Quality & costs of community residential supports for people with intellectual disabilities (ID) and challenging behaviour (CB).

Emerson, Eric and Robertson, Janet and Felce, D. and Meek, A. and Carr, D. and Knapp, Martin and Hallam, Angela (2004) Quality & costs of community residential supports for people with intellectual disabilities (ID) and challenging behaviour (CB). Journal of Intellectual Disability Research, 48 (4-5). p. 415. ISSN 0964-2633

Abstract

Aim: To compare the cost effectiveness of two approaches to providing community residential supports to people with ID and CB: non-congregate settings where the minority of residents have CB and congregate settings where the majority of residents have CB. Method: Longitudinal matched groups design. N = 25 per group. Data collect at two points in time separated by 12 months. Main outcome measures: costs of service provision, nature of support provided, quality of life of residents (including choice, activities, social networks, risks and community involvement), views of families, views of neighbours, and staff stress and morale. Results: Congregate care was associated with higher costs, higher staffing ratios, and better quality internal working practices. However, these inputs did not translate to better outcomes for residents. Non-congregate care was associated with greater access to day activities, less reliance on medication and physical restraint to control CB, and less risk. Levels of staff contact and participant engagement were low in both models of care. Conclusions: Noncongregate settings are more cost effective. The results reinforce existing government guidance in the UK that care should be taken to avoid congregating together people with CB.