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Supported Accommodation

Supported Accommodation

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Supported Accommodation

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  1. Supported Accommodation Eric Emerson

  2. Three Themes • Lessons from history • The policy context • Lessons from evaluation research • Costs & benefits • Lessons from epidemiology/demography • Future need & demand

  3. Royal Albert Asylum, Lancaster

  4. Intermediate Boys Class, Royal Albert, 1903

  5. 1960’s & 1970’s • Scandals & inquiries • Social justice - unacceptable gap between normative notions of common decency and conditions

  6. Key Messages • Weak association between building design and purpose (and life experiences of people with learning disabilities) • Good intentions are not enough • Humility

  7. % Change in LD Hospital ‘Beds’: 1980 - 2005

  8. 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 ?

  9. 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?

  10. Key Messages • Deinstitutionalisation was to the benefit of people with learning disabilities • Inequalities • What benefits • Who benefits

  11. 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’?

  12. 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?

  13. 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

  14. 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

  15. 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

  16. Social Exclusion: Production (Employment, Age <60)

  17. Social Exclusion: Relationships Contact with Family

  18. Social Exclusion: Relationships Contact with Friends

  19. Choice (Alone or with Support)

  20. Health

  21. Key Messages • Significant problems remain in addressing (among other things) aspects of • Social exclusion • Choice, control & self-determination • Health and well-being

  22. 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

  23. Predicted Change in Administrative Population in England

  24. 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

  25. Key Messages • Increased ‘need’, especially among older age groups • Reduced capacity of informal care • Increased expectations & demand

  26. 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

  27. For a copy of this presentation .. eric.emerson@lancaster.ac.uk