Exploring the efficacy of housing alternatives for adults with an acquired brain or spinal injury: A systematic review

Abstract

Objective: Housing for people with acquired brain injury (ABI) or spinal cord injury (SCI) remains a significant issue in Australia and internationally. This review examined the current research evidence regarding the efficacy of housing alternatives for adults with ABI or SCI in relation to four principal outcomes of interest: the person’s (1) community integration/participation, (2) independence, (3) psychosocial well-being and (4) quality of life. The review also sought to identify how the reported efficacy of the housing alternatives might be impacted by individual factors. Method: For this systematic review, quantitative empirical, peer-reviewed research published after 1 January 2003 was sought. Ten journal articles met the eligibility criteria. None of the included studies comprised an adult SCI sample. Results: The research identified lower levels of community integration/participation, independence, psychosocial well-being and quality of life for adults (particularly younger adults) with ABI living in ‘structured settings’ (i.e., residential care) compared to those living in ‘home-like’ environments (i.e., private homes) and ‘disability-specific’ settings (i.e., shared supported accommodation, group homes, foster care homes, cluster units). Conclusion: More research is needed to compare ‘home-like’ and ‘disability-specific’ settings, and individual housing models more generally (i.e., living at home with friends vs with family vs living in shared supported accommodation vs living in residential care). This review identified a number of limitations in the current evidence base and several important directions for future research. Policymakers, architects, designers, builders, developers, funding agencies, international researchers as well as people with ABI or SCI and their families may benefit from the findings of this review.

The outcomes of individualized housing for people with disability and complex needs: a scoping review

“…Individualized housing options also demonstrated favourable outcomes in regards to social relationships [51][52][53], challenging behaviour [42,44,49], mood [49,59] and participation in domestic tasks [44,57]. These findings align with previous research that has highlighted the benefits of individualized housing regarding selfdetermination, functional skills improvement, meaningful social interaction and psychological wellbeing [29,[63][64][65][66][67]. In contrast, outcomes regarding adaptive behaviour, self-care, scheduled activities and safety showed no difference, or less favourable results, when compared to group homes [40,42,44,46,56,57].…”

“…Findings from the current review suggest that support arrangements are not adequate in some individualized housing options, and as a result may be impairing the outcomes of people with disability [40,41,47,50]. Previous research investigating similar housing models has also highlighted the importance of well-structured support models that consist of paid support as well as family, friends and community members [26,67,76]. In Australia, the Specialist Disability Accommodation (SDA) program was developed to encourage investment and growth in individualized housing options for people with disability [77].…”

“…Unfortunately, the severity of physical limitations was only reported in a handful of studies [40,46,48,49,58], so substantial conclusions cannot be drawn regarding the appropriateness of individualized housing for people with significant physical limitations. Previous research has documented the different employment outcomes [75] and support needs [67] for people with physical impairments or acquired neurological disabilities compared to people with intellectual disability. It is therefore likely that living in individualized housing will be associated with unique outcomes for people with different types of disabilities.…”

Accessible independent housing for people with disabilities: A scoping review of promising practices, policies and interventions

“…People with disabilities are particularly vulnerable to missing out on acquiring affordable and accessible housing and deserve solutions that enhance their access to appropriate housing. Although the literature on the housing needs of people with disabilities is growing, most of the focus is on elderly populations, those with mental health conditions (and risk of homelessness and 'housing first' programs), and people with developmental or intellectual disabilities living in group homes or supported housing (e.g., onsite-support and services offered to occupants to maintain their well-being) [2,[31][32][33][34][35][36][37]. While this research is valuable, there is a critical need to synthesize the most promising practices [38][39][40], policies [41,42] and interventions (e.g., home modifications [17,27,[43][44][45][46], universal design [11,47], architectural planning and design [48], smart home technology [49][50][51], grants and funding [52][53][54] to enhance accessible independent housing for people with various types of disabilities.…”

Housing and Support for People with Disability: Perspectives of Motor Accident, Disability and Injury Insurers across Australia and New Zealand

“…In the Australian context, researchers have systematically informed the recent evidence base regarding housing models and features [ 22 , 23 ], design principles [ 24 ]; housing efficacy [ 25 ]; housing innovation by individual insurers [ 26 , 27 ]; housing markets [ 28 ] and stakeholder perspectives [ 29 ]. Recent mapping of the Australian funding landscape for housing for people with an acquired brain or spinal cord injury posits that publicly available information on housing and support options provided by insurers is limited, highlights ‘the need for policy makers to provide transparent information about housing entitlement’ and calls for a more unified evidence base [ 18 ].…”