Adults with intellectual disabilities and challenging behaviour: the costs and outcomes of in- and out-of-area placements.
Out-of-area placements cost less but deliver lower well-being and higher hidden risks.
01Research in Context
What this study did
Tassé et al. (2013) compared two living setups for adults with intellectual disability and challenging behaviour.
One group stayed in local services. The other moved to out-of-area placements.
The team tracked costs and quality-of-life scores for both groups.
What they found
Local placements cost more but gave better quality of life.
Out-of-area spots saved money yet scored lower on well-being checks.
No clear winner emerged; you must weigh price against life quality.
How this fits with other research
Early et al. (2012) warn that no quality-of-life tool is proven for people with ID plus challenging behaviour. This weakens any cost-versus-quality claim.
Fournier et al. (2004) showed specialist inpatient units cut out-of-area moves and improved behaviour. Their data hint that staying local can be both cheaper and better, the opposite of J’s money-saving finding.
Godoy-Giménez et al. (2024) add a darker note: adults in residential care face twice the caregiver abuse risk. Lower price may hide human costs that dollars never show.
Why it matters
When you sit at the funding table, remember cheaper beds can backfire. Use Marta’s abuse stats and K’s outcome gains to argue for local, well-staffed options. Push for validated QOL tools before you sign off on any move.
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02At a glance
03Original abstract
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 out-of-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.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01558.x