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Community living for adults with intellectual disabilities: unravelling the cost effectiveness discourse
- Author:
- FELCE David
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 14(3), 2017, pp.187-197.
- Publisher:
- Wiley
This article considers the requirements for a rigorous cost-effectiveness analysis and then reviews the evidence base on services for people with intellectual disabilities (ID) with an emphasis on the transition from institutional services to those in the community and postodeinstitutionalization 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. (Edited publisher abstract)
Does size matter? or staffing levels or costs?
- Author:
- FELCE David
- Journal article citation:
- Llais, 67, Winter 2003, pp.3-7.
- Publisher:
- Learning Disability Wales
Describes recent work which has sought to understand why quality of life in staffed community group homes varies. A sample of 51 houses in Wales accommodating 6 or fewer people were surveyed. The survey particularly looked at staff-service user rations and costs; size related to cost; and provider agency.
Community housing costs
- Author:
- FELCE David
- Journal article citation:
- Tizard Learning Disability Review, 1(1), January 1996, pp.39-43.
- Publisher:
- Emerald
Small-scale community residential services are often held to be costly. However, such a simple assertion obscures a greater complexity which underlies the relationship between the nature of services, their resource requirements and their quality outcome. The article asserts that there are some economies of scale to be found but not as strong as popular belief would hold.
Is community care expensive? The costs and benefits of residential models for people with severe mental handicaps
- Author:
- FELCE David
- Journal article citation:
- Mental Handicap, 21(1), March 1993, pp.2-6.
- Publisher:
- British Institute of Mental Handicap
Analyses studies which contribute information on the costs and benefits of different forms of residential service for people with severe mental handicaps, finding that expectations of diseconomies arising in small scale provision are not borne out in general.
Exploring the relationships between costs and quality of services for adults with severe intellectual disabilities and the most severe challenging behaviours in Wales: a multivariate regression analysis
- Authors:
- FELCE David, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 25(4), December 2000, pp.307-326.
- Publisher:
- Taylor and Francis
A survey in Wales of people with severe intellectual disabilities and the most severe challenging behaviour identified adults living in new specialist community housing and 19 in traditional services. This study explored the relationships between resident characteristics, service characteristics, service processes, quality of life outcome and costs in a series of mutivariate regression analyses.