THE COST-EFFECTIVENESS OF COMMUNITY CARE FOR ADULTS WITH LEARNING-DISABILITIES LEAVING LONG-STAY HOSPITAL IN NORTHERN-IRELAND

Among the many questions concerning the replacement of long-stay hospi tal services with community-based care are those of cost and cost-effe ctiveness. Is community care more expensive than hospital care! Are le vels of expenditure associated with clients' needs and changes in thei r well-being? By following a cohort of people discharged from seven lo ng-stay hospitals in Northern Ireland, this wide-ranging evaluation wa s able to address such cost-related questions. Although nearly three-q uarters of the sample were living in private sector residential or nur sing homes, a six-fold variation in the total costs of support was fou nd. However, at the mean, community care was less expensive than hospi tal care. For only ten people in our sample of 192 clients did the cos ts of community care exceed the average cost of long-stay inpatient ca re. Multivariate analysis revealed that the costs of community care 'p ackages' were linked to some client needs, but higher spending was not unequivocally associated with better client outcomes. Care in the com munity is reasonably cost-effective in Northern Ireland when compared with long-term hospital care. However, there is a case for increasing expenditure on community care for people with learning difficulties, t o increase use of services provided outside the accommodation and enha nce staffing arrangements within the accommodation facilities. Distrib uting resources appropriately and targeting resources on priority need s through coordination will hep to continue to improve clients' qualit y of life.