Quality of life in a community-based service in rural Australia

Abstract

The goal of community-based care is rhetorically constructed as promoting independence, participation in community and the enjoyment of rights as citizens. Although this philosophy is now widely accepted, debate still continues about the outcomes of this model of care. Whereas studies to date have relied on a small, consensual, set of objective indices of “engagement”, ability levels, and community activity to make external judgments about the quality of service users' lives, the inclusion of users' subjective perceptions has recently come to be seen as an important component of evaluation methodology. The formalised assessment of “quality of life” has emerged as an organising construct in service evaluation practice, and has been proposed as a key criterion for assessing the success of community-based services. This study examines a community-based service, accommodating thirty-four people with intellectual disabilities in a regional Australian city and small rural towns, using both established measures of service quality and also novel measures of service users' quality of life (QOL) and sense of community. Results indicate significant variation in the quality of service provision in a context of restricted scope for domestic participation, little autonomy, and impoverished community membership. It appears that the reality of service outcomes for individuals with intellectual disabilities here is in some tension with the rhetorical commitments of community-based service providers.