Costs, quality and staffing in services for people with severe learning disabilities

Studies on the costs and benefits of different forms of residential service for people with severe learning disabilities are reviewed. These include ordinary housing, larger community services and traditional hospitals. The common expectation that there are diseconomies arising in small scale provision is not borne out in general. Rather, it is important to look closely at the interrelationship between staffing, costs and size, particularly at very small sizes. Research on service quality has shown better outcomes associated with ordinary housing compared to larger and more traditional provision; these outcomes include developmental growth, engagement in community and domestic daily living activities, social contact, quality of the environment, choice and variety of activity. The cost effectiveness advantage of ordinary housing services over traditional hospitals can be concluded. As housing services continue to decrease in size, staffing must be well planned in relation to the support needs of individuals if costs are not to increase. However, such a priority appears consistent with the need to develop individualised plans for resident activity and staff deployment to ensure that the welfare of residents is maximised and that staff input results in worthwhile outcomes for service users