Community-based care for people with complex learning disabilities and challenging behaviour saves money and vastly improves their quality of life compared with institutional care, research has found.
Research following former residents of Orchard Hill hospital in Sutton, south London, which was at the centre of an abuse scandal in 2007, found their quality of life score rose from 106 to 207 over 18 months after moving to community-based settings.
In 2007 a report by the Healthcare Commission revealed institutional abuse at Orchard Hill that deprived residents of privacy and dignity. It also said there were management failings at all levels at the service run by Sutton and Merton Primary Care Trust.
“What this demonstrates is that you can develop supported living for people with very complex needs and give people better outcomes and value for money in the community,” said Shaun O’Leary, executive head of adult and safeguarding at Sutton Council. “Who wouldn’t want that?”
The research, commissioned by the council and PCT and based on surveys of residents, staff and relatives, showed marked improvements for 39 former residents particularly in the standard of care planning and their autonomy and choice.
However, there was only a small improvement in the amount of social interaction and relationships that people had. Thirty four of the residents moved to supported living and five to care homes.
Report co-author David Sines, professor of community health care nursing at Bucks New University, said the key to the success was very far advanced planning for up to three years before the move. “The new care providers actually located a senior manager of the organisation at Orchard Hill prior to the move. Firstly, they could get to know the resident before the transfer and secondly, they were able to start working with the staff groups who were going to transfer across to the new service with the residents.”
The report also showed that the cost of community support was significantly lower than institutionalised support. The average annual cost of care at Orchard Hill was estimated to be £133,531, while care in a community supported living environment was £101,000.
However, the saving were spread across care costs, housing benefit costs and income related benefits.
Sines said the savings, combined with the improvements in care, gave fresh impetus for an end to institutional care.
Stories of improvement.
Care staff: “People often associate me with ‘going out’ and one of the tenants, having shown me briefly around his flat, collected his coat and started to put it on. I explained that I could not take him out today but he continued to do up his coat and went to the front door. His carer, who had been hoovering, fetched his own coat saying, “this can wait if you want to go out,” and they both left. I later saw them coming out of the coffee shop. This is a very small thing, but it could never have happened at Orchard Hill.”
Care staff: “One service user’s outbursts of self-injury have decreased quite significantly since moving out of Orchard Hill. My observation has been that, because some of the time that is spent with him now is more quality-based and is his time, rather than him always being part of a group, he seems to be much more contented.”
Care staff: “A tenant who had moved into her new flat a few weeks earlier was at the opening event of the scheme. Spontaneously, she took herself to the front of the crowd that had gathered for the opening event and made a speech, welcoming everyone to her new home. This was an incredible sight to witness for the staff present.”
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