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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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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
1960’s & 1970’s • Scandals & inquiries • Social justice - unacceptable gap between normative notions of common decency and conditions
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 … • Who succeeds? (Who fails?) • People with lower support needs and who do not have challenging behaviours • What are the ‘benefits’ of deinstitutionalisation ?
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 Messages • Deinstitutionalisation was to the benefit of people with learning disabilities • Inequalities • What benefits • Who benefits
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’?
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 • 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 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? • 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: Relationships Contact with Family
Social Exclusion: Relationships Contact with Friends
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 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 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 Messages • Increased ‘need’, especially among older age groups • Reduced capacity of informal care • Increased expectations & demand
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
For a copy of this presentation .. eric.emerson@lancaster.ac.uk