People with learning disabilities in 'out-of-area' residential placements: 2. Reasons for and effects of placement.
Out-of-area residential placements often happen because local services are full, and they can leave adults with learning disabilities with less choice and community life.
01Research in Context
What this study did
The team talked to adults with learning disabilities who lived far from home. They asked why the move happened and how life felt now.
Staff and family were also interviewed. Notes were coded for themes like choice, money, and local service gaps.
What they found
Most moves were forced by missing local beds or budget limits, not personal need.
Life after the move was mixed. Many people lost friends, had fewer activities, and felt less in control. Quality scores were lower than UK norms.
How this fits with other research
Friedman (2019) later showed the same thing in a big U.S. sample: provider-run group homes often copy old hospital limits.
Pilowsky et al. (1998) looked at the flip side. Adults who left nursing homes for community houses gained adaptive skills. Together the papers say place matters, not just label.
Spreat et al. (2005) add a cost lens. Community placements saved money and boosted integration, but vocational slots dropped. The 2006 study explains one reason: out-of-area moves can cut access to day programs and familiar staff.
Young (2006), published the same year, tracked matched adults moved to either dispersed houses or cluster centres. Dispersed houses won on choice and skills. van Schrojenstein Lantman-de Valk et al. (2006) fills the gap by showing what happens when no local option exists at all.
Why it matters
Before you approve an out-of-county bed, map what the person will lose—day service, job coach, friend network—and write a plan to replace it. Push commissioners for local expansion; the evidence stack shows remote placements risk poorer choice and inclusion.
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02At a glance
03Original abstract
BACKGROUND: Official guidance on out-of-area placements creates incentives that could lead to people being placed against their own best interests, with negative consequences for them and for the 'receiving' authorities. METHOD: Information was collected for 30 people through interviews with them, their families, home managers and care managers. Interviews concerned resident needs, reasons for placement, the homes, care management arrangements, resident quality of life and social inclusion. Information on care standards was abstracted from official records. RESULTS: The main reasons for out-of-area placement were insufficient local services of acceptable quality, financial incentives and loss of family contact through prior institutionalization. The effects varied, with the most disabled people experiencing worst outcomes. Some aspects were worse than comparison studies (choice, community involvement, number of homes meeting all the national minimum standards), some were the same (participation, family visiting and other contact), and one was better (visits to families). Variation was also evident in the involvement of social services staff from the placing authority and in ease of access to local healthcare resources. CONCLUSIONS: Social services and health authorities should develop services locally that can support people with the full range of individual needs. Perverse incentives should be removed, perhaps by increasing the application of direct payments and personalized budgets.
Journal of intellectual disability research : JIDR, 2006 · doi:10.1111/j.1365-2788.2006.00848.x