A longitudinal study of the intra-country variations in the provision of residential care for adult persons with an intellectual disability

Background Small-scale community accommodationis the preferred alternative internationally tothe institutional and congregated services that previouslydominated residential care for persons withintellectual disability. The strategies required forchanging to new service models are not wellresearched.Method The National Intellectual Disability Databasein Ireland provided the data to explore thechanges in provision that occurred over a 10-yearperiod and the extent of the intra-country variationacross eight administrative areas for health services.Data were extracted for 2 years, 1999 and 2009, forover 7000 adult persons resident in either congregatedor community-based accommodation. Comparativeindicators were calculated for the eightareas as well as nationally. In addition, over 4000persons living in congregated settings were trackedover the 10 years to ascertain relocations as well asgathering information on the numbers of peoplenewly admitted to each type of accommodation.Results Marked variations across the eight areaswere found in the overall numbers of people in residentialaccommodation, the proportion of personsliving in congregated settings and the extent ofchanges in the numbers of people in each typeof accommodation. Moreover, fewer than 15% ofpeople had relocated nationally from congregatedsettings over the 10-year period and the number ofnew admissions to this form of provision remainedhigh in certain areas.Conclusions The implementation of new formsof provision was not uniform across Ireland andpossible reasons are proposed. Among the widerlessons internationally is the need for robustsystems to monitor service provision nationallyand locally if equity of access is to be achieved.