Supporting carers

The number of individuals who provide unpaid care across the UK is rising: it currently stands at approximately 8 800 000 people. Some carers can experience a cycle of financial difficulty, isolation, physical and mental ill health. Recommendations for support of this marginalised group have become enshrined in national health policy and GPs have a pivotal role in delivering this help. Involving carers in management plans and providing appropriate support can improve a carer’s wellbeing, and reduce avoidable hospital admissions and residential placements, thus, enabling people to live independent lives for longer. Every caring circumstance is different. In order to provide appropriate, tailored, timely support there needs to be individual identification, assessment and support of carers.

Trend Change in the Intellectual Disability Nursing Home Census From 1977 to 2004

The Omnibus Budget Reconciliation Act (OBRA) of 1987 was expected to reduce inappropriate residential placements of persons with intellectual disability (ID) in nursing homes. Utilizing the nationally representative 1977, 1985, 1995, and 2004 National Nursing Home Surveys (NNHS), we estimate trend change in the ID nursing home census pre- and post-OBRA. We find a marked decrease in number and percentage, and a shift in the age distribution of the ID nursing home census, most pronounced between 1985 and 1995. We contend that these trend changes, concurrent with growth in the overall nursing home population, provide empirical evidence that policy changes that occurred during the OBRA enactment period were successful in reducing inappropriate residential placements of persons with ID in nursing homes.

A Response to ‘Weighing Up the Evidence and Local Experience of Residential Care’

We are in agreement with some of the points made in the recent article by Tregeagle, ‘Weighing up the evidence and local experience of residential care’ (Children Australia, 42(4), 240–247). For example, there can be no dispute about the high costs of residential placements or that achieving a stable residential environment is very challenging. Table 1 provides a three state cost comparison of residential placements (Ainsworth, 2017).

Pragmatism and practicalities: Residential placement and reintegration of young males who have sexually abused

Human service responses to sexual abuse perpetrated by young people are often extensive and expensive, and yet many aspects of these responses remain contentious. In 2007, as members of Aotearoa New Zealand Association of Social Workers (ANZASW), we prepared a submission to the Social Services Committee for the Inquiry into the Care and Rehabilitation of Youth Sex Offenders. This paper expands on points made in the ANZASW submission, with a particular focus on availability of suitable residential placements for young men who have sexually abused. The paper then considers issues relevant to reintegration of these youth into the community following a period in residential placement.

They’re Not All at Home

Using an integrated administrative data set, out-of-home residential placements (i.e., child welfare, juvenile justice, mental health) were examined in a sample of early adolescents in a large urban school district. Out-of-home placements were tracked across Grades 7 to 9 in a population of 58,000 youth. This included 10,911 students identified for special education (7,028 with learning disabilities, 1,247 with serious emotional disturbance, 1,245 with intellectual disabilities, 804 with speech and language impairments, and 587 with other disabilities). Students who received special education were twice as likely to experience out-of-home placements. The rates and types of out-of-home placements were differentially related to specific special education classifications. In particular, youth with serious emotional disturbance were more likely to experience out-of-home placements and to be involved in multiple sectors. Findings are discussed in relation to the development of intensive emotional and behavioral interventions for early adolescents who receive special education services.

Characteristics of the most expensive residential placements for adults with learning disabilities in South East England: a follow-up survey

Purpose – The purpose of this paper is to investigate the characteristics of the highest cost residential placements provided for adults with learning disabilities in the South East of England, comparing findings with a previous survey. Design/methodology/approach – Lead commissioners for NHS and Local Authority teams in the South-East of England were asked to provide information on the five highest cost placements that they currently commissioned. Findings – The average placement cost was £200,000 per annum with a range from £81,000 to £430,000 per annum. Individual characteristics of people placed were broadly similar to those identified in previous studies. Originality/value – Significant resources are used to support relatively few individuals. These individuals’ needs and characteristics suggest areas for research and practice development.

Residential Transitions Among Adults With Intellectual Disability Across 20 Years

The present study addresses critical gaps in the literature by examining residential transitions among 303 adults with intellectual disability (ID) over 10 years (Part 1) and 75 adults with Down syndrome over 20 years (Part 2). All adults lived at home at the start of the study, but many moved to a variety of settings. Several characteristics of the adults with ID differed across settings, most notably adaptive behavior and the number of residential transitions, whereas characteristics such as age, type of disability, and behavior problems were less predictive of residential placements. The number of moves over the course of the study varied widely, with critical links to earlier family dynamics, social relationships, and health and adaptive behavior.

Will There Always Be an Institution? II: The Impact of New Service Models—Residential Alternatives to Institutions

In this two-part series of articles, it is predicted that institutions will be phased out because of five trends: development of nonresidential community services; new conceptualizations of and attitudes toward residential services: increased usage of individual rather than group residential placements; provision of small, specialized group residences; and a decline in the incidence and prevalence of severe and profound retardation due to reduction in the birthrate of high risk groups, improvement of health services for the population generally and for high risk groups specifically, increased practice of abortion, general environmental betterment, and early childhood education. In this (second) part, the impact of the developing new service model upon the institution is discussed.

Will There Always Be An Institution? I: The Impact of Epidemiological Trends

In this two-part series of articles, it is predicted that institutions will be phased out because of five trends: development of nonresidential community services; new conceptualizations of and attitudes toward residential services; increased usage of individual rather than group residential placements; provision of small, specialized group residences; and a decline in the incidence and prevalence of severe and profound retardation due to reduction in the birthrate of high risk groups, improvement of health services for the population generally and for high risk groups specifically, increased practice of abortion, general environmental betterment, and early childhood education. In this (first) part, the impact of the predicted epidemiological trends upon residential services is discussed.