Relocating people with intellectual disability to new accommodation and support settings: Contrasts between personalized arrangements and group home placements

Racial Disparities in COVID-19 Experiences Among Older Adults With Disabling Conditions

OBJECTIVES

This paper examines the health, work, and financial experiences of older adults with disabling conditions during the COVID-19 pandemic. It also explores the role of county- and state-level conditions in these experiences.

METHODS

Using data from the 2020 Health and Retirement Study, we estimated regression models to assess differences in outcomes between those with and without disabling conditions and by race/ethnicity. We used multilevel modeling to assess whether and how county or state factors might be associated with the differences in these effects.

RESULTS

Older adults with disabilities were more likely to report experiencing financial hardships, delaying health care, and experiencing effects on work than those without disabilities; these differences are heighted between race and ethnicity. Older adults with disabilities were more likely to live in counties with greater social vulnerability.

DISCUSSION

This work underscores the importance of developing a robust, disability-inclusive public health response that protects older adults.

A community living experience: Views of people with intellectual disability with extensive support needs, families, and professionals

BACKGROUND

Despite the benefits of community living for people with intellectual disabilities (ID) and extensive support needs, they remain highly institutionalized.

AIMS

To qualitatively analyze the perceptions of people with ID, including those with extensive support needs, professionals, and family members six months after the implementation of 11 community homes for 47 people in different regions of Spain METHODS: Thematic analysis of 77 individual interviews conducted with 13 people with ID, 30 professionals and 34 family members was performed using Nvivo12.

RESULTS

Seven themes were found: (1) "the room as I like it", (2) "sometimes I don't obey", (3) "here I do a bit of everything", (4) "lots of people love me here", (5) "all thanks to them, who have helped me" (6) "I miss my mom", and (7) "I'm happy here".

IMPLICATIONS

Transitioning into the community has shown a clear positive change in emotional well-being, opportunities to participate in activities or exercise control over one's life. Nevertheless, certain restrictions were still present in people's lives, which significantly limit their right to independent living. While many of these restrictions may disappear, professional practices typical of a medical model can be recreated in services located in the community.

Expectations of Personal Life Development and Decision-Making in People with Moderate Intellectual Disabilities

People with intellectual disabilities have a need for personal and social development that is often unknown or poorly understood. The main motivation is the fact that students belong to a group usually excluded from the ordinary educational process. That process is replaced with measures that focus on caring for students rather than promoting their development. The objective of this research is to understand the expectations for personal development and decision-making of students with intellectual disabilities. To achieve the stated objective, a qualitative research based on two complementary approaches, grounded theory and case study, has been employed. The sample (n = 28) was drawn from a specific study program for the training and development of people with intellectual disabilities at the University of Murcia, called "We are all Campus". We aim to identify the different perceptions of their reality and potential for personal development, to understand their decision-making and what motivates them. Likewise, we investigate the self-perceptions of students with intellectual disabilities have and their understanding of their future life expectations. The main conclusions show that the training program represents an opportunity for students' progression and personal development. Thus far, the expectations of the students have remained the same, focusing on their work and social inclusion.

Unlimited Surrounding: A Scoping Review on the Impact of the Built Environment on Health, Behavior, and Quality of Life of Individuals With Intellectual Disabilities in Long-Term Care

OBJECTIVES

To identify available literature on the impact of built environments on health, behavior, and quality of life of individuals with intellectual disabilities in long-term care. Additionally, we aimed to map the available literature, (re)frame the overall research situation in this area, and formulate recommendations.

BACKGROUND

Long-term care facilities in the Netherlands are planned without using knowledge from research regarding evidence-based design because it is unclear what evidence is available about the impact of long-term care built environments on individuals with intellectual disabilities receiving 24/7 care.

METHODS

Twelve scientific databases were searched for keyword combinations. After systematically screening 3,095 documents, 276 were included in the analysis.

RESULTS

There is an underrepresentation of research and publications in intellectual disabilities, compared to other user groups living in long-term care facilities. A total of 26 design components were found in all groups; as for intellectual disabilities, research was available on only seven of them. Community care, home-likeness, and variety seem to have a positive effect on health, behavior, and quality of life. There are conflicting results regarding the effects of house size.

CONCLUSIONS

Although individuals with intellectual disabilities live in long-term care facilities, sometimes for life, little research has been conducted on the impact of the built environment on them. In the future, more empirical research should be conducted, addressing all aspects of quality of life and specific design components, with hypotheses based on needs assessments and the use of good research designs. This requires an investment of time and funding.

Family experiences of personalised accommodation and support for people with intellectual disability

Previous studies suggest that family members of people with intellectual disabilities prefer them to move to supervised living arrangements such as group homes. In Ireland, personalised arrangements are emerging, but families have had little exposure to this option. In this qualitative study, we explored the perspectives of family members following their relative's move to personalised support options, mostly from group homes. Semi-structured interviews were conducted in 2011 with a family member of 17 people who had previously moved, with follow-up interviews held with 12 of them up to 18 months later. Thematic analysis on interview transcripts was conducted by three researchers. The family members spoke favourably of the new arrangements. A core theme of enabled independence emerged with subthemes of greater self-reliance in personal care, increased confidence, more social inclusion and gains for relatives. Reservations focussed on the need for more support hours, managing risk and loneliness.

Intellectual disability and independent living: Professionals' views via a Delphi study

BACKGROUND

The Convention on the Rights of Persons with Disabilities (2006) states that people have the right to decide where to live and with whom. Professionals play a key role in supporting processes for independent living (IL). This research aimed to identify which ideas generated more or less consensus among professionals regarding the role of different agents involved in the processes of IL in Spain.

METHOD

The Delphi method was applied to an expert panel of 25 professionals.

RESULTS

A high consensus was reached regarding the role that people with intellectual disabilities, their families and their natural support networks play in supporting IL processes, but there was less consensus on the role played by organizations and professionals.

CONCLUSIONS

The study highlights the need to promote practices that favour the decision-making capacity of individuals to move towards models of support based on community and the human rights model.

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

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.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.

eHealth in the support of people with mild intellectual disability in daily life: A systematic review

BACKGROUND

eHealth has recently made rapid progress in care, support and treatment. However, studies on the use of eHealth to support people with a mild intellectual disability in daily life are limited. A systematic review was conducted to provide an overview of this use of eHealth.

METHODS

Seven databases were searched for relevant studies and assessed according to the PRISMA guidelines. Descriptive analyses were deployed using the Matching Person to Technology model to evaluate the key areas contributing to successful eHealth use.

RESULTS

Most of the 46 studies included were small-scale case studies and focused on using eHealth to acquire daily living skills and vocational skills. In addition, several studies focused on eHealth use for self-support in daily living, and three studies focused on remote professional support.

CONCLUSIONS

eHealth offers opportunities to support people with mild intellectual disability in various different contexts of daily life. Scientific research on this topic is in its early stage, and further high-quality research is needed.

Information infrastructure and quality person-centred support in supported accommodation: An integrative review

OBJECTIVES

To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support.

METHODS

We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis.

RESULT

All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support; 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information.

CONCLUSIONS

Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs.

PRACTICE IMPLICATIONS

Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.

The views and experiences of families and direct care support workers regarding the expression of sexuality by adults with intellectual disabilities: A narrative review of the international research evidence

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. However, the experiences and views of families and direct care support workers and their support and development needs in the topic area are unclear.

AIMS

The aim of this narrative review was to explore the views and experiences of families and direct care support workers in relation to the expression of sexuality by adults with intellectual disabilities and to identify their distinct support and development needs.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from May 1998 to June 2018 was undertaken. Included studies had to address specific criteria: peer reviewed papers, the use of appropriate research methods, and focus exclusively on the individual views and opinions of families and direct care support workers. The search of relevant databases yielded 313 hits. Following the application of explicit inclusion and exclusion criteria, 11 papers were deemed suitable for the review. The PRISMA checklist was utlised in the process. Quality was assessed using a recognized framework.

OUTCOMES AND RESULTS

The data were analysed and key findings highlighted issues for families and direct care support workers including: attitudes and beliefs; fear of abuse, exploitation and harm; new technologies; supporting developments in practice; and education and training programmes.

CONCLUSIONS AND IMPLICATIONS

Families and direct care support workers have specific support and education needs. Future healthcare initiatives need to be developed that are fully responsive to the identified concerns and requirements of families and direct care support workers.

Changes in the self-rated well-being of people who move from congregated settings to personalized arrangements and group home placements

A natural experiment contrasted the self-rated well-being of people with intellectual disabilities ( n = 75) and those with enduring mental health problems ( n = 44) after they moved to new accommodation and support options, while others remained in congregated settings or living in the family home. Most support staff also provided well-being ratings. In personalized arrangements, personal well-being was significantly higher than in congregated settings; particularly for people with intellectual disability who had higher support needs compared to people with mental health problems. Moving to a group home also brought some improvement in the well-being ratings of people with intellectual disability but only for those with higher support needs. Such moves seemed to lead to a decline in well-being for those with mental health problems. There were marked discrepancies between ratings given by the person with those of staff. The well-being measure shows promise for use in further comparative and longitudinal studies.

The role of support staff as people move from congregated settings to group homes and personalized arrangements in Ireland

The movement of people with intellectual disabilities into the community is increasingly endorsed by public policy. Whilst staff are critical to a successful transition to the community, there is only scattered research on their role in supporting people to move. In this study, 32 staff and the 16 people with intellectual disabilities they supported to move from congregated settings to group homes or personalized living arrangements in the community were interviewed on two occasions, before (time 1) and after (time 2) the move. In congregated settings, staff steered the move to community living, they helped them to settle in community group homes and supported them to increase control over their lives in personalized community arrangements, where they support became increasingly more personalized and geared towards community participation and development of social relationships. Implications for staff training are drawn.