Rational resourcing and productivity in staffed housing for people with intellectual disabilities: The relationship of staff in

Rational resourcing and productivity in staffed housing for people with intellectual disabilities: The relationship of staff input to resident characteristics and service quality

Felce, D., Jones, E., Lowe, K. & Perry

2003,

Reviewed by Eric Emerson, Professor of Clinical Psychology, Institute for Health Research, Lancaster University Methodology Random selection of 51 supported accommodation settings (7 statutory sector, 32 voluntary sector and 12 private sector) in Wales supporting six or fewer residents. Information collected by interview and direct non-participant observation on inputs (staffing, costs, physical structure), process (e.g., person centred support practices, amount of support received by staff) and outcomes (e.g., engagement in constructive domestic activity) form 163 participants across the 51 settings. Critical Appraisal Well constructed study with clear and appropriate sampling strategy. Small sample (of settings) means that caution needs to be exercised in generalising results. Key Findings resource allocation (higher staff hours and costs) were predicted by indicators of level of participant need (lower ability, greater challenging behaviour), (smaller) size of setting, voluntary agency provision, not living in private sector accommodation with a live-in proprietor and length of operation; receipt of (more) support from staff was predicted by indicators of level of participant need (higher ability combined with lower challenging behaviour), higher staffing ratios and more person centred practices; engagement in constructive domestic activity was predicted by indicators of level of participant need (higher ability) and receipt of support from staff. Social Work Practice/Policy Implications The modest association between costs and indicators of need suggests that commissioning agencies need to pay careful attention to the 'rationality' of resource allocation in supported accommodation. More able (and less challenging) participants received more support from staff and enjoyed a greater quality of life (as indicated by their extent of participation in ongoing activities). These results point to the operation of an 'inverse system of care' in which those with the greatest need receive less support and a poorer quality of life. Such systems are discriminatory and clearly run counter to current policy regarding the targeting of resources at those in greatest need. These results indicate that commissioners and managers should play particular attention to issues of quality in services supporting people with more severe disabilities and the use of this information in the commissioning process to drive up the quality of provision (see also Office of the Deputy Prime Minister and Department of Health [2003, forthcoming]. Housing and Support Options for People with Learning Disabilities . London : ODPM and DH. and Quality and Costs of Residential Provision for People with Learning Disabilities July 1999 HSC 1999/162: LAC (99) 28 ).