The cost-effectiveness of community care for adults with learning disabilities leaving long-stay hospital in Northern Ireland.

Among the many questions concerning the replacement of long-stay hospital services with community-based care are those of cost and cost-effectiveness. Is community care more expensive than hospital care? Are levels of expenditure associated with clients' needs and changes in their well-being? By following a cohort of people discharged from seven long-stay hospitals in Northern Ireland, this wide-ranging evaluation was able to address such cost-related questions. Although nearly three-quarters of the sample were living in private sector residential or nursing homes, a six-fold variation in the total costs of support was found. However, at the mean, community care was less expensive than hospital care. For only ten people in our sample of 192 clients did the costs of community care exceed the average cost of long-stay inpatient care. Multivariate analysis revealed that the costs of community care 'packages' were linked to some client needs, but higher spending was not unequivocally associated with better client outcomes. Care in the community is reasonably cost-effective in Northern Ireland when compared with long-term hospital care. However, there is a case for increasing expenditure on community care for people with learning difficulties, to increase use of services provided outside the accommodation and enhance staffing arrangements within the accommodation facilities. Distributing resources appropriately and targeting resources on priority needs through coordination will hep to continue to improve clients' quality of life.