Effectiveness of Supported Living in Relation to Shared Accommodation
EFFECTIVENESS OF SUPPORTED LIVING IN RELATION TO SHARED ACCOMMODATION
http://www.sprc.unsw.edu.au/reports/Research_Plan.pdf
Executive Summary:
The Disability Policy and Research Working Group commissioned the UNSW Consortium to research the effectiveness of supported living in
relation to shared accommodation to improve service delivery for people with disability. This research project aims to build on
existing knowledge, and increase understanding about accommodation services and housing for people with disabilities. The objective is
to improve service delivery to people with disabilities. The project entailed two main parts. Part 1 (Improving Access to Housing for
People with Disabilities), aimed to improve understanding of how people with disabilities access housing in Australia, as well as to
identify strategies to improve access to housing. Part 2 (Improving Accommodation Models for people with disabilities who require 24-hour
care) described innovative models of care for people with disabilities requiring 24-hour support, developed a service framework
identifying and describing key components of successful models, and a cost-effectiveness analysis of selected models compared to 24-hour
staffed group homes.
The report combines the two parts and includes an overview of existing national and international approaches to 24-hour supported
living, including examples of innovative models; an outline of the primary goals of supported living; an analysis of facilitators and
barriers to successful provision of supported living; a framework for assessing the effectiveness of approaches to 24-hour accommodation
support based on the goals and facilitators and barriers outlined in previous sections; a detailed analysis of six case studies of
innovative Australian approaches to supported accommodation, followed by an application of the assessment framework to the six case studies and a cost effectiveness analysis of the case studies; and a conclusion for policy implications of the research.
The most pervasive trend in current approaches to supported accommodation in Australia and the other countries studied (the U.S
and Europe with a focus on the U.K) is deinstitutionalisation. The process is advancing in most countries, including Australia. The most
common form of formal residential accommodation support is 24-hour staffed group homes, although there is a trend towards preference of semi-independent living and supporting informal care. An important policy trend is the move towards individualisation of services and
many countries have been examining different methods for such provision, including direct funding mechanisms and individualised
case management.
The four main goals of supported living identified in the research are (i) human rights concerns for people with disability and the
equalisation of their position in society to that of the general population, with a focus on empowerment; (ii) quality of life,
including social participation; (iii) independent living with a focus on self-determination and choice; and (iv) cost effectiveness for the
person using accommodation support and the most effective use of limited funding.
The main facilitators and barriers to successful provision of accommodation support identified in the research are: effective and
supportive legislation and agreements; beneficial and compatible building legislation; effective and streamlined interagency
coordination; the nature of the supported living arrangements; funding and demand management; staffing quality including training
and management; discrimination, including the specific interests of Indigenous people and people with cultural and linguistic interests;
levels of flexibility and choice in service types and levels; and support for the involvement of informal carers.
The research developed a framework for assessing the effectiveness of approaches to accommodation support based on the goals and
facilitators and barriers. The domains include (i) the outcomes and goals of the approach (independent living, quality of life and
cultural appropriateness); (ii) administrative systems such as interagency coordination and the policies and practices of the
service provider; (iii) service viability in relation to availability, flexibility and mobility of funding for the service user, sustainability of the service, ability to expand and replicability of the service; and (iv) quality of staffing, informal support and coordination between formal and informal support.
Six national case studies of new approaches to support for people who have 24-hour support needs examined in the research are (i) the Lower Great Southern community Living Association in Western Australia; (ii) My Place in Western Australia; (iii) Noarlunga in South
Australia; (iv) the Opening Doors Project in South Australia; (v) Tom Karpany House in South Australia; and (vi) Uniting Care Wesley -
South East Project in South Australia. All of the approaches are effective when analysed with the effectiveness framework. Despite the
wide range of practices and goals in the case studies, all are focused on fostering independence while providing individualised and
holistic approaches to service provision. All of the case studies were assessed as being replicable and suitable for people with a
range of support needs.
In addition, the cost effectiveness analysis found positive results compared to support provided in group homes. Direct housing costs to
the disability government agencies, service provider and person with isability in the case studies seem to be less than some group home
models. This is probably because of the range of places that people live and the source of contributions to the housing costs. These
included clients contributions, co-resident contributions, subsidised rent through social housing and economic costs to family members
through informal care arrangements. The implication is that the other economic housing costs associated with these approaches are incurred by other parts of government (eg. social housing) or families. None of the service providers own the housing in the case studies.
Accommodation support and management costs for the case studies also appeared to be lower than or similar to group home costs. The range includes lower costs where people's support needs change following stabilisation of suitable accommodation support and housing. The analysis found that the benefits are likely to be higher for clients in these alternative models of accommodation support than for matched people living in a group home.
