Costs & Benefits

The following research details the costs and benefits in the transition to community based living.  In sum the argument supporting community based living and services is multidisciplinary encompassing fundamental rights, social justice and economic justification ensuring long term benefits in growth, employment and social inclusion.

  • Jim Mansell, Martin Knapp, Julie Beadle-Brown and Jeni Beecham (2007)‘Deinstitutionalisation and community living – outcomes and costs: report of a European Study’ Canterbury: Tizard Centre, University of Kent

Volume 1 – Executive Summary here.

Volume 2 -Main Report here

Volume 3 – Country Reports here.  Some individual country reports are available and can be accessed here.

This substantial report is the most wide-ranging study of its kind.  It brings together available information on the number of disabled people living in residential institutions in 28 European countries, identifies successful strategies for replacing institutions with community-based services and pays particular attention to economic issues in the transition.  For the purpose of the study the European Commission defined a residential institution as an establishment in which more than 30 people lived, of whom at least 80% were mentally or physically disabled.  Since this report, it has been clarified that the size of an institution is not to be the prime consideration as segregated arrangements of 30 persons or less are still institutions and therefore contrary to the CRPD and EU law.

  • Jennifer Hurstfield, Urvashi Parashar and Kerry Schofield ‘The costs and benefits of independent living’ (2007) HM Gov. Office for Disability Issues, Department for Work and Pensions.  Executive Summary here

This report was commissioned by the Office for Disability Issues to inform the ‘invest and save’ proposals ahead of the HM Treasuries Comprehensive Spending Review of 2007.  The comparison of costs and benefits where possible were assessed at individual, service delivery and macro-economic levels.  The study presents firstly an extensive literature review on potential costs and benefits  associated with Independent Living (IL) support in comparison to conventional service provision.  Secondly, five case studies of individuals with differing support needs provided examples of costs and benefits where IL support was shown to significantly outweigh the benefits that were mentioned for conventional forms of support.  The authors found that despite differences of methodology and available data, published material to date indicates the delivery of IL support to disabled people is more cost effective, or at least no more expensive, than traditional care provision.  At service delivery level institutional provision of services were shown to be far more costly than IL support mechanisms.  Extensive qualitative evidence on IL benefits and the considerable improvements in terms of physical and emotional well-being were also found.

  • Debbie Jolly ‘Research paper on Community Living and the support of Independent Living: Costs and Benefits’ January 2009 ENIL here

This report elaborates the human rights argument for the full support of community living for all including children, persons with disabilities and older persons.  It addresses three key arguments acting against the transition to community based living namely;

  1. a) The costs of deinstitutionalisation and community living are higher than institutionalising disabled people.
  2. b) Disabled people, especially those with perceived higher support needs will be unable to support themselves outside the institutional context, be it a large institution or a small group home institution.
  3. c) The process of community living and independent living will take time and require a change in the local systems

The report adopts a comparative approach to institutionalisation (large and small scale including group homes) vs. community living evidencing cost savings, better quality of life and maximised economic contributions of persons with disabilities living in the community with proper support, including Personal Assistance.

Georgette Mulheir ‘Ending Institutionalisation: an analysis of the financing of the deinstitutionalisation process in Bulgaria’ (2014) here.

Lumos performed an analysis of the financing of the deinstitutionalisation process in Bulgaria.  While progress has been made, resistance to fully close institution buildings, ring fence funds and commit these to the development of supportive community services, the total number of children in some form of care (institutions, small group homes or foster care) has risen since 2013.  Moreover the cost per child that remain in institutional care has risen presenting clear evidence that family support is more cost effective.