Costs of village community, residential campus and dispersed housing provision for people with intellectual disability.
Smaller community homes and village communities cost more than large campuses but may offer different benefits—match housing type to individual needs, not just price.
01Research in Context
What this study did
The team looked at three places where adults with intellectual disability live in the UK. They tracked every pound spent on each person for a full year. They also noted age, gender, behavior needs, and how each home was run.
The three models were village communities, large campus sites, and small scattered houses. Staff kept daily logs and finance offices shared invoices. No one moved homes for the study; the researchers just watched what was already happening.
What they found
Costs swung widely inside every model. The biggest bills showed up where people had severe ID, challenging behavior, or came straight from hospital. Smaller homes and village setups usually cost more than big campuses.
Younger men living in tiny settings topped the price list. Yet higher spending did not map to better outcomes in this study; it only flagged more intense needs.
How this fits with other research
Cramm et al. (2009) visited the same village style and found residents loved their jobs and friends. Their happy stories add lived meaning to the higher price tag Williams et al. (2002) reported.
Friedman (2023) and Lakin et al. (2010) show US Medicaid now pours billions into home-and-community waivers, not big facilities. These newer figures update the 2002 UK snapshot and confirm small homes are the costly norm today.
Dinora et al. (2020) go one step further: sponsored residential homes buy more community participation than larger sites. So the extra money A et al. saw may actually buy richer lives, not just steeper bills.
Why it matters
When you write a person-centered plan, do not stop at the cheapest bed. Use the 2002 cost drivers as a checklist: severe ID, injury-causing behavior, hospital discharge, small setting. If these boxes are ticked, budget for higher funding up front and argue for sponsored-residential or village options that Parthenia links to better inclusion. Match the home to the person, then defend the price with data.
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02At a glance
03Original abstract
BACKGROUND: In recent years, a growing volume of research evidence has been generated about the relative cost-effectiveness of various types of community-based residential supports for people with intellectual disability (ID) in the UK. However, few reliable data are available to inform planners, commissioners or service providers about the quality and costs of providing support within residential or village communities. METHODS: The evaluation described in the present paper aimed to fill some of the gaps in knowledge by examining the comparative costs of supporting people in village community settings, in National Health Service (NHS) residential campuses and in dispersed, community-based housing schemes. The complete service package received by each study participant was described and costed, and a series of statistical analyses was undertaken to identify factors associated with variations in the cost of support. The analyses reported in the present paper were based on comparisons of 86 people living in village communities, 133 in residential campuses and 281 in dispersed housing schemes. RESULTS: Wide variations in cost were found, not only between models of accommodation, but between individual organizations, settings and service users. Multivariate analysis revealed that higher costs were associated with supports for people with higher levels of ID and more severe challenging behaviour. The cost of support was affected by the size of the residential setting, with smaller facilities likely to be more expensive. Associations were also found between increased costs, and services for younger users, male users and people who had not moved from a NHS hospital. Generally, more sophisticated service processes within the setting were associated with higher costs; although systematic arrangements for supervision and training of staff had a negative effect on cost. CONCLUSIONS: The cost findings should be considered alongside evidence on outcomes. A comparison of village communities and dispersed housing schemes suggests that both models of provision appear be associated with particular benefits, although different types of setting are appropriate for different individuals and therefore, the continued development of a range of residential models is important.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00409.x