Costes y consecuencias a largo plazo: atención comunitaria a pacientes con retraso mental [Longer-term costs and consequences: community care for people with learning disabilities]

Replacing long-stay hospital care with community care has long been on the policy agenda in many countries. Research was conducted to explore the short and longer term impacts of community care on users, services and costs for people with learning disabilities in England. Study members had left long-stay hospital between 1986 and 1989 and, although not the most disabled of the hospital residents, five years later still required high levels of support. At nine months after discharge, clients had increased their skill levels and showed greater satisfaction with their lives but the community service was more costly than hospital care. Four years later, clients' improvements in skills and behaviour were modest but overall satisfaction was still high. Clients lived in well-supported accommodation and continued to use a wide range of services, over and above the support offered in the accommodation facility. The average costs of community care at five years after discharge were similar to the nine months costs and showed a seven-fold variation. Nearly half of this variation could be explained by client needs and characteristics measured in hospital. The research results imply that resources were targeted on needs but that identifying the boundary between admirable stability in service provision and its less desirable corollary, inflexibility, is not easy.