Adults with intellectual disabilities and challenging behaviour: the costs and outcomes of in- and out-of-area placements
2013
Background People with severe challenging behaviour
are vulnerable to exclusion from local services
and removal to out-of-area placements if locally
available supported accommodation is insufficient
to meet their needs. There are concerns about the
high costs and potentially poorer outcomes of outof-
area placements but relatively little is known
about how costs and outcomes compare with provision
for a similar population placed locally.
Methods Costs, quality of care and a wide range of
quality of life outcomes for 38 people with intellectual
disabilities and challenging behaviour living
in-area and 38 similar people living out-of-area were
compared. The two groups were matched as far as
possible on risk factors for out-of-area placement.
The out-of-area group represented two-thirds of
the total number of people who originated from
the territory served by the largest specialist health
service in Wales and were placed in residential
settings at least 10 miles beyond its boundaries.
Results There was a mixed pattern of quality of
care and quality of outcome advantages between
the two types of setting, although in-area placements
had a greater number of advantages than
out-of-area placements. Unexpectedly, out-of-area
placements had lower total costs, accommodation
costs and daytime activity costs.
Conclusions No overall conclusion could be reached
about cost-effectiveness. A number of potential
reasons for the differences in cost were identified.
Although additional resources may be needed to
provide in-area services for those currently placed
out-of-area, government policy to provide comprehensively
for those who want to live locally, irrespective
of their needs, appears to be attainable.
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