The Evaluation of NIMROD, a Community-Based Service for People with Mental Handicap: Revenue Costs

Abstract

The cost implications of moving from a system of services for people with mental handicaps centred on large institutions to a network of community-based services are not precisely known. The provision of the NIMROD service in a part of Cardiff, with its aim not only to meet the residential needs of adults comprehensively by providing a number of houses in the community but also to develop a support service to people living in their family home, gave an opportunity to investigate and report the revenue costs of a number of service elements with respect to a defined total population. The residential costs of intensively staffed houses in 1986-87, varying in size from two to six places, were found to range between pounds 16,473 and pounds 23,319 per person per year. With the addition of community support costs, such as the provision of day services, the total costs of care per resident averaged pounds 21,708; range, pounds 18,883-pounds 26,009. These compared to the total costs in a minimally staffed house of pounds 9,678 per resident. The costs of community support services for people living in their family homes averaged pounds 5,614 inclusive of DSS benefits, of which pounds 1,743 was accounted for by the NIMROD domiciliary support service, office base and administrative overheads. The residential costs reported were compared to other cost data in the literature. The study supports previous conclusions that there is little evidence of diseconomy attached to small scale per se but that the way staffing levels and therefore staff costs are determined is critical. No evidence was found in this study to link greater cost to better quality.

Costs of village community, residential campus and dispersed housing provision for people with intellectual disability

“…Knapp et al 1992; Cambridge et al 1994; Raynes et al 1994; Beecham et al. 1997), although it is evident that the economies of scale associated with larger or more centralized residential services are mediated through a number of other factors (Felce 1981; Davies et al. 1990; Raynes et al 1994).…”

Community Living for Adults with Intellectual Disabilities: Unravelling the Cost Effectiveness Discourse

“…For example, Felce and Emerson (2005) summarized UK research. Early studies showed that the costs of 25-person residential facilities and six-to eight-person group homes tended to be more expensive than equivalent large institutions, albeit only slightly so when resident characteristics and occupancy levels were taken into account (Davies, Felce, Lowe, & de Paiva, 1991;Felce, 1986;Felce, Mansell, & Kushlick, 1980). However, cost assessment in these studies was not comprehensive.…”

Staff turnover in ordinary housing services for people with severe or profound mental handicaps

“…Once mechanisms for training and on-the-job management are in place, length of service should relate to the development of experience and relevant skills which in mm should itifluence service effectiveness and quality of outcome. Residential services for people with severe or profound mental handicaps are particularly staff intensive, with the costs of staff representing approximately 75% of total expenditures (Davies et al 1991). Therefore, staff ttirnover and staff development are of more than passing interest to those concerned with service management or with service quality.…”