The quality and costs of residential services for adults with multiple disabilities: a comparative evaluation.
Small neighborhood group homes give adults with multiple disabilities more choice and community life without raising costs, but only if staff truly share control.
01Research in Context
What this study did
The team visited 54 homes for adults with multiple disabilities. They compared three setups: small group homes in regular neighborhoods, large campus cottages, and big institutions.
Staff counted how often residents got real choices, went into town, and received active support. Accountants tracked every dollar spent on care, food, rent, and staff pay.
What they found
Neighborhood group homes scored highest on choice, community use, and staff help. Campus and institutional homes scored lower, but all types showed a wide range.
Price tag surprised everyone: the best homes cost no more than the poorer ones. Tax dollars bought better lives when spent on ordinary houses on ordinary streets.
How this fits with other research
Lam et al. (2011) asked the adults with ID the same question sixteen years later. Their survey echoed C et al.: group homes and family-model homes still beat independent or family-only settings for planning, support access, and satisfaction.
Friedman (2019) throws cold water on the party. That review shows many “community” group homes copy institutional rules—curfews, set menus, visitor bans—so quality gains can fade if agencies ignore real autonomy.
McSweeney et al. (1993) looks like a contradiction: when people left hospital for community care, problem behavior spiked. The difference is timing. C et al. studied adults already settled in homes; K et al. watched the risky first six months after a move. Extra behavior support during relocation closes the gap.
Why it matters
You can pitch group homes to funders with hard numbers: better choice and community access cost zero extra. Yet remember Carli’s warning—check for house rules that mimic institutions. Visit at night and weekends. If you see staff writing menus or banning visitors, train them to hand those choices back to residents.
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Join Free →During your next home visit, list three daily choices (food, music, outing) residents actually make; if you can’t find three, write a choice-training plan for staff.
02At a glance
03Original abstract
The costs and quality of four different service models for 40 adults with multiple disabilities were compared. The four service models were: specialised institution-based units; a specialised, campus-style, further education service; specialised community-based group homes; and "ordinary" community-based group homes. Some information was also available from five adults with multiple disabilities living in traditional institutions for people with mental retardation. On almost all measures of service outcome the specialised group-home model was the "preferred" service model, although this model was not associated with particularly high service costs. There was, however, considerable variation in quality within, as well as between, service models, with some residents in all service models experiencing levels of support and engagement similar to those found in traditional institutions. The results of the study are discussed in relation to notions of typical practice and normative standards. The implications of the findings are discussed.
Research in developmental disabilities, 1995 · doi:10.1016/0891-4222(95)00029-1