Content uploaded by Em Bould
Author content
All content in this area was uploaded by Em Bould on Dec 13, 2017
Content may be subject to copyright.
THE CENTRE FOR APPLIED DISABILITY RESEARCH The Centre for Applied Disability Research (CADR)
is an initiative of NDS. CADR aims to improve the wellbeing of people living with disability by gathering
insights, building understanding and sharing knowledge. CADR’s applied research agenda is helping
to build the evidence base and support stakeholders to better understand what works, for whom,
under what circumstances and at what cost.
RESEARCH TO ACTION GUIDES Our objective is to build a comprehensive online collection of disability
research and translational resources for the Australian context. Our Research to Action Guides
are based on the best available local and international evidence and put together by subject matter
experts to support research end users to engage with the evidence. We gather and analyse evidence
about what works, and package that information into efcient and practical resources.
ACKNOWLEDGMENTS This Guide was authored by Professor Christine Bigby and Dr Emma Bould
from the Living with Disability Research Centre at La Trobe University, Melbourne.
Thanks to Ben Pawson for his contribution to this Research to Action Guide and all those involved in
building the evidence base this guide is based upon.
SUGGESTED CITATION Bigby, C. & Bould, E. (2017) Guide to Good Group Homes, Evidence about what
makes the most difference to the quality of group homes. Centre for Applied Disability Research.
Available at www.cadr.org.au
The guide is also available from the La Trobe University Research repository
http://hdl.handle.net/1959.9/563197
ABOUT THIS GUIDE This Research to Action Guide to Good Group Homes forms part of a suite of
resources on this topic. The suite includes other resources, such as research papers, reports and
information about ongoing projects also available at the CADR Clearing House, www.cadr.org.au.
This Guide summarises an extensive review of the research literature the Living with Disability (LiDs)
Research Centre published in 2016. LiDs looked at the propositions (suggestions) about what makes
a difference to the quality of group homes and thus the quality of life of the people with intellectual
disability who live there. LiDs reviewed the strength of research evidence for these and reached
conclusions about the factors that are most important to quality. The guide uses practice examples
from papers published as a part of the research program on group homes led by Professor Christine
Bigby since 2004.
The Guide will be most useful for two different audiences. Families or carers trying to asses a group
home for someone with intellectual disability they support, which can be a daunting and confusing
task. The second audience for this guide is professionals wanting to know what needs to be in place
to provide a good Quality of Life for people with intellectual disability in a group home.
FEEDBACK Do you have feedback, or a suggestion for a Research to Action Guide? We welcome your
thoughts and ideas. Please contact info@cadr.org.au.
NDS gratefully acknowledges the support of the NSW Government in establishing the NDS Centre for
Applied Disability Research.
This Guide has been developed via a National Disability Research and Development Grant via the
Research and Data Working Group (RDWG), representing all Australian Governments.
1
CONTENTS
Introduction...................................................2
Quality of life and group homes ...................... 3
Propositions about practice ...........................6
Propositions about culture – ‘How things
are done around here’ ..................................8
Propositions about design and resources .... 12
Propositions about external factors ............. 13
Summary ................................................... 14
References ..................................................15
Appendix .....................................................16
Terms used .................................................. 17
Reference material ......................................19
2
INTRODUCTION
For many years, group homes have been the principle supported accommodation option for
people with intellectual disability who are no longer able to live at home with their parents.
The funding options under the NDIS will help to support new, more exible and potentially
individualised options that separate housing and support. In 2017, approximately 16,500 people
live in group homes, most of whom have an intellectual disability. While it is possible to have a
good quality of life in a group home, they are not all the same. Many things can make a noticeable
difference to the quality of group homes but research evidence strongly suggests that two
factors; how staff act and whether they use Active Support are the most signicant factors that
make a difference to quality.
How staff act is inuenced by practice leadership (the support they receive from a frontline
manager), and the culture in the group home. There is also strong evidence that managers,
auditors and potential consumers should not rely on paperwork or second-hand reports to
judge the quality of a group home. Rather, it is important to observe what actually happens in the
home. This guide should help you know what to look for in making a judgement about the quality
of a group home.
This guide summarises an extensive review of the research literature published in 20161. It
examines propositions (suggestions) about what makes a difference to the quality of group
homes and the quality of life of the people with intellectual disability who live there. The strength
of research evidence for these propositions has been reviewed and conclusions reached about
the factors that are most important to quality.
The guide uses practice examples from papers published as a part of the research program on
group homes led by Professor Christine Bigby since 20042. More details about the method and
links to the research papers are in the appendix.
3
QUALITY OF LIFE AND GROUP HOMES
In considering quality, this review draws on the eight Quality of Life domains identied by
Schalock et al help to think about the different things that make up a ‘good life’3. Some of
these domains are objective and easily identied; such as rights and material wellbeing.
However, some are subjective and depend on a person’s own views of what is important to
them. Emotional wellbeing can look very different from person to person. For example, some
people like being tidy and ordered, whilst others enjoy being creative and disorganised. This
emphasises the importance of knowing a person, understanding what is important to them and
what things like ‘homeliness’, ‘meaningful’ or ‘exciting’ mean to them.
The quality of life of people with more severe or profound intellectual disability is closely tied
to the support they receive. Position descriptions for staff in group homes show that they are
expected to support people across all domains of quality of life. Their role is not restricted to
what happens in the house and extends to things such as supporting people to maintain family
relationships or building connections with people in the local community.
There is strong evidence of considerable variation in the quality of group homes, even among
those with similar funding.4 The quality of support provided to people living in a group home can
vary from day to day, between group homes managed by different organisations and between
group homes in the same organisation5. It also shows that people with more severe levels of
disability consistently receive poorer quality of support compared to other people. These are
the reasons why it is important to understand what makes a difference to the quality of a group
home and how to identify what a good one looks like.
Table 1 describes what each of the eight Quality of Life domains might look like for people
with more severe and profound intellectual disability. It has been adapted from a paper titled
“Identifying good group homes for people with severe intellectual disability.”6
4
Table 1. Quality of Life Domains
Domain of QoL Description
Social
Inclusion
People are present in their local community. They generally use the same
services as other community members and are recognised and known by other
people in the community where they live. They take part in activities with other
people who do not have disabilities and have a sense of belonging to one or
more of their communities.
Interpersonal
Relations
People are valued as equals by the staff who support them. They have positive
interactions with staff and a variety of social relationships with people outside
their home. They are supported to have regular contact with family members
where applicable and with friends.
Self-
Determination
People are regarded by staff and feel like individuals, and they are supported
to make choices and express preferences. Their choices are respected, and
they are supported to make decisions or included in decision making processes
about services and plans about their goals.
Rights People are treated with dignity and respect, they have privacy for personal care
and other times when they want it. They have a sense of ownership of their
home. They have someone outside the group home who advocates for them and
represents their interests. There are arrangements in place for support with
decision making and there are clear processes to make complaints.
Personal
Development
People are supported to be engaged and participate in meaningful activities and
social relationships. The activities they carry out reect their preferences, but
they are also supported to try out new things. People are supported to exercise
choice and control on how they spend their time.
Emotional
Wellbeing
People appear content and at ease in their home and with the staff who support
them. They are comfortable with the level of stimulation and sensory demand
in their environment. They feel listened to and valued. They do not show
challenging behaviour or have long periods of self-stimulatory behaviour.
Physical
Wellbeing
People feel safe and pain-free. Their health is regularly monitored, and expert
advice and medical care sought when necessary. They are encouraged to eat
well and exercise and are in the best possible health. They have personalised
and respectful support with all aspects of personal care.
Material
Wellbeing
People live in a house that is adapted to their needs, can access transport so they
can be in their community and have their own money and possessions.
5
PROPOSITIONS AND TYPES OF EVIDENCE ABOUT GOOD GROUP HOMES
This review identied many propositions about what makes good quality group homes.
A proposition is a statement that there is a connection between good quality and ‘doing
something’ or ‘having something in place’. An example of a proposition might be “if there is
strong practice leadership in a group home, the quality will be better.”
Factors that affect quality all work together, so each proposition should not be considered on
its own. For example, having strong practice leadership on its own is not enough to deliver good
quality services.
The propositions about what makes a difference to the quality of group homes can be split into
ve broad topics:
1. Practice: How the staff and managers act
2. Culture: ‘How things are done around here’
3. Design and Resources: Small size and sufcient staff for people supported
4. Policy and Procedures: How the organisation organises itself
5. External: Government regulation and community attitudes
This review then rated the strength of the evidence for each proposition:
• Strong – Clear, strong and long-standing evidence.
• Emerging – Some strong evidence but there has been little research.
• Weak – Research has shown there to be little evidence.
• Mixed – Research has reached conicting conclusions.
6
PROPOSITIONS ABOUT PRACTICE
The proposition with the strongest evidence overall is that how staff communicate, interact and
provide assistance to the people they support has an impact on the quality of a group home.
STAFF PRACTICE THAT REFLECTS ACTIVE SUPPORT
Active Support is a way of providing just the right amount of assistance to enable a person with
intellectual disability to successfully take part in meaningful activities and social relationships.
The evidence is strong that where staff use good Active Support, there are better outcomes for
the people they support. This is true for the people with intellectual disability but particularly for
those with complex needs and more severe disabilities.
Active Support can include people doing something practical with materials such as vacuum
cleaning, hanging out washing, laying a table or washing up, or interacting with other people
by talking or listening to them and paying attention to what they are doing. It can also include
activities like taking part in a group activity, such as playing a board game or being part of a
cheer squad.
“The support worker asked Jo what she wanted to take for lunch tomorrow and
showed her several options. Jo pointed to the chocolate cake. The support worker
brought the cake over to Jo and supported her to hold the knife and cut a piece of
cake. Then the support worker brought over some cling lm and Jo wrapped the
piece of cake.”
“The support worker sat on the oor next to Fred and read through the directions
on the mufn mix packet. She said, “Do you want to come and help me make these?”
showing him the picture on the front of the box. Fred showed no interest so the
support worker said, “I’ll put all the ingredients in the bowl and you can help me stir
– do you want to do that?” She did this and took the bowl to Fred and sat down next
to him. She placed Fred’s hand on the spoon, putting his hand on top and encouraged
him to stir. She asked if he wanted to taste the mixture, putting a small amount on
the spoon and offering it to him. Initially, he pulled away, but when asked again he
tried it and took up the offer for another spoonful.”
Learn more about Active Support and see videos of good practice on this online resource:
www.activesupportresource.net.au
GOOD PRACTICE LEADERSHIP
There is strong emerging evidence that good practice leadership helps support workers to use
Active Support. Practice leaders also need to be skilled at Active Support to set a good example
for other staff.
Practice leadership has ve elements.
1. Coaching and modelling: Spending time with staff providing them with feedback and
demonstrating good practice.
“I’m part of the actual goings on of the house. You set the standard. People model themselves
on what they see you do.”7
7
2. Supervision: Giving honest feedback to staff about their support. Informal supervision
is often preferred but the evidence suggests regular planned individual supervision is
important.
“That’s a bit of a skill, to get people to the point where they can sit down and say, ‘Oh yes, I
was doing this but I didn’t think I was doing as well as I could have been.’ Supervision is not
just you sitting there telling people a list of jobs they’ve got to do.”
3. Leading team meetings: Providing regular forums where staff can share knowledge about
the people they support and ideas about opportunities for them to be engaged.
“The meeting is where you can bring all your concerns. If we’ve got an issue with our client’s
autistic behaviours, [which] are always changing, then as a team, we’ll go, ‘Look, I’ve tried
this, I’ve tried that, that worked, that didn’t’ and then we come up with a plan.”
4. Staff allocations for every shift: Ensuring staff receive clear directions about who they are
supporting and what their particular needs are on that day. There is never just the ‘usual
routine’.
“You have a shift plan on a Thursday that tells staff exactly what they are expected to do
when they get into the service and the people we support can also know what they are
going to do on a Thursday…Clearly, this is only a guide and may be altered on the day at the
beginning of the shift depending on what’s been happening that day.”
5. Focus on quality of life outcomes: Ensuring that every aspect of the work that staff do is
focused on providing the best possible support for every person in the group home.
“We want to encourage and support people to have a quality of life. And it’s our challenge to
actually support the person so that that can actually happen.”
STAFF PRACTICE TAKES ACCOUNT OF DIFFERENCES IN INDIVIDUAL SUPPORT NEEDS
Responding to individual differences and enabling communication, choice and control is at the
core of Active Support. There is emerging evidence about the use of Positive Behaviour Support
with people who have challenging behaviour, particularly when used in combination with Active
Support.
There is relatively weak evidence about other types of practice. These include the SPELL
framework to support people with autism and intensive interactions with people with severe or
profound intellectual disability.
8
PROPOSITIONS ABOUT CULTURE – ‘HOW THINGS ARE DONE
AROUND HERE’
Everyone has a sense of what is meant by ‘culture’ but it can be hard to dene and measure.
Embedded in culture are the hidden assumptions about the generally accepted ‘way we do things
around here’. Culture represents shared values, attitudes and expected behaviours.
Some aspects of culture are easy to see. For example, some group homes have separate
crockery or toilets for staff. Think about the values this represents.
The way staff talk to or about people with disability can also illustrate culture. For example,
consider the contrasting attitudes these staff have about the people they support:
• “They are all grabbers or shitters in this house”
• “We just call them people, like I would call you a person”
Culture can also be observed in the way staff behave and what they expect of each other. If the
way staff work is organised around the needs and preferences of the people they support, then
culture may be person-centred. In contrast, support workers might organise their work to
suit their own preferences or needs, such as in the choices they make about the type of outings
they organise or TV programs on in the living room. This might indicate a more ‘staff-centred’
culture.
There is emerging evidence that culture impacts on the quality of group homes. Figure 1
illustrates the differences between culture in better and poorer quality group homes.
9
Figure 1. Difference between culture in better and poorer quality group homes
Likely to be found in underperforming homes Dimensions of Culture Likely to be found in better homes
Overarching characteristics Cohesive, Respectful, Enabling, Motivating
In-groups may be powerful or the values of the
frontline manager may not reect those of the
organisation.
Alignment of power-holders values
The values of frontline managers are the same
as the organisation. They are strong leaders and
there is shared responsibility among staff and
teamwork.
People supported seen as ‘other,’ fundamentally
different, ‘too disabled,’ lacking skills, or as able to
watch but not be involved.
Regard for residents
Positive regard for people supported as being
equal but staff recognise and attend to their
differences.
Staff role is doing things for people not with them –
such as looking after people and taking them on
group outings.
Perceived purpose
Staff role is centred around helping each person
live the life they want, recognising and respecting
preferences, being inclusive and engaging, and
ensuring care dignity and comfort.
Practice is staff-centred and staff needs are
prioritised. People supported are not seen as
individuals.
Working practices Practice is person-centred – attentive, relational,
exible, with fun interactions.
Resistance to external inuences and ideas. Orientation to change and new ideas Open to ideas and outsiders.
10
The culture in better group homes can be characterised in the following ways.
1) Enabling - People are supported to be included in their home, engaged, have their choices
and dignity respected and staff practice is attentive, based on relationships and includes
moments of fun.
“Bruno leads a conversation about where Seth wants to go. It is worked out that they will go
to City Mall, where Seth will get a haircut, get something to eat, and have a head massage.
Bruno tells me that although the mall is further than some of the local shopping centres it is
one that Seth prefers.”
2) Motivating - there is strong leadership, shared values and shared responsibility between
staff for the quality of their support. Staff are an effective team and are open to new ideas
and collaborating with those outside the team.
“There’s a standard the practice leader expects from everyone that works here and if you’re
not doing it, believe me! But she treats everyone the same. [How do you know you are doing a
good job?] Madge would tell us if we were not.”
3) Respectful – people with intellectual disabilities are positively regarded by staff and seen as
part of the same diverse humanity as themselves. Staff acknowledge and attend to individual
differences.
“If the residents are not ready the bus has to wait, says Hetty.”
“He relies on my judgement a lot I suppose; what we do and where we go, which is okay,
because the basic fact is that Hank can’t tell me exactly what he wants to do, but we try and
nd stuff that he likes to do.”
4) Cohesive - all the staff are on the same page and there are no cliques of staff working on
their own agendas.
“We all share the same work ethic …that’s why we have all these notes and communication
things going on, so that it’s passed on and handed over.”
11
PROPOSITIONS ABOUT POLICY AND PROCEDURES – HOW THE
ORGANISATION ORGANISES ITSELF
There are many propositions that the policies and procedures of organisations inuence the
quality of group homes. However, there is very little evidence or even research about these, and
the evidence that does exist is weak or mixed.
Policies about training in Active Support, workshops and hands-on
There is strong evidence that training in Active Support, which includes both classroom
workshops and hands-on mentoring in the home by an experienced trainer, has the strongest
link to improved staff practice. This means all staff in a group home should expect to attend at
least a one or two-day workshop and have on-the-job mentoring from an experienced trainer
where they work.
Human Resources (HR) policies and procedures
There is some emerging evidence about the importance of strong HR practices on the quality of
staff practice and culture. This research points to the positive inuence of having:
• Disciplinary procedures that support frontline managers in holding staff responsible for the
quality of their practice.
• Recruitment processes that include ways of nding out the values of potential staff, and
use of probation to ensure the approach of new staff is consistent with the values of the
organisation.
• Expectations that are clearly conveyed to staff through orientation, training, and
performance management.
• Processes in place to help new staff become familiar with the people supported in a group
home, such as the use of shadow shifts and working alongside experienced staff.
Procedures to guide staff in planning for the people they support
There is mixed evidence about the impact of individual planning systems on the quality of group
homes.
Staff characteristics and turnover
There is weak evidence that staff characteristics such as satisfaction, stress levels,
professional qualications or experience impact on the quality of group homes. There is also
weak evidence about the inuence of staff stability or turnover on quality.
12
PROPOSITIONS ABOUT DESIGN AND RESOURCES
There is strong evidence about the design and resources necessary for quality group homes.
However, these are not enough to lead to good outcomes. For example, a carefully designed and
well-resourced home without a strong practice leader and staff skilled in Active Support will not
be a good quality home.
Size and location
There is strong evidence that group homes should be small in size with no more than six people,
be similar to other houses in the local area and dispersed throughout a community rather than
clustered together in one place.
Stafng levels
There is strong evidence that there must be sufcient staff. However, there is no formula for
working this out. The number of staff needed depends on the nature and severity of disability,
as well as the required needs of the people being supported. There is evidence that having more
staff does not lead to better outcomes.
Mix of people
There is strong evidence that when the people supported in a group home have a mix of abilities
and support needs, this leads to better outcomes. In particular, people with complex support
needs associated with challenging behaviour should not be grouped together in a house.
13
PROPOSITIONS ABOUT EXTERNAL FACTORS
Group homes are subject to state and federal laws that regulate service standards. There is
almost no evidence about the impact of the external environment or actions of inspectors,
standards or regulations on quality. There is emerging evidence from the UK that conclusions
reached through inspection processes do not match those found through research. Standards
are often judged by looking at paperwork and processes rather than observing the way
staff work, and the everyday life of people living in group homes. Evidence shows that staff
overestimate how good their practice is, and that paperwork is not a reliable indicator of what
staff have done or what has happened in a group home.
CLOSING STATEMENT
This review has summarised several decades of research that has tried to better understand
how to support people who live in group homes to have a better quality of life. A small sized
house in the community and sufcient staff resources are necessary but not sufcient for a
good quality group home. What staff do, how they support the people who live in the house, how
they work together in a team and whether there is a competent practice leader are what really
makes a difference.
Choosing a group home can be a difcult and challenging task that may have to be done in a
hurry. Not all group homes are the same quality and the best way to make a judgement is by
going to have a look, watching how staff interact with the people who live there and talking to
them about how they understand their role. This review and the accompanying guide should
prepare you for what to look for and what to ask staff and managers about.
14
SUMMARY
Table 2 outlines what makes the most difference to the quality of a group home
Practice of
frontline staff
and managers
Staff use Active Support - they do things with people rather than for them.
Staff adapt their communication and support to each individual.
Staff use positive behaviour support to promote quality of life for the
individual.
Frontline managers lead practice. They often observe the way staff work,
demonstrate good practice, coach staff, lead the team and supervise
individual staff.
Culture
Service culture is clear, enabling for the people supported, motivating for
staff, and respectful of the people supported by regarding them as equal
and recognising their need for support.
Policy and
procedures
Staff are trained in Active Support both in the classroom and in the home
while they work.
The organisation hires staff who put the quality of life of people rst.
There are strong HR policies around recruitment of staff and holding staff
responsible for the quality of their support.
The staff are skilled to support the needs of the people in the house.
Design
The group home is small with no more than six people, similar to houses
in the local area. There are enough staff for the needs of the people
who live there. There is a mix of people in terms of the severity of their
disability and they do not all have challenging behaviour (e.g. aggressive
or destructive type behaviours).
15
REFERENCES
1. Bigby, C., and J. Beadle-Brown, Improving quality of life outcomes in supported
accommodation for people with intellectual disability: What makes a difference? 2016,
Journal of Applied Research in Intellectual Disabilities; Available from:
http://onlinelibrary.wiley.com/doi/10.1111/jar.12291/full
2. Bigby, C., E. Bould, J. Beadle-Brown, Comparing costs and outcomes of supported living
with group homes in Australia, 2017. Journal of Intellectual and Developmental
Disabilities, p. 1-13; Available from:
http://www.tandfonline.com/doi/full/10.3109/13668250.2017.1299117
3. Schalock, R., Brown, I., Brown, R., Cummins, R. A., Felce, D., Matikka, L., Parmenter,
T.R. (2002). Conceptualization, measurement, and application of quality of life for
persons with intellectual disabilities: Report of an international panel of experts. Mental
Retardation, 40, 457–470.
4. Beadle-Brown J., Beecham, J., Mansell, J., Baumker, T, Leigh, J, Whelton, R., &
Richardson, L. (2012). Outcomes and costs of skilled support for people with severe or
profound intellectual disability and complex needs. London: National Institute of Health
Research
5. Bigby, C., Bould, E., & Beadle-Brown, J. (2017) Implementation of active support over
time in Australia. Journal of Intellectual and Developmental Disability
http://www.tandfonline.com/doi/full/10.3109/13668250.2017.1353681
6. Bigby, C., Knox, M., Beadle Brown, J., & Bould, E. (2014). Identifying good group
homes for people with severe intellectual disability: Qualitative indicators using a quality
of life framework. Intellectual and Developmental Disability, 52(5), 348-366.
doi: 10.1352/1934-9556-.5.348 http://hdl.handle.net/1959.9/553198
7. We use direct quotes from research interviews and eld notes to illustrate abstract
ideas. All of these quotes come from published or unpublished research data collected
as part of the Living with Disability Research Centre’s program of research about group
homes (see appendix for more details).
16
APPENDIX
METHODOLOGY
This Research to Action guide has been developed for the NDS Centre for Applied Disability
Research. It summarises an extensive review of the research literature published by the La
Trobe University in 2016.1 This examined propositions (suggestions) about what makes a
difference to the quality of group homes and thus the quality of life of the people with intellectual
disability who live there.
The strength of research evidence for these was reviewed and conclusions reached about the
factors that are most important to quality.
This guide uses practice examples from papers published as a part of the research program on
group homes led by Professor Christine Bigby since 2004.
More details about the method and links to the research papers are included at the end of this
appendix.
BACKGROUND
Most people who live in group homes have intellectual disability. They may also have health or
mental health problems, or physical or sensory difculties. Some group homes support people
with severe physical disabilities or traumatic brain injury but very little research has looked at
the quality of services for these specic groups.
Group homes have been the principle accommodation option for people with disability for many
years. This means people with very different severities of intellectual disability live in group
homes. Some people have severe or profound disabilities and very high support needs, others
have a mild intellectual disability and lower support needs. Some people just need support to
manage their money, make decisions or manage unexpected circumstances while others may
need support 24 hours a day to ensure their safety. They may also need help with self-care
tasks like showering or dressing themselves.
Research in Victoria shows that about a third of the people who live in group homes have similar
support needs to people who live more independently in supported living.2
The age of people who live in group homes is also very varied. Some people are aged in their 60s
or older. There is no reason that people cannot remain in a group home as they get older. There
are no rules about moving when a person reaches a particular age.
17
TERMS USED
Different words are used in Australia to describe the same things when people talk about group
homes. Here are some of the common words, who might use them and the terms we will use
throughout the associated Practice Guide.
TYPES OF SUPPORTED ACCOMMODATION
Group homes are one type of supported accommodation. In this guide ‘group homes’ means
• An average looking house in an ordinary street that does not look different from others
around it.
• A place close to transport and local amenities like shops, libraries and cultural venues.
• A house where between one to six people live together, with their own rooms and shared
living spaces.
• A place where housing and support usually go together. The house is usually owned by
government or a non-government organisation.
• A house where people pay rent and household costs are shared.
• A place that has 24-hour support from paid staff, shared between the people who live there.
Staff are responsible for supporting all aspects of people’s lives including facilitating access
to health services, enabling community participation and safeguarding rights
• In addition to group home staff, people living there may also get support for social inclusion
from other programs or other specialist support or health services.
Sometimes group homes are referred to as ‘residential support services’ or ‘community
residential units’. Similar terms are also used by different countries to refer to quite different
types of services. For example, in Sweden, a group home may be a group of self-contained
apartments each with their own front door but some shared living space as well.
There are other types of supported accommodation for people with intellectual disability who
choose to live away from their family home. They can be described in the following ways.
• Supported living normally means between one to three people sharing their own home or a
rented property with drop-in support. In this type of supported accommodation housing and
support are usually separated.
• Cluster accommodation normally means a cluster of individual units on one site, which may
resemble individual group homes or supported accommodation. The distinguishing feature is
the cluster is often distinctly separate from the surrounding houses. Increasingly however,
new developments ‘salt and peppering’ where for example, a ‘cluster’ of apartments
for supported living are scattered across one oor of an apartment block. While each is
separate, there may be some on call or shared support across apartments.
• An institution normally refers to a large service with more than 20 people under one roof on
the same site.
18
The NDIS is introducing new models of supported accommodation and new words to describe
disability support services and accommodation. Terms are evolving, for example, specialist
disability accommodation may refer to a service like a group home or supported living while
supported independent living may refer only to support for daily tasks, not the accommodation
itself.
More information about these types of services can be found on the NDIS website:
• SIL - Supported Independent Living – assistance with and/or supervising tasks of daily life to
develop the skills of individuals to live as autonomously as possible.
• SDA - Specialist Disability Accommodation – accommodation for people who require
specialist housing solutions, including to assist with the delivery of supports that cater for their
extreme functional impairment or very high support needs.
www.ndis.gov.au/specialist-disability-accommodation.html
PEOPLE WHO WORK IN OR VISIT GROUP HOMES
Organisations use different terms to refer to similar organisational roles, staff or people
supported by the service. Below are some of these which are used in this guide.
• Support Worker: Frontline staff, disability support workers, disability support professionals,
or direct support workers. Support workers are responsible for direct support of people
supported by the service.
• Practice Leader: Home manager, house supervisor, team leader or frontline manager. A
practice leader is a frontline manager of staff who has a key role in maintaining a high quality
of practice by support workers.
• Regional Manager: Operational manager, cluster manager, district manager or group
manager. A regional manager is the manager of the practice leader.
PEOPLE WHO LIVE IN GROUP HOMES
• The people we support: Client, resident, tenant or service user. In this guide the people who
live in group homes are referred to as either ‘people we support’ or ‘resident’.
19
REFERENCE MATERIAL
The key research papers that formed the basis for this review of the literature are listed
below. The review was primarily based on Improving quality of life outcomes in supported
accommodation for people with intellectual disability: What makes a difference?1; which was an
extensive review of the academic literature.
As such that paper refers to many other journal articles. Some of the key publications from
the group home research program at La Trobe University are listed along with those that have
informed work in this eld.
Many of these articles are available as open access via the link provided. Pre-publication
versions of non-open access papers are available in the La Trobe University research
repository (follow link and search for ‘Bigby’).
http://arrow.latrobe.edu.au:8080/vital/access/manager/Index
• Bigby, C., and J. Beadle-Brown, Improving quality of life outcomes in supported
accommodation for people with intellectual disability: What makes a difference? 2016,
Journal of Applied Research in Intellectual Disabilities; Available from:
http://onlinelibrary.wiley.com/doi/10.1111/jar.12291/full
• Bigby, C., M. Knox, J. Beadle-Brown and E. Bould. Identifying good group homes for people
with severe intellectual disability: Qualitative indicators using a quality of life framework,
2014. Intellectual and Developmental Disability. 52(5): p. 348-366; Available from:
http://hdl.handle.net/1959.9/553198
• Bigby, C., and J. Beadle-Brown, Culture in better group homes for people with severe and
profound intellectual disability, 2016, Intellectual and Developmental Disabilities. 54:
p. 316-331; Available from: http://hdl.handle.net/1959.9/560355
• Bigby, C., M. Knox, J. Beadle-Brown, and T. Clement, ‘We just call them people’: Positive
regard for people with severe intellectual disability who live in of group homes, 2015. Journal
of Applied Research in Intellectual Disability. 28: p. 283–295; Available from:
http://hdl.handle.net/1959.9/552586
• Bigby, C., M. Knox, J. Beadle-Brown, T. Clement, J. Mansell, Uncovering dimensions of
informal culture in underperforming group homes for people with severe intellectual
disabilities, 2012. Intellectual and Developmental Disabilities. 50(6): p. 452–467; Available
from: http://hdl.handle.net/1959.9/510535
• Bigby, C., E. Bould, J. Beadle-Brown, Comparing costs and outcomes of supported living with
group homes in Australia, 2017. Journal of Intellectual and Developmental Disabilities, p. 1-13;
Available from: http://www.tandfonline.com/doi/full/10.3109/13668250.2017.1299117
• Beadle Brown, J., Bigby, C., Bould, E. (2015). Observing practice leadership in intellectual and
developmental disability services.
• Journal of Intellectual Disability Research. 59(12): p. 1081–1093D; Available after January
2018 from: http://onlinelibrary.wiley.com/doi/10.1111/jir.12208/full
http://hdl.handle.net/1959.9/560922
20
• Quilliam, C., Bigby, C., & Douglas, J., (2017) Staff perspectives of paperwork in group homes
for people with intellectual disability. Journal of Intellectual and Developmental Disabilities
http://www.tandfonline.com/doi/full/10.3109/13668250.2017.1378315
BOOKS
• Mansell, J., and J. Beadle-Brown, 2012, Active Support, Jessica Kingsley: London; Available
from: http://www.jkp.com/aus/active-support.html
• Clement, T. and C. Bigby, 2010, Group homes for people with intellectual disabilities:
Encouraging inclusion and participation, Jessica Kingsley: London; Available from:
http://www.jkp.com/aus/group-homes-for-people-with-intellectual-disabilities.html
• Bigby, C. & Bould, E. (2014) Guide to Visiting and Good Group Homes, Ofce of the Public
Advocate, Victoria: Melbourne; Available from: http://bit.ly/LiDs-GHVisit
[http://hdl.handle.net/1959.9/522703]
NDS gratefully acknowledges the support of
the NSW Government in establishing the NDS
Centre for Applied Disability Research.
GOOD GROUP HOMES GUIDE This guide has been written for people with disability. It is for people
who live in group homes and people who are thinking about group homes. It contains information
about good group homes and can help you make choices about where you want to live.
THE HOUSE
The house should not look different
to other houses in the street.
There will be other people living there,
but no more than ve other people.
Inside, you should see the people
living there doing everyday things
– It’s not a hotel.
You should be able to go into
most places in the house.
You should have your own bedroom,
with your things in it.
3
THE STAFF
The staff should treat you well. You feel
that you can tell them if there is
anything you are not happy about.
The staff should help you to be involved
in cooking, cleaning, laundry and other
things that have to be done in a home.
They should help you do things for
yourself, help you do things you nd
difcult, and help you with new things
you want to try.
You should be able to say what you
want and what you want to do. Staff
should pay attention to what you want
and not ignore you.
You should know the staff and they
should know you. They should know
how you get your message across.
They should know what you like to do
and what you don’t like to do.
You should be able to try new
things and meet new people in the
neighbourhood.
The manager is good at providing
support and helps the other staff to
be as good as they can be.
The staff will have had training and
are always thinking about how to make
things as good as possible. They talk
to each other and their manager about
how to provide better support.
You should know what you are doing
every day and which staff are going to
be there.
You should be able to change your mind
about what you want to do at any time.
The staff should also know what they
are going to do while working in the
house.
Note: All images with the exception of image 2 are the copyright of La Trobe University,
Living with Disability Research Centre, unless otherwise stated, and can be reproduced with
appropriate acknowledgement. Image 2 is courtesy of The Tipping Foundation, copyright 2017:
All rights reserved.
THE STAFF
NDS gratefully acknowledges the support of the NSW Government in establishing the NDS Centre for Applied
Disability Research. This Guide has been developed via a National Disability Research and Development Grant
via the Research and Data Working Group (RDWG), representing all Australian Governments.
2
INTRODUCTION
People with disability have the right to live anywhere in the community. People can live on their
own, with family and friends, or share with others.
Many people with disability – especially people with intellectual disability – live with other people
with disability in group homes. The quality of group homes can be very different from home to
home.
Choosing where to live is an important decision. It can be fun but it can also be difcult. For
people with disability and families, choosing where to live can be a stressful time. It can mean
big changes.
This guide will help you think about what makes a good group home. It has some ideas of things
to look for when you visit a group home and questions to ask staff. It is useful for people with
disability, family, advocates and even disability staff.
SEE FOR YOURSELF
It is important to visit a group home to see what happens there. Websites, adverts and
brochures can help you think about different group homes, but it is best to look for yourself
before you make any decisions.
Everyone involved in the decision should try and visit, especially the person considering living in
the group home. Visit several times, on different days and at different times of the day. Ask the
permission of the people who live in the home if you can visit, and take care not to invade their
privacy.
Spend some time seeing what happens. Watch how staff interact with the people who live there.
Are they helping people make choices? Does it feel like a home where everyone is taking part?
Are staff are doing things with people, or is it like a hotel where people are sitting around and
staff do everything for them.
ASK QUESTIONS
Not all aspects of quality are easy to see. Asking staff and managers questions can help you nd
out what is important to them in the way they work with the people who live there.
It can be hard asking tricky questions. It might help to take someone else with you who knows
the person who is thinking about living there, or someone who has experience of group homes.
WHAT MAKES A DIFFERENCE?
This guide is based on research about what makes the most difference to the quality of group
homes2. You can read a summary of this research here www.cadr.org.au/about-cadr/research
-to-action-guides. The research tells us that the things that make the most difference are:
• Practice of frontline staff and managers (how they act)
• Culture (expectations about how things are done in the home)
• Policy and procedures (how the organisation organises itself)
• Design (physical aspects, how many people, and who lives there)
3
Table 1. What makes the most difference to quality?
Practice of frontline staff
and managers
• Staff do things with people rather than for them. (This is
called Active Support.)
• Staff adapt their communication and support for each
individual.
• Staff use positive behaviour support - to promote quality of
life for the individual.
• Frontline managers watch how staff work; demonstrate
good practice; coach staff; lead the team; and supervise
individual staff
Culture
• Service culture is enabling for the people supported;
motivating for staff; and respectful of the people supported
- regarding them as equal human beings and recognising
their need for support. All staff are on the same page about
how they support people and what is expected of them.
Policy and procedures
• The organisation hires staff who put the quality of life of
people who live there rst.
• There are strong policies around recruitment of staff and
holding staff responsible for the quality of their support.
• Staff are trained in Active Support. They have had
classroom as well as on-the-job training.
Design and resources
• The group home is small, housing no more than six people.
• The house looks similar to other houses in the local area.
• There are enough staff for the people who live there.
• People in the house have different support needs.
• Not everyone has challenging behaviour (e.g. aggressive or
destructive behaviours).
4
THINGS TO LOOK FOR – QUESTIONS TO ASK
PRACTICE OF FRONTLINE STAFF AND CULTURE
HOW DO THE STAFF INTERACT WITH YOU AND THE PEOPLE THEY SUPPORT?
All communication in the house by staff should be warm and respectful. Here are some
examples of respectful and not-so-respectful behaviour.
Respectful Not Respectful
Staff introduce you to the people who live
there.
Staff talk about people in front of them.
Staff talk about people as adults who can
make choices and decisions about their
own lives.
Staff use derogatory terms when talking
about the people who live in the house.
Staff see people as individuals and use
their names.
Staff regard people as part of a group –
they simply say ‘the guys’, ‘our guys’ or
‘the residents’.
Staff knock on bedroom doors before they
enter.
Staff talk about people as objects – for
example, ‘loading the bus’; ‘doing personal
care’; ‘feeding’; ‘showering’.
For people who use wheelchairs, staff check with
the person and let them know what is happening
before they start to wheel them somewhere.
Staff seem to be talking to each other more
than the people they are supporting.
COMMUNICATION STYLES
You should see staff using different ways of communicating with each person they support. This
should be right for each person’s level of understanding and ways of communicating.
If people do not use or understand words to communicate, staff should use communication aids
to talk with people. Examples include electronic devices, pictures, pointing, symbols and chat
books.
HOW DO STAFF ACT AND WHAT TYPE OF SUPPORT DO THEY PROVIDE – WHAT TO LOOK FOR
Do you see staff do things with people so they can be involved in meaningful activities around the
house - e.g. washing up or cooking? This is called Active Support.
Here are some examples that staff are using Active Support:
• Someone who lives in the house opens the front door to you.
• People are not sitting doing nothing for long periods of time.
• Staff talk with the people who live there – they do not only respond when people ask for
attention, perhaps through their behaviour.
5
• All people are getting similar attention from staff – staff are not spending more time with
people who are more able, have lower support needs and communicate using words.
• Staff are attentive – they notice when a person is trying to communicate with them and
respond to them.
• Staff are responsive – they take notice and act on the choices or preferences that people
express rather than ignore or override them.
• Staff offer choices to people they support. This means not everyone eats the same meal
or does the same thing at the same time. Everyone spends time doing the things that they
choose.
• People get the type and amount of support they need to successfully take part in activities
– this may be anything from hand over hand assistance from staff to a verbal prompt
depending on the person’s needs.
• When people are invited to participate in an activity, it is clear from visual or non-verbal
cues what they are being invited to do.
• Staff rarely do household tasks on their own. They are not likely to be in the kitchen or
laundry on their own.
QUESTIONS TO ASK STAFF ABOUT THEIR WORK
Asking questions can help you get to know staff and the way they work. Some questions may be
harder to answer because staff must respect the privacy of people who live there.
Some examples of questions you could ask are:
• Do you know what people like and do not like?
• Do people all go to bed at the same time, or do they have individual routines according to their
preferences?
• Do you know about the friends and relatives of people you support? How do you ensure they
stay in regular contact?
• Are families welcome to visit the group home?
• Do families play any other roles in relation to the group home?
• How often do you offer new choices so people can try out new things?
• Do the people who live in the home know people in their neighbourhood?
• Do you know about the needs of each person you support - for example, their health, age,
communication style or any challenging behaviours?
• Does each person have a support plan, including a behaviour support planwhere necessary?
• Is anyone ever locked in a room or prevented from accessing a part of the house?
• Is anyone ever restrained, and what guidance is there about if and when you restrain a
person?
• Are staff open to doing things differently and new ideas about support? For example, what do
they know about the changes happening in the disability sector?
• Did staff share condential information about the people in the house with you? Did they talk
about people in front of them without including them in the conversation?
6
PRACTICE OF FRONTLINE MANAGERS – WHAT TO LOOK FOR
Is there strong practice leadership in the house? Is there a motivating culture for staff? If so,
you should see evidence that there is a manager or senior staff member - who is the leader in
the house - who:
• Has condence and is respected by all staff;
• Often spends time in the house;
• Is skilled at Active Support and sets a good example to staff about what is expected of them;
• Leads team meetings that all staff attend and in which practice, rather than housekeeping, is
the main thing on the agenda;
• Often meets to provide supervision to each staff member; and
• Makes sure each staff member working in the house knows what they are going to be doing.
You should expect to see:
• Staff who are organised;
• A plan for what staff are going to do in the house each day;
• A plan for each person who lives in the house for what they are doing today;
• A plan that is accessible in pictures or easy words;
• The frontline manager supports people who live in the house or works alongside staff, rather
than sitting in the ofce for most of the time; and
• Flexible routines or plans for the day that allow people living in the house to change what they
want to do if they choose.
WHAT TO ASK STAFF ABOUT PRACTICE LEADERSHIP AND CULTURE:
• When was their last supervision session with their frontline manager? What did they talk
about?
• How do they know what they are expected to do in the house each day?
• When did they last attend a staff meeting? Did the staff share experiences with each other
about supporting the people who live in the house?
• How does the frontline manager know about what happens in the house and the quality of
staff practice?
• How often is the frontline manager at the house? When the manager is in the house, where
do they spend most of their time?
• Does the frontline manager regularly observe you working with people in the house, and do
they give you feedback?
• What have you learned about good practice from the frontline manager?
• How are decisions made about which staff work at which times? Decisions should reect the
preferences and needs of the people who live in the house rather than those of staff.
7
POLICIES AND PROCEDURES – WHAT TO EXPECT AND ASK ABOUT
Organisations will have policies and procedures about what should happen in the group home
and how staff are expected to behave.
Some policies make a difference to the quality of a group home, especially ones that help create
expectations about staff behaviour. These include:
• Recruiting staff with values that are respectful of people with intellectual disability and their
human rights.
• Staff skills - All staff have training in Active Support. That this training is both a workshop in a
classroom and on-the-job training by an experienced trainer.
• Staff accountability - Staff are clear about the quality of support they are expected to provide
and that they will be held responsible for it by their managers.
• Staff are known by the people they support. There are procedures to ensure new staff work
alongside more experienced staff and staff who know the people being supported well.
DESIGN AND RESOURCES – WHAT TO LOOK FOR
Good group homes should look and feel like any other home in the community as much as
possible. Things to look out for include:
• The house is like any other house in the neighbourhood.
• The house is close to transport and public amenities.
• The house is close to the family of the person who is thinking about living there.
• There are no signs at the gate or front door with the logo of the organisation or other things
that might suggest this home is different from any other in the street.
• There are no more than six people living in the house.
• The people living in the house have differing support needs.
• There is private space - at least one bedroom for every person who lives there. Everyone
can go into all other places in the house.
• The décor reects the people who live there, including people’s photos or personal
possessions in different parts of the house.
• You may see some specialist equipment to support people to engage in activities or be more
independent. For example, a large switch that can be pressed to turn on a blender, a device
that holds and tips water from a hot kettle, small jugs or containers for liquids so people can
pour their own drinks.
• There is no separate crockery or cutlery for staff.
• There is no separate staff toilet or bathroom.
NDS gratefully acknowledges the support of the NSW Government in establishing the NDS Centre for Applied
Disability Research. This Guide has been developed via a National Disability Research and Development Grant
via the Research and Data Working Group (RDWG), representing all Australian Governments.
