Deinstitutionalisation and community living. Outcomes and costs: report of a European Study

Contents

1. INTRODUCTION 1

2. METHOD 3

3. CONCLUSIONS AND RECOMMENDATIONS 4

REVIEW OF EXISTING SOURCES OF INFORMATION 4
Recommendations  4
1. Agree a harmonised data set at European level  4
2. Publish statistics demonstrating progress in each country  5

THE CHANGE PROCESS IN THREE COUNTRIES  5

COST-EFFECTIVENESS OF COMMUNITY VERSUS INSTITUTIONAL MODELS OF RESIDENTIAL CARE AND CHANGE OVER TIME 6
System structures  6
Policies and plans 6
Costs, needs and outcomes 7
Supply constraints 9
Local economic development  9
Opportunity costs of capital 9
Funding flows  10
Multiple funding sources 10
Dynamics of change 10

RECOMMENDATIONS  10
Strengthening the vision of new possibilities in the community  11
3. Adopt policies in favour of inclusion 11
4. Develop legislative support for inclusion  11
5. Strengthen the voice of disabled people, families and their advocates in policy  12
6. Require professional bodies to make their policies consistent with supporting inclusion  12
7. Encourage media interest in and support of inclusion  12
8. Learn from best practice in other countries  12
Sustaining public dissatisfaction with current institutional arrangements  12
9. Open institutions to independent scrutiny 12
10. Create inspectorates to protect and promote the rights of individuals  13
11. Emphasise comparisons of quality of life 13
Creating some practical demonstrations of how things can be better  13
12. Create innovative services  13
13. Include everyone from the start  13
Reducing resistance to change by managing incentives for different actors in the process  13
14. Create new funding opportunities 13
15. Remove obstacles to development of services in the community 14
16. Make funding of new services contingent on quality  14