Residential services in Europe –

findings from the DECLOC study.

J. Beadle-Brown, J. Mansell, M. Knapp, J. Beecham and

the DECLOC group, with funding from the European
Commission.
Aims of the project
To provide scientific evidence to inform and
stimulate policy development in the reallocation of
financial resources to best meet the needs of people
with disabilities, through a transition from large
institutions to a system of community-based
services and independent living.
Project partners
Consortium leaders

University of Kent (Prof Jim Mansell, Dr Julie Beadle-Brown)

London School of Economics (Prof Martin Knapp)

Partners

University of Siegen (Dr Johannes Schädler)

Psicost Scientific Research Association (Prof Luis Salvador-Carulla)

Charles University, Prague (Dr Jan Siska)

Catholic University of Leuven with European Association of Service
Providers for People with Disabilities (Prof Chantal Van Audenhove, Mr Luk
Zelderloo)

Reference Group

European Disability Forum

Inclusion Europe

Mental Health Initiative, Open Society Institute

Autism Europe

Mental Health Europe
Project structure

Phase 1
Collate existing information on number of disabled people
in institutions in 28 countries

Phase 2
Analyse economic and policy arrangements required for
transition to community-based services

Phase 3
Report in a form suitable for stakeholders and policy-
makers
Phase 1
Collect, analyse and interpret existing statistical
and other quantitative data from 28 European
countries on the number of people with disabilities
placed in large residential institutions (institutions
where more than 30 people live, of whom at least
80% are disabled), including:

the type of disabilities concerned,

the age and gender of residents,

the nature of the services received and

the number, type and qualification of staff
involved,
Phase 2
Analyse the economic, financial and organisational
arrangements necessary for an optimal transition
from a system of large institutions to one based on
community services and independent living, using
regions of three countries (England, Germany and
Italy) as case studies to illustrate the issues
involved
Phase 1 country template

Description of service types (size, main disability
group served, age group served, management,
funding, etc)

Numbers in each type of service for children,
younger adults, older people

Breakdown by age, gender, disability

Number of staff and training of staff

Information on costs of services

Sources used to compile the templates
Phase 1 commentary

Completeness and accuracy of the data in the
associated template

Important background factors
(definitions/distinctions of disability types, age of
majority etc)

Summary of data which did not fit the template –
eg from research studies or about one particular
region

Issues in each country – eg regional variation,
issues re ethnicity or religious groups.
Phase 1 findings

Effort to collate existing data

Completeness and accuracy of official data

Estimates of number of people in institutional care

Conclusions and Recommendations
Effort

Individual countries varied in the extent to which

(i) key informant(s) could be identified who were willing to
help provide or access the data required – eventually found in
26 of the 28 countries

(ii) there was already data available at national level, and

(iii) information on the definitions used and the quality and
completeness of the data was available.

National data, albeit of limited coverage, was found in 23 of
the 28 countries

However, in general, getting comprehensive national data
was very difficult.
 Types of services

Group homes: typically 5-6 people living together, though some
examples may have up to 10 people resident.

Residential homes: typically between 10 and 30 places, usually
providing 24-hour staffing.

Campuses: group homes clustered together on the same site and
usually sharing staff and some facilities. Staff are available 24-hours
a day.

Residential schools for disabled children and colleges for young
adults:

Social care homes or residential institutions: large establishments
serving more than 30 residents (sometimes many more residents than
this).

Hospitals or nursing homes: typically larger establishments, usually
over 30 places, organised primarily around medical and nursing
practices and providing 24-hour staffing.
Completeness - size
Country Places Size<30 Size>30 Not classified
Austria
Belgium 25750 5164 18130 2456
Bulgaria 13269 216 11540 1513
Cyprus 495 495
Czech 66865 9858 57007
Denmark 62081 62081
Estonia 22421 1805 7243 13373
Finland 18032 18032
France 224827 224827
Germany
Greece
Hungary 24390 1114 23276
Ireland 9369 9369
Italy 117241 14514 81428 21299
Latvia 10053 10053
Lithuania 45464 180 14924 30360
Luxembourg 704 410 294 0
Malta 642 88 544 10
Netherlands 64144 59450 4694
Poland 73741 73741
Portugal 11422 4427 6995 0
Romania 32783 214 28348 4221
Slovakia 12252 716 3142 8394
Slovenia 821 821
Spain 181636 2425 777 178434
Sweden 29578 29578
Turkey 9494 86 3127 6281
UK 129548 33530 48781 47237
Total 1186962 124339 235131 827492
Completeness - disability
Country Places ID MH PSD Mixed Not classified
or other
Austria
Belgium 25750 13345 1477 550 10378
Bulgaria 13269 8482 1376 2078 1333
Cyprus 495 495
Czech 66865 16047 1122 1399 2213 46084
Denmark 62081 62081
Estonia 22421 1945 940 2009 334 17193
Finland 18032 12532 5500 0
France 224827 107188 34239 28777 14352 40271
Germany
Greece
Hungary 24390 5351 19038 1
Ireland 9369 8073 515 781
Italy 117241 32806 3258 72906 8271
Latvia 13463 2405 1642 1128 3299 4989
Lithuania 45464 2814 805 11495 30350
Luxembourg 704 704
Malta 642 199 314 10 119
Netherland 64144 64144
Poland 73741 17294 4047 2586 49814
Portugal 11422 360 2216 8114 732
Romania 32783 7040 7563 1120 1457 15603
Slovakia 12252 1093 5585 5574
Slovenia 821 821
Spain 181636 20376 2948 3514 1822 152976
Sweden 29578 29578
Turkey 9494 2805 86 367 3 6233
UK 129548 46877 23205 8606 18330 32530
Total 1190432 264968 123599 59266 161544 581055
Breakdown by disability, age and
gender

Breakdown by disability limited in most countries – data on
ID more readily available in most countries. However in
Italy for example, more data was available for MH. In some
countries, in particular in Central and Eastern Europe, most
institutions catered for mixed disabilities.

Breakdown by gender incomplete for almost all countries –
only Luxembourg could provide complete breakdown by
gender.
 Completeness - age

On average, 15% of residential places are classified as for
children in 21 out of 28 countries where some data was
available.

This average figure conceals some variation –

sixteen countries reported less than 15% of residential places being
allocated for children, with the remaining five reporting between 27%
and 48%.

Low levels of residential provision may reflect

(i) low levels of service so that families support children at home
without help,

(ii) that children are placed in services intended for adults, or

(iii) that families are provided with high enough levels of service at
home to enable them to support their children without seeking
residential
placement.

In terms of older people, in some countries difficult to separate, in
others no data available on age breakdown.
Staffing

Number of staff : good data (at least for service
types listed) for 7 countries, partial data for some
others.

Staff qualifications: only relatively good data for 2
countries – Belgium and Netherlands.

For some countries information available for some
service types but not others or for a sample of each
service type.
Estimates of number of people in
institutional care

Rough estimates – using a variety of data sources.

At least 1.45million people in residential care
across Europe

Over 70% of those in residential care live in
services of more than 30 places.

Estimated rates per 100,000 of institutionalisation
range from 0 (Sweden) to over 500 (Estonia and
Latvia)
Conclusions
Article 31 of the UN Convention on the Rights of Persons with
Disabilities requires States to collect data ‘to enable them to
formulate and implement policies to give effect to the present
Convention’. Such information ‘shall be disaggregated as
appropriate’ and used to address the barriers faced by disabled
people in exercising their rights. States ‘shall assume
responsibility for the dissemination of these statistics and ensure
their accessibility to persons with disabilities and others’.

Countries taking part in this study have some way to go to meet

these requirements
 Conclusions
Comprehensive information is not available

On all types of residential services

Nor on all client groups.

Nor is there clarity about the definition of kinds and
characteristics of services provided or people served

Where such information exist, it is not always collated at
national level.

The data presented in the report form a starting point – both in
terms of specifying what is currently available and in terms of
estimating the numbers of disabled people in residential care

Future efforts need to build on these findings to enable
countries to fulfil their obligations.
Recommendations
1. Agree a harmonised data set at European level
2. Publish statistics demonstrating progress in each
country
Recommendations 1

The European Commission should promote joint work between Member States and
Eurostat to define a minimum data set for residential services (defined broadly) for
people with disabilities.

The data set needs to include information that will permit the review of Member
States’ progress in the closure of institutions and of the growth of independent
living and services in the community.

The data set needs to be workable both for countries which still have services
largely based in institutions, where the distinction between institutional care and
care at home is very clear, and for countries which are in the advanced stages of
replacing institutions with community-based services and independent living. This
is likely to require a combination of information about numbers of places in
services (eg how many places are there in residential establishments where more
than 30 people live, of whom at least 80% are mentally or physically disabled?)
with information about people (eg how many people live in a house or apartment
they own or rent, with what amount of staff support each week?).

The data set needs to include sufficient information about the people served
(gender, ethnicity, primary disability) to enable States to ensure that everyone is
benefiting from the transition away from institutions to better alternatives in the
community.
 Recommendations 2

The European Commission should work with Eurostat towards the regular
publication of statistics demonstrating progress in each country in the
transition away from institutions to better alternatives in the community.
These statistics should be available on the world-wide web and should be
freely available to disabled people, other members of the public, disabled
people, non-governmental organisations and governmental organisations, so
that they may use them in commenting upon and assisting in the
development of better services.

The publication of statistics should be accompanied by an assessment by
Eurostat of their accuracy and completeness for each country.

The Commission should work with Member States to identify a single
source of information at national level in each country, competent to provide
the information needed for the minimum data set and should promote the
publication in print and on the world-wide web of the information available
for each country.
Further information
Report and resources:
http://www.kent.ac.uk/tizard/research/DECL_network/ind
ex.html

j.d.beadle-brown@kent.ac.uk