Development and outcomes of community-based services in Hungary

Aims: This study compares the characteristics and quality of life outcomes of people in institutions and group homes in Hungary.Method: Fifteen group homes and institutions participated in the study. Six from each group home, and 12 individuals from each institution (N = 120) were selected randomly to take part. A sub-sample (n = 60) of matched groups was selected based on age, gender and adaptive skills. Data about quality of life was collected in six domains using informant reports and direct observation during field visits. Domains included: community participation, social relationships, self-determination and choice, health and psychotropic medication; engagement in meaningful activities, and quality of staff support. Results: Smaller-scale community-based arrangements in Hungary have similar advantages and weaknesses to those reported in other countries. People who live in group homes enjoyed more choice and participated in more domestic activities. Community participation was related to the location of the setting rather than type of provision. People who lived in villages and rural areas had fewer opportunities in their local community. Levels of psychotropic medication were alarmingly high in all three groups, particularly in institutions and independent group homes.Conclusion: Limitations as well as implications for policy and practice are discussed.