Residential Services - Congregated Settings

What is a Congregated Setting?

A congregated setting is where 10 or more people with a disability are housed in a single living unit or placed in accommodation that is campus or institution based.

Over 3000 people with disabilities in Ireland live in congregated settings. 

For 93% intellectual disability is their main disability.1

What do we know about congregated settings?

“A Time to Move On from Congregated Settings” is a report published by the Health Service Executive in 2011.

The report found that many people with disability living in congregated settings live isolated lives, segregated from the community and family; many experience institutional living conditions where they lack basic privacy and dignity. 

While costs varied from centre to centre, the average payment per person by the Health Service Executive was €106,000.

The report proposed a new model of accommodation and support in the community.

What is the alternative?

All housing arrangements for people moving from congregated settings should be in ordinary neighbourhoods (dispersed housing) in the community.

There should be individualised supports (supported living) to enable each person to live in the home of their choice and be included in the community. 

A person moving from a congregated setting or any person with disability may:

Choose to live on their own   

Share with others who do not have a disability 

Share their home with other people with a disability (to a maximum of four people with a disability and each should have chosen to live with the other 3 people)   

Live with their own family or opt for long‐term placement with another family.

There should be no new admissions to congregated settings.

Inclusion in the community means a high level of engagement with the local community and wider society. 

It means opportunity to explore individual interests and choices rather than being confined to a set range of centre based and group activities. Inclusion also means access to meaningful employment and valued roles in the community.

Does community living cost more?

Community living is no more expensive than institutional care once the comparison is made on the basis of comparable needs and comparable quality of care.

Over and over again studies show that community services are better than institutions. There is however an increased cost in closing institutions at a leisurely pace.

Apart from depriving those remaining in institutional care opportunities and a better quality of life, drawn-out downsizing of an institution gives rise to prolonged periods of paying higher costs for inferior outcomes1.

Progress since 2011

In 2011 a seven year timeframe was planned for the full implementation of the report’s recommendations. 3000 people with disability continue to live in congregated or institutional settings.

In 2016 the HSE plans to- work towards- the transition of 310 people to homes in the community2

In some regions the number of people in congregated settings has reduced by a third; in other regions it has actually increased.3

Challenges

There is a risk that institutional practises can migrate to community settings3; it is not just a case of replacing one set of buildings with another.

Successful community living requires close attention to the way services are set up and run, especially the quality of support staff.

Community based support services must be in place, carefully planned around the needs and wishes of individual people and then continually monitored.

Successful community living involves a network of local community contacts, supporters, friends and advocates.

Responsibility for housing rests with housing authorities while the health services should provide for the health and social personal needs of people with disabilities living in the community.

Choice of accommodation should not determine what services are provided and equally choice of service providers should not affect the choice of accommodation or the ability to remain in accommodation chosen.

References:

1. Time to Move On from Congregated Settings. Report of the Working Group on Congregated Settings. HSE 2011. 

2.HSE  Social-Care-Division-Operational-Plan-2016 

3. Tatlow-Golden, M., Linehan, C., O’Doherty, S., Craig, S., Kerr, M., Lynch, C., McConkey, R., & Staines, A. (2014). Living Arrangement Options for People with Intellectual Disability: A Scoping Review. Dublin: School of Social Work and Social Policy, Trinity College Dublin.

Congregated Settings Factsheet (PDF)

Congregated Settings Report