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

Abstract

Purpose: Worldwide, disability systems are moving away from congregated living towards individualized models of housing. Individualized housing aims to provide choice regarding living arrangements and the option to live in houses in the community, just like people without disability. The purpose of this scoping review was to determine what is currently known about outcomes associated with individualized housing for adults with disability and complex needs. Methods: Five databases were systematically searched to find studies that reported on outcomes associated with individualized housing for adults (aged 18-65 years) with disability and complex needs. Results: Individualized housing was positively associated with human rights (i.e., self-determination, choice and autonomy) outcomes. Individualized housing also demonstrated favourable outcomes in regards to domestic tasks, social relationships, challenging behaviour and mood. However, outcomes regarding adaptive behaviour, self-care, scheduled activities and safety showed no difference, or less favourable results, when compared to group homes. Conclusions: The literature indicates that individualized housing has favourable outcomes for people with disability, particularly for human rights. Quality formal and informal supports were identified as important for positive outcomes in individualized housing. Future research should use clear and consistent terminology and longitudinal research methods to investigate individualized housing outcomes for people with disability. ä IMPLICATIONS FOR REHABILITATIONIndividualized housing models can foster self-determination, choice and autonomy for adults with disability and complex needs. Having alignment between paid and informal support is important for positive outcomes of individualized housing arrangements. A more substantial evidence base regarding individualized housing outcomes, in particular long-term outcomes, and outcomes for people with an acquired disability, is required.

Housing at the fulcrum: a systems approach to uncovering built environment obstacles to city scale accessibility and inclusion

“…The pivotal role we identified of access to appropriately designed housing in many issues that create obstacles to participating across multiple city domains resonates with the findings of a number of researchers (Dunn, 1990;Franz et al, 2014;Oliver et al, 2020;Pendall et al, 2012;Saugeres, 2011;Tually et al, 2011;Wiesel et al, 2015). Prominently, the findings echo the conclusions of Imrie, who situates the causes and impacts of inadequate housing to the social, political and institutional contexts that inform the responses of built environment professionals and policy makers to the needs of people with disability for physical access.…”

“…While access barriers to housing are recognised as varied, they mostly stem from a shortage of affordable and well-designed housing. Indeed, there remains in Australia a significant shortage of affordable housing to meet the needs of people with disabilities (Oliver, Gosden-Kaye, Winkler, & Douglas, 2020;Saugeres, 2011;Tually, Beer, & McLoughlin, 2011;Wiesel et al, 2015). This despite the clearly recognised benefits of housing designed to meet the individual needs of people with disability, which include self-determination, choice and autonomy (Oliver et al, 2020).…”

“…Indeed, there remains in Australia a significant shortage of affordable housing to meet the needs of people with disabilities (Oliver, Gosden-Kaye, Winkler, & Douglas, 2020;Saugeres, 2011;Tually, Beer, & McLoughlin, 2011;Wiesel et al, 2015). This despite the clearly recognised benefits of housing designed to meet the individual needs of people with disability, which include self-determination, choice and autonomy (Oliver et al, 2020). In view of the complex and interconnected nature of the problems associated with accessibility in the city, a new approach to researching and understanding the issue was deemed necessary.…”

Supported residential services as a type of “total institution”: Implications for the National Disability Insurance Scheme (NDIS)

“…Research on the housing needs and preferences of people with psychosocial disability internationally and in Australia indicates that supported group housing, with all services provided under the one roof, is not what not what people prefer (Harvey et al, 2012; Nelson et al, 2007). This is consistent with decades of research illustrating the negative impact of institutionalisation on everyday choices (Wiesel & Bigby, 2015), recovery outcomes (Chopra & Herrman, 2011), self‐determination (Robertson et al, 2001) and health and social outcomes (Oliver et al, 2020). Indeed, an exploration of the outcomes in different housing types for people with psychosocial disability is a focus of research in Australia and elsewhere (Brackertz et al, 2020; Hayes et al, 2018; Krotofil et al, 2018; McPherson et al, 2018).…”

Current services and outcomes of formerly institutionalised and never‐institutionalised US adults with intellectual and developmental disabilities: A propensity score matching analysis

“…The community living supports available to service users today, especially living with funded support with family or in one's own home, are fundamentally different from the small or large group homes to which many institutional residents moved at the peak of the deinstitutionalization era in the 1980s and 1990s. Moreover, today's more individualised living arrangements are consistently associated with better outcomes (Oliver et al, 2022). Arguably, the combination of more individualised living arrangements and no institutionalisation has resulted in an objectively improved service system with better outcomes for service users.…”