Time to Move On from Congregated Settings
The policy of decongregation is set out in Time to Move on from Congregated Settings - a Strategy for Community Inclusion (2011). This policy commits to moving people out of congregated settings where 10 or more people live together to ordinary homes within the community where no more than four individuals live together
Our work includes a suite of research that points to significant improvements in outcomes following decongregation, provides an examination of the cost and budgetary implications of decongregation, and examines good practice in staff and management changes that stem from the transition to community living. We have also conducted supporting literature reviews.
Moving In, Moving on Report
As part of the National Disability Authority’s strategic commitment to conducting research to support the implementation of key national strategies, the NDA conducted a study to evaluate the outcomes and costs of living in congregated and community person-centred models of service in the disability sector. The findings of the study are presented in the report ‘Moving In, Moving On: An evaluation of the outcomes and costs of congregated and community models of service in the disability sector’. The study was funded by the Health Service Executive (HSE) as part of the Transforming Lives programme.
The findings indicated that quality of life outcomes improved for participants after they moved from congregated settings to the community. Participants and staff reported families visiting more often, residents having more opportunities to go out and about, and to exercise more choice and control over their daily lives. Further analysis, which examined different models of care, found that quality of life was better for people who received person-centred services, and worse for people who lived in congregated settings, could not choose who they lived with, did not like who they lived with, or were experiencing pain.
The cost analysis indicated a cost uplift of 60% for providing services in community rather than congregated settings for those yet to transition from congregated settings. The level of support required by residents is a key driver of costs with higher support needs incurring higher costs - mainly due to the need for additional frontline staff.
The full report is accompanied by a literature review and a technical annex which provides more detailed information on the methodology and tools used and on the findings. A Plain English and an Easy Read version of the Executive Summary are also available.
This report was launched in an online webinar in December 2021. The agenda for this event included presentations form NDA researchers, video contributions from participants of the study and reflections from the HSE. The video of this launch is available on the Transforming Disability Services page.
Staff and Change Management: Good Practice in the Transition to Community Residential Disability Services
The transition of persons with disabilities living in congregated settings to smaller homes in the community is ongoing as part of the Time to Move on from Congregated Settings policy. Research internationally and in Ireland has largely focused on the experiences and outcomes for residents.
The aim of the 'Staff and Change Management' research was to focus on the experiences of staff and managers, recognising the very important role they play in supporting persons with disabilities in residential settings to live a life of their choosing.
NDA Background Research on Decongregation from Institutional Settings
The papers outlined below helped inform the Time to Move on From Congregated Setting Strategy.
This document 'Moving to Community Living: A review of literature on quality outcomes and costs of deinstitutionalisation in Europe' published in 2008, presents a review of literature on the process of deinstitutionalisation throughout Europe. The paper notes the need for national and local government to support the decongregation process. It advises that the shift to community living can be promoted by developing and supporting innovative services and showcasing examples of community living.
We commissioned a report 'Dispersed or Clustered Housing for Disabled Adults: A Systematic Review', from the Tizard Centre, University of Kent that was published in 2009. The report examines international research findings comparing the impact on quality of life of two different types of housing for people with disabilities; clustered communities of housing built for and inhabited only by people with disabilities versus integrated housing in existing communities.
The NDA published a paper 'Models of Residential Provision for People with Disabilities' in 2010, that reviewed residential options available to people with disabilities in Ireland and internationally and found that compared to congregated settings, smaller, community-based dwellings that provide opportunities for choice and control are associated with better outcomes for people with disabilities.
In 2005 the NDA commissioned a consortium of researchers from Ireland, the United Kingdom and the United States of America to examine the quality and costs of supported accommodation for people with intellectual disabilities.