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Supported Accommodation. Eric Emerson. Three Themes . Lessons from history The policy context Lessons from evaluation research Costs & benefits Lessons from epidemiology/demography Future need & demand. Royal Albert Asylum, Lancaster. Intermediate Boys Class, Royal Albert, 1903.

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Three themes
Three Themes

  • Lessons from history

    • The policy context

  • Lessons from evaluation research

    • Costs & benefits

  • Lessons from epidemiology/demography

    • Future need & demand




1960 s 1970 s
1960’s & 1970’s

  • Scandals & inquiries

  • Social justice - unacceptable gap between normative notions of common decency and conditions


Key messages
Key Messages

  • Weak association between building design and purpose (and life experiences of people with learning disabilities)

  • Good intentions are not enough

  • Humility



Policy driven questions
Policy-driven Questions …

  • Who succeeds? (Who fails?)

    • People with lower support needs and who do not have challenging behaviours

  • What are the ‘benefits’ of deinstitutionalisation ?


Benefits

Systematic review of UK and Irish studies 1981-1995

118 publications

70 separate studies

5,800 people with learning disabilities

(Currently being updated for NDA, Ireland)

Clear benefits

community presence, engagement, support, satisfaction

Possible/probable benefits

friendships, choice

No benefits

challenging behaviour

No systematic disadvantages

Benefits?


Key messages1
Key Messages

  • Deinstitutionalisation was to the benefit of people with learning disabilities

  • Inequalities

    • What benefits

    • Who benefits


Policy driven questions1
Policy-driven Questions …

  • What are the determinants of quality in community-based provision?

  • Cost-effectiveness of alternative approaches to community-based provision?

  • Do community-based supports provide an acceptable ‘quality of life’?


The determinants of quality

Moderate links between outcomes and

participant ability

staff support & staff management practices

some structural characteristics (clustering, functional grouping - but only for challenging behaviour, size?, model?)

Weak (if any) links between outcomes and

structural characteristics (size?, provider, model?)

resources (costs, staffing ratios, qualifications & skills)

But what about ….

Neighbourhoods?

Organisational culture?

The Determinants of Quality?


Costs benefits
Costs & Benefits

  • Little relationship between cost and size (except at lower end for people with higher support needs)

  • Cluster/campus housing has marginally lower cost and significantly lower benefits

  • Grouping together people who have challenging behaviour has higher costs and possibly lower benefits


Key messages2
Key Messages

  • More dispersed (and smaller) services do tend to provide more positive life experiences (largely at no greater cost)

  • Resources are largely unrelated to outcomes

  • Inequalities

    • What benefits

    • Who benefits


An acceptable quality of life
An Acceptable Quality of Life?

  • Face-to-face interviews with 1,729 people

    • supported through the ‘Supporting People’ programme (554)

    • in registered residential care homes (913)

    • in NHS accommodation (262)

  • Themes

    • Social exclusion

    • Choice & control

    • Health & well-being

www.ic.nhs.uk


Social exclusion production employment age 60
Social Exclusion: Production (Employment, Age <60)


Social exclusion relationships
Social Exclusion: Relationships

Contact with Family


Social exclusion relationships1
Social Exclusion: Relationships

Contact with Friends




Key messages3
Key Messages

  • Significant problems remain in addressing (among other things) aspects of

    • Social exclusion

    • Choice, control & self-determination

    • Health and well-being


Changes in the need demand for supported accommodation
Changes in the Need/Demand for Supported Accommodation

  • Changes in the population of people with learning disabilities

    • Incidence

      • No reliable information

    • Prevalence

      • Increased life expectancy

        • In general

        • Children with severe and profound disabilities

        • Older adults

    • Age structure

      • Ageing of the baby boomers



Changes in the need demand for supported accommodation1
Changes in the Need/Demand for Supported Accommodation

  • Changes in expectations

    • Moving away from home

    • Suitability

  • Changes in capacity of informal care

    • Lone carers

      • 32% of children with disabilities in Britain in 2002 were being brought up by a lone parent

      • % of children in lone parent households has risen from 6% in 1971 to 22% in 2004

    • Women & work


Key messages4
Key Messages

  • Increased ‘need’, especially among older age groups

  • Reduced capacity of informal care

  • Increased expectations & demand


Conclusions
Conclusions

  • Need to invest in

    • Dispersed (smaller scale) options

    • Monitoring quality outcomes

    • Continue to addressing social exclusion, choice & health

    • Addressing systemic inequalities

    • Expanding volume of provision

  • Humility & good intentions



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