People with learning difficulties living in community homes: their views and the quality of the service

Services for people with learning difficulties are currently moving from predominantly institutional facilities to community based services. The two studies addressed this major change by assessing the views of the users and using a number of quality of service measures. Study I investigated twenty-one people who had left hospitals in Leicestershire. An assessment of each person was completed which included the views of users and carers and quality of service measures. The majority of users expressed a preference for their community placement. In addition, it was found that their measured views were not statistically associated with any quality of service measure. It was decided to investigate this finding further in Study II by using a different methodological approach. Study II used an innovative methodology emphasising outcome measures and involving six detailed case studies of people living in community residential services. These all addressed the same set of questions by the systematic collection and analysis of in-depth, objective information. An important advantage of this methodology was that it enabled a number of processes to be identified, which were not detectable using large sample techniques. It was found that certain features of service style, such as systematic allocation of domestic tasks, were powerful influences over the amount of time that people participated in these activities. Time spent in integrated settings used by the general public was influenced by factors such as having an active link in the community, e.g., a person to visit. Users in Study II expressed greater dissatisfaction than those in Study I, and some people wanted to move to places offering greater independence. Factors were identified which influenced this viewpoint, including knowledge of alternative residential placements. Guidelines for practice are offered. Recommendations are made for case study designs which will enable processes to be identified. Suggestions are given for implementation and feedback within services, and for targets to be achieved.