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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)
People with intellectual disabilities at the end of their lives: the case for specialist care?
- Authors:
- FORRESTER-JONES Rachel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 30(6), 2017, pp.1138-1150.
- Publisher:
- Wiley
Background: People with intellectual disabilities have a shorter life expectancy, but healthcare improvements mean that they are beginning to live longer, with associated health difficulties. This means that there is an urgent need to focus research on ageing as well as end-of-life care. This study aimed to explore a specialist intellectual disability service for older people who are dying and how it related to their quality of life and to costs associated with care provided. Method: Data were collected for nine residents and 15 staff members of the specialist service. A single case study design with mixed methods including observations, interviews, standardised questionnaires and costs analysis was utilised. Results: The study found positive results regarding overall quality of life, although individuals had limited social networks. Placement fees paid by local health trusts and social services departments were slightly higher than the estimated cost of care reflecting good financial management by a small voluntary sector organisation. Conclusion: Whilst the philosophical arguments around “specialist” care persist, this service fills a gap in intellectual disability care provision. (Edited publisher abstract)
A systematic review of the literature on the benefits for employers of employing people with learning disabilities
- Authors:
- BEYER Stephen, BEYER Annie
- Publisher:
- Mencap
- Publication year:
- 2017
- Pagination:
- 42
- Place of publication:
- London
This report reviews the literature on the business case for employers of employing people with a learning disability. For the review, systematic searches for research and grey literature were conducted on five databases, including Social Care Online. The results are presented broadly under the following areas: economic benefit to employers, in terms of work quality and reliability; improvements to workforce cohesion and staff morale; benefits from customer reaction and reputation; and perceived additional costs for employers, such as the need for additional support supervisors and making ‘reasonable adjustments’ in the workplace. Although the review found limited research literature on the financial costs and benefits to employers, it found that with the right support and job matching, people with a learning disability are valuable employees. It identifies research that people with a learning disability generally do stay in work longer, are sick less; are reliable time-keepers; and help promote good relationships with, and between co-workers. In addition, many of the ‘reasonable adjustments’ employers need to make are often cost neutral. The report concludes by highlighting the need for good supportive government policies and for job coach supported employment to be more widely available, for employers to deliver good employment opportunities for people with learning disabilities. (Edited publisher abstract)
Economic impact of inclusion of disabled persons in the labour market
- Author:
- BEYER Stephen
- Publisher:
- EASPD
- Publication year:
- 2017
- Pagination:
- iv, 80
- Place of publication:
- Brussels
This literature review was commissioned by EASPD to improve its understanding of the employment of people with disabilities in Europe and the strength of the financial case for inclusive employment. It provides cost-benefit analyses of labour market inclusion of people with disabilities can have for governments and public authorities, as well as the wider benefits for businesses and individuals. The review carried out extensive and structured searches on a number of database for research articles in English, published between 1980 and 2016. The main findings show that disabled people, taxpayers and government are likely to benefit financially in the long term from greater investment in employment in the open labour market of persons with disabilities. It also identified a large variety of models, working to different objectives, which support people with disabilities in work, training and employment. In terms of models supporting persons with disabilities into the open labour market, supported employment and individual placement and support have proved to be effective in doing so and with high cost-benefit return to the taxpayer. (Edited publisher abstract)
Value for money? An examination of the relationship between need and cost in intellectual disability services
- Authors:
- CRONIN Jodi, BOURKE Jane
- Journal article citation:
- Health and Social Care in the Community, 25(3), 2017, pp.1227-1236.
- Publisher:
- Wiley
The recent economic crisis along with changing demographic trends has stimulated an increased interest in the value obtained from social care expenditure so as to ensure the sustainability of systems in the future. In Ireland, the Department of Health, further to a recent review of its disability services, committed to a new approach that will reshape and redesign its disability service provision. It specifically outlined a reorganisation of financing services, from a model of prospective block grant funding to a system of individualised budgeting based on an assessment of need. This paper examines the relationship between need, service utilisation and cost for high-cost users of adult intellectual disability residential services in an Irish county under the current model of block grant financing. The analysis reported is based on primary data collected from 68 high-cost users of adult intellectual disability residential services in an Irish county in 2013. Statistical analysis was performed to identify the relationship between need and cost, and also to examine the variations in the cost of support between the service provider organisations. The analysis determined an association between need and cost, with poorer levels of psychological well-being related to higher costs. However, the study found no evident relationship between staff/client ratios, the numbers of staff engaged at the residential units and need. An examination of cost variations between the service provider organisations revealed that agency status; service unit size; client and staff characteristics all contributed to variations in the cost of care. This study supports the development of a national resource allocation framework as being fundamental to the equitable and transparent distribution of scarce resources, as recommended by the Department of Health in Ireland. (Publisher abstract)
An exploration of costs of community-based specialist health service provision for the management of aggressive behaviour in adults with intellectual disabilities
- Authors:
- UNWIN Gemma, SHOUMITRO Deb, DEB Tanya
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 30(2), 2017, pp.316-325.
- Publisher:
- Wiley
Background: In the UK, people with intellectual disabilities who exhibit aggressive behaviour often receive community-based specialist health services from a community learning disability team (CLDT). The aim of this study was to estimate costs associated with this provision and to identify predictors of higher costs. Method: Costs were estimated for 60 adults with intellectual disabilities and aggressive behaviour who attended specialist psychiatric outpatient clinics in the West Midlands region of the UK, including contact time with members of the CLDT and use of psychotropic medication over a 12-month period. Results: Mean total cost of 12-month service provision was £418 (95% confidence interval [CI] £299–557). Mean total cost of 12-month psychotropic medication was £369 (95% CI £256–492). Amongst individual members of the CLDT, mean costs were highest for psychiatrists (£181) and relatively lower for community nurses (£70) and clinical psychologists (£30), and lowest for physiotherapists (£13). Male sex, presence of expressive verbal communication and presence of epilepsy were independently associated with 12-month medication and service use costs, accounting for 23% of the variance in cost. Conclusions: It seems that in terms of costs, there is an overreliance on medication and psychiatrists and a relatively lesser reliance on other CLDT members such as community nurses and clinical psychologists for the management of aggressive behaviour in adults with intellectual disabilities within community settings. Health commissioners may wish to explore this relative cost discrepancy further and try to redress the balance where appropriate. (Edited publisher abstract)
Housing choices discussion paper 1: what is the evidence for the cost or cost-effectiveness of housing and support options for people with care or support needs?
- Authors:
- HARFLETT Naomi, et al
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2017
- Pagination:
- 12
- Place of publication:
- Bath
A brief summary of evidence on the costs and cost-effectiveness of residential care and other housing and support options for older people, people with learning disabilities and people with mental health problems. It draws on a review of peer reviewed and grey literature in the UK and Ireland from 2000 onwards. The paper highlights limitations in the available evidence, which include limitations in terms of quantity; quality; lack of reliability of unit costs used in the research, and difficulties of making comparisons across studies. It then provides a broad summary of the evidence that is available. The paper finds that limitations in quality and quantity mean that there is not sufficient, reliable evidence in which to inform housing and support decisions on the basis of cost. It concludes that there is therefore a strong argument that decisions about an individual’s housing and support should be based on other factors supported in current health and social care policy such as rights, inclusion, choice and control. (Edited publisher abstract)