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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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Presentation Transcript
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

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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