Community Living for Adults with Intellectual Disabilities: Unravelling the Cost Effectiveness Discourse

Abstract

The requirements for a rigorous cost‐effectiveness analysis are considered. The evidence base on services for people with ID is then reviewed with an emphasis on the transition from institutional services to those in the community and postdeinstitutionalization research on the costs and outcomes of different forms of community provision. Despite certain limitations, a number of conclusions are possible: (a) overall, community services provide for a better quality of life than institutional care; (b) whether community service costs are more or less than institutional costs may depend on factors such as funding mechanisms, wage rates and the level of investment in institutional services prior to deinstitutionalization, that are likely to differ between countries; (c) economies of scale are not pervasive but may arise among settings with very small group sizes depending on staffing model; (d) the costs of staffing are a major element in total service package costs and there is scope to relate staff input more precisely to the needs and characteristics of service users; (e) the factors responsible for variation in costs and outcomes are incompletely understood; (f) however, resource input does not appear to result in enhanced outcome; (g) greater staff input is inefficiently translated into performance which affects service users; and therefore, (h) operational culture and staff training and management are important determinants of ultimate outcome. More research is required on the factors that drive costs on the one hand and outcomes on the other. An international consensus is required on the important variables to be described when doing research on residential support arrangements, so that relationships between environmental characteristics and either costs or outcome can be identified with greater confidence.

Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review

“…The primary importance of our findings is that community care is not unambiguously less expensive than institutional care over time. Consistent with earlier non-systematic assessments of this issue, the data are inconclusive 22 23. Advocates sometimes argue that deinstitutionalisation is what economists call a dominant strategy, that is, one that both reduces costs and improves outcomes.…”

“…Our search strategy did turn up a larger body of cross-sectional comparisons, for example, of the cost of living in institutional settings versus community settings. Prior reviews have reported similarly mixed findings on the relative costs and there are additional concerns about the robustness of such comparisons and unobserved confounding, particularly with routinely collected data 23. A strength of the studies included in our review is that confounding concerns are minimised by the use of participants as their own controls.…”

Irish persons with intellectual disability moving from family care to residential accommodation in a period of austerity

“…This analysis suggests that any increased funding from government should be balanced between facilitating people to move from family care as well as reducing the numbers living in congregated settings. It is unlikely that this expansion of provision could be funded from existing budgets, even assuming that more cost‐effective alternatives such as individualized supported living options were deployed (Felce, ).…”

Untitled

“…Mokslininkai yra atlikę nemažai tyrimų, analizuojančių proto negalios aspektus (Bakk, Grunewald, 1997;Felce, 2016). Pagalbą apgyvendinant asmenis, turinčius protinę ar vystymosi negalią, nagrinėjo K. C. Lakin, R. J.…”