terrible facility. And I left residential a few months after that in disgust (for that, and other things I saw), but am still in HS. There are good folks in this field, but residential is a fucking cesspool
It's a direct democracy, so generally Citizens decide what constitutes "service"...or at worst "representatives" (if we'd building off the framework of the idea). As far as administrative regions vs. federal..well, assuming we have a system that's not broken and janky like this one, I think we could manage. As far as weighting things like "health risks", yeah that's a serious weakness here...but not an unaddressable one.
What I see is a world where we aren't screeching about "immigrants" because most folks are similarly just residents. And residents have every right and protection as a citizen...aside from voting or holding office. I see a world where the responsibility of such power also comes with commitment to building society...rather than simply being born, whining, and burning everything down in a tantrum...as we basically see now with bourgeoisie white folks.
Don't throw an idea away just because it isn't immediately a panacea to every broken aspect of our current system.