A longitudinal study of the intra-country variations in the provision of residential care for adult persons with an intellectual disability.
National data reveal huge regional gaps in moving adults with ID from large facilities to community homes.
01Research in Context
What this study did
McGeown et al. (2013) tracked where adults with intellectual disability lived for ten years. They used the national ID database to see who moved out of large congregate settings.
The study covered the whole country, not just one city. It counted how many people shifted to smaller community homes in each region.
What they found
Less than 15 % of adults moved from big institutions to community homes over the decade. Some regions moved almost no one; others moved far more.
The data showed a patchwork: neighboring areas could differ by wide margins.
How this fits with other research
Moss et al. (2008) saw a 70 % drop in large-institution use across the United States between 1977 and 2007. McGeown et al. (2013) now show that, inside one country, the same shift crawls along at under 15 % in ten years. The national picture hides slow local progress.
Cohen-Almeida et al. (2000) followed one Scottish region for twenty years and found about half of adults moved to community homes. Their single-region rate beats the national rate reported by R et al., proving that local policy and funding—not just time—drive change.
Lerman et al. (1995) proved that moving out of institutions can boost adaptive skills within six months. R et al. remind us that opportunity to move depends on where you live; the benefit is real but access is uneven.
Why it matters
If you write transition plans or place adults in housing, map your region’s track record. Compare it with nearby areas and use the numbers to argue for fairer funding or faster timelines. Your client may be stuck in a setting not because they need it, but because the local system moves slowly.
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02At a glance
03Original abstract
BACKGROUND: Small-scale community accommodation is the preferred alternative internationally to the institutional and congregated services that previously dominated residential care for persons with intellectual disability. The strategies required for changing to new service models are not well researched. METHOD: The National Intellectual Disability Database in Ireland provided the data to explore the changes in provision that occurred over a 10-year period and the extent of the intra-country variation across eight administrative areas for health services. Data were extracted for 2 years, 1999 and 2009, for over 7000 adult persons resident in either congregated or community-based accommodation. Comparative indicators were calculated for the eight areas as well as nationally. In addition, over 4000 persons living in congregated settings were tracked over the 10 years to ascertain relocations as well as gathering information on the numbers of people newly admitted to each type of accommodation. RESULTS: Marked variations across the eight areas were found in the overall numbers of people in residential accommodation, the proportion of persons living in congregated settings and the extent of changes in the numbers of people in each type of accommodation. Moreover, fewer than 15% of people had relocated nationally from congregated settings over the 10-year period and the number of new admissions to this form of provision remained high in certain areas. CONCLUSIONS: The implementation of new forms of provision was not uniform across Ireland and possible reasons are proposed. Among the wider lessons internationally is the need for robust systems to monitor service provision nationally and locally if equity of access is to be achieved.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01592.x