A key aim of public policy has been to move people with a learning disability from segregated settings into ordinary housing, with the expectation that they would become integrated in and accepted by the rest of society. Despite this policy, people with a learning disability have high rates of unemployment, social isolation, mental disorders and premature death.

Aims

This raises questions about the dominant capitalist mode of care and makes it essential to consider alternative types of residence.

Materials and Methods

This study reviews research into shared‐care communities in which people with a learning disability share their lives with families and volunteers (“co‐workers”), either in dispersed housing or in village settlements.

Results

Reviews of research into types of accommodation for people with a learning disability have compared dispersed housing with “congregate” housing, finding that the former provide a better quality of life. However, they also found wide variations in outcome, which can be attributed to the heterogeneous range of accommodation categorised as “congregate.” When shared‐care communities are analysed separately, they were found to offer accommodation as homely as dispersed housing, with a similar lack of institutional practices. Residents in shared‐care communities were also more likely than those in other types of accommodation to be involved in planning their own lives and in accessing professional health and social care. Research into shared‐care communities has attributed these outcomes to the availability of meaningful and diverse employment, opportunities for friendship and long‐term relationships with co‐workers.

Discussion

These conclusions are supported by the results of official inspections and by recent research, which has emphasised how the quality of life of residents with a learning disability is improved when there are long‐term emotional bonds between staff and clients. It is concluded, therefore, that shared‐care communities offer a viable alternative to traditional dispersed housing for people with a learning disability. Choice of accommodation has often been denied to people with a learning disability, even though the rest of the population now live in a wide variety of living circumstances. It is therefore recommended that public policy accepts the need for shared‐life communities as one of a range of living options for people with a learning disability, rather than enforcing one type of accommodation deemed “normal.

1 RESIDENTIAL ALTERNATIVES

Social policy in England incorporates the recognition that people of all physical and mental capacities have a right to experience and enjoy the ordinary things in life. This policy of “inclusion” has driven efforts to move people with a learning disability away from isolated and segregated settings and integrate them into the mainstream population. It is thereby hoped to provide them with the same possibilities to work, earn, socialise, travel, own things, and seek pleasure and fulfilment in all the manifold ways available to human beings (Department of Health, 2001 ; Lyons, 2015b ; Parkin, 2016 ). From the 1980s onwards, the practical implementation of this policy has involved resettling former hospital inpatients into a diverse range of accommodation, including residential care units, nursing care (particularly for those with additional disabilities), units managed by the NHS and the private sector for people with mental and behavioural disorders, small staffed homes (dispersed or clustered), and adult placements (Hatton, Glover, Emerson, & Brown, 2016 ; Hatton et al., 2014 ; Parkin, 2016 ). However, the most characteristic type of accommodation funded by public authorities for people with a learning disability has been the small staffed home. This usually comprises an ordinary urban or suburban dwelling adapted to accommodate a small group of residents supported in their day‐to‐day tasks by a rota of staff. Proponents of this model claimed that living in an ordinary house in a neighbourhood surrounded by ordinary people will provide a sense of place and purpose, and that, using the same shops and leisure facilities as the rest of the population, people with a learning disability would no longer be stigmatised and would instead become accepted as members of the “community” (King's Fund, 1980 ). In recent years, there has been a trend towards smaller staffed homes, with greater security of tenure for their residents (Emerson, 2005 ).

Yet in spite of these changes in accommodation, the life of many people with a learning disability remains far from ordinary. Although the great majority express a desire to work, less than one in five people with a learning disability are in employment, and this is mainly part‐time and low‐paid (Lyons, 2016 ; Papworth Trust, 2013 ). People with a learning disability continue to have limited opportunities to form and sustain personal relationships, whether intimate or friendly. They are far less likely than the rest of the population to marry or have a long‐term partner with whom to share their lives (Kersh, Corona, & Siperstein, 2013 ). For many, personal relationships are confined to their immediate family, and many continue to live with their ageing parents (Ryan, Taggart, Truesdale‐Kennedy, & Slevin, 2014 ). Loneliness, combined with the other disadvantages suffered by people with a learning disability, may account for the significantly higher rates of mental disorders among people with a learning disability than in the general population (Cooper, Smiley, Morrison, Williamson, & Allan, 2006 ; Verdonschot, de Witte, Reichrath, Buntinx, & Curfs, 2009 ). People with a learning disability are also at greater risk than the rest of the population of violent and sexual victimisation and offending, considerably increased when they also have a mental disorder (Fogden, Thomas, Daffern, & Ogloff, 2016 ; House of Lords House of Commons Joint Committee on Human Rights, 2008 ). Indeed, people with a learning disability express concern at their own vulnerability (Bond & Hurst, 2010 ; Gjermestad, Luteberget, Midjo, & Witsø, 2018 ). People with a learning disability have a significantly lower life‐expectancy (13 years for men and 20 years for women). The most common reasons for deaths being assessed as premature are “delays or problems with diagnosis or treatment; and problems with identifying needs and providing appropriate care in response to changing needs” (Heslop et al., 2013 , p. 3).

These problems indicate that although placing people with a learning disability in an ordinary house may provide a convincing pastiche of a normal life, it does not by itself result in either social acceptance or equal treatment by the rest of society. Clapton ( 2009 ) has proposed that to achieve these goals instead requires a broad commitment in society as a whole to the principle of “ethical inclusion.” This involves recognising that all people are interdependent with a need for mutuality and flexibility in their relationships with each other; and the positive valuation of diversity and complexity in themselves, even where individuals deviate from what is deemed “normal.” Parmenter ( 2014 ) has argued that ethical inclusion of this kind is impeded where societies are dominated by neoliberal economic policies in which people are valued primarily by their income and their consumption of goods and services. In such a value‐system, disabled people at best become redefined as active consumers of support services (Lyons, 2015a ). At worst, they may be perceived as “negative consumers” of public finances, and hence of diminished value (Cumella, 2008 ).

A further problem with achieving ethical inclusion is that the lives of people with a learning disability are increasingly organised according to what can be termed the “capitalist mode of care.” This replaces the historic concept of “care” as an act of practical altruism driven by compassion and a sense of communal obligation. The capitalist mode fragments the activities of care into various categories of “support,” each of which is priced and delivered as part of a financial transaction between the recipients (or more frequently a public authority acting on their behalf) and various agencies that are either private corporations or not‐for‐profit organisations. These agencies can be very large. As an example, one of the main providers of accommodation for people with a learning disability in England, Wales and Northern Ireland has 1679 tenants. These live in 737 properties, with the median being three‐bedrooms/residence (Golden Lane Housing, 2016 ). The capacity of these agencies to deliver a high quality of care is impeded by reductions in government support for local authorities, and hence the amount they spend on social care. From 2010/11 to 2016/17, expenditure in cash terms increased by 3.5% but real terms funding fell by 5.9% from £15.8 billion to £14.9 billion (Harker & Sandford, 2017 ). Reductions in public finance and the power of government agencies as monopoly purchasers have the effect of reducing expenditure/client (Commission for Social Care Inspection, 2008 ). Provider organisations respond by employing many of their staff (particularly those in day‐to‐day contact with their clients) on remuneration close to the minimum wage. This in turn makes it difficult to recruit or retain staff suitable for this type of work (Care Quality Commission, 2017 ), but may also generate among staff an alienation characteristic of industrial process work (Jackson, 2011 , 2015 ).

Change to dominant social values to promote greater ethical inclusion, however desirable, is difficult to achieve in the short run. This makes it essential to consider existing alternatives to the capitalist mode of care. In the case of people with a learning disability, these include the various shared‐life communities which were first established by parents of people with a learning disability in the middle of the 20th century. Shared‐life communities (also termed “intentional communities”) have developed as a response to two main factors. The first has been the concern among many parents and families of people with a learning disability that they are at risk of violence or exploitation in ordinary urban society and would at best lead lives that are isolated and unstimulating. Secondly, the creation of village communities and shared‐life networks was part of the wider international movement to create egalitarian communities as an alternative to the class divisions of society, seen elsewhere in the establishment of kibbutzim and communes. Indeed, the first Camphill Community was established by Jewish refugees from Austria, whose commitment to embracing all people irrespective of disability, religion or nationality was an explicit rejection of Nazi policies of enforced uniformity and the mass murder of disabled people in the name of eugenics (Brennan‐Krohn, 2011 ). This idealism can be seen in the two largest organisations of shared‐life communities in the UK (Camphill and L'Arche), which promote an egalitarian pattern of organisation in place of the usual hierarchical separation between staff and clients found in most services for people with a learning disability. In place of salaried support workers, “co‐workers” (Camphill) and “assistants” (L'Arche) are motivated by a personal calling to work alongside people with a learning disability, sharing their homes and family life (Randell & Cumella, 2009 ). The social life of shared‐care communities therefore differs from that of other types of residence in that people with a learning disability are not the recipients of care and support provided by paid employees, but are expected to be active and equal participants in the operation of a communal way of life.

Such communities are diverse in organisation and location, but most are in rural settings, with some organised as “villages” comprising a cluster of small homes, workplaces, and educational and recreational facilities. However, there are some shared‐life communities in urban locations and individual communities vary greatly in size. For instance, a recent CQC report on the L'Arche community in Ipswich found it comprised ten people with a learning disability in two separate houses, living with seven assistants (Care Quality Commission, 2016 ). An analysis of inspections of Camphill facilities carried out by the Scottish Care Inspectorate found that all eleven were rated as either “good,” “very good” or “excellent” in all four inspection criteria (Lyons, 2015b ). Official statistics are not collected on the total number of residents of shared‐life communities, but the white paper Valuing People(Department of Health, 2001 ) estimated at that time that there were 73 such communities in England, with a combined population of about 3000.

Shared‐life communities have received only limited attention from academic researchers, and there have been few studies published on the outcomes of living in such a community for people with a learning disability. This study looks at available research and discusses future lines of enquiry.

2 COMPARATIVE RESEARCH STUDIES

A search in Medline, the NIHR Centre for Reviews and Dissemination, Social Care Online and Google Scholar, shows that there have been two papers in the last 10 years which have reviewed research studies comparing alternative types of residence for people with a learning disability: by Kozma, Mansell, and Beadle‐Brown ( 2009 ) and by Mansell and Beadle‐Brown ( 2009 ). Both papers are concerned with comparing residences according to number of residents in each site, with samples dichotomised between “dispersed” and “clustered” (Mansell & Beadle‐Brown) or “dispersed” and “congregate” (Kozma et al., 2009 ). These have both been influential papers. The paper by Kozma et al. ( 2009 ) is the only paper comparing “dispersed” and “clustered” accommodation on the database of the University of York NIHR Centre for Reviews and Dissemination ( 2018 ). The paper by Mansell and Beadle‐Brown formed the basis for a policy statement by the Comparative Policy and Practice Special Interest Research Group of the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD; Mansell & Beadle‐Brown, 2010 ). This text remains IASSIDD policy and appears on the organisation's website (International Association for the Scientific Study of Intellectual and Developmental Disabilities, 2018 ).

The paper by Kozma et al. is the most comprehensive and systematic of the pair, and its conclusions will be considered first. Kozma et al. ( 2009 ) used systematic search techniques and identified 68 studies from ten different countries which were published in English from 1997 and which had compared different types of residence for people with a learning disability. All but two had used quantitative methods, and the majority (49) were longitudinal studies assessing the impact of resettlement for former hospital inpatients. Nineteen of the studies were termed “post‐deinstitutionalisation” and compared outcomes in different forms of community‐based residential circumstances. Only one study reported any participation by people with a learning disability in the research.

The conclusions of the study are that “People in small‐scale community‐based residences or in semi‐independent or supported living arrangements have a better objective quality of life than do people in large, congregate settings. Particularly, they have more choice‐making opportunities; larger social networks and more friends; access more mainstream facilities, and participate more in community life; have more chances to acquire new skills and develop or maintain existing skills; and are more satisfied with their living arrangements” (Kozma et al., 2009 , p. 210). However, few differences were found with respect to the extent of contacts with members of residents’ families, adaptive behaviour and challenging behaviour. Several of the studies included in the review reported that mortality rates were higher among residents in smaller nonhospital settings. Only three of the studies measured exposure to violence and abuse, finding that people with a learning disability in smaller nonhospital settings were at greater risk than those in intentional communities or campus settings.

The authors of the review noted that their conclusions are qualified by the finding that there are wide variations in outcome within each type of “living arrangement.” They express concern that this result “might threaten the consensus supporting deinstitutionalisation and community living policies by removing the evidence that community services are better for everyone” (Kozma et al., 2009 , p. 213). They attempt to explain this problematic variability on an ad hoc basis for each type of outcome variable. For instance, variations in the degree of participation in the “community” and the extent of friendship networks are attributed to differences in the degree of disability among residents, while variations in opportunities for “choice‐making” are attributed to “structural and procedural aspects of the service.” The authors recommend that future research considers the extent to which “organisational determinants” contribute to variations in outcome.

One explanation for the variations in outcome within different categories of “living arrangements” not considered by the authors of this review is that their categories are not homogeneous. Thus, they group the types of places in which people with a learning disability reside into either “small‐scale community‐based residences or in semi‐independent or supported living arrangements”; on one hand and “large congregate settings” on the other. Thus, the first category includes people living in a group with staff on site as well as people living alone in their own accommodation but with support staff visiting with varying degrees of frequency. The second category conflates such diverse entities as hospitals, nursing homes, clusters of small residences and the larger shared‐care communities.

A similar problem occurs with the review by Mansell and Beadle‐Brown ( 2009 ). This was confined to research papers which have compared “dispersed housing” with “clustered housing.” The first of these categories is similar to that used by Kozma et al., while the second includes village communities (such as those using shared‐life principles), clusters of accommodation managed by hospitals (some on the sites of the former hospitals) and clusters of a small number of houses in a single street. The review included papers published in English after 1990 which compared these two categories of accommodation. Nineteen papers were identified. The authors conclude that “dispersed housing is superior to cluster housing on the majority of quality indicators studied. The only exception to this is that village communities for people with less severe disability have some benefits. However, these only serve a population with lower support needs and they depend on a supply of people willing to live communally with residents with disability” (p. 321).

However, nine of the 19 reports reviewed by Mansell & Beadle‐Brown are from the same research survey, carried out by the Hester Adrian Research Centre (HARC) under the leadership of Professor Eric Emerson. This is the only study of those reviewed by Mansell and Beadle‐Brown which includes a sample of residents in village communities. It also has a sample size almost as large as the remaining ten papers in the review combined. It is therefore necessary to review this study in detail to assess the validity of the conclusions reached by Mansell and Beadle‐Brown.

The HARC study (Emerson et al., 1999a , 1999b ; Emerson, Robertson, Gregory, Hatton et al., 1999 ; Emerson, Robertson, Gregory, Kessissoglou et al., 1999 ) compared outcomes for residents in three categories of accommodation in which the individual residents were selected as examples of best practice:

· “Village communities,” with a sample of 86 long‐term residents in three shared‐life communities in the UK. These involved clusters of homes managed by charitable organisations. The villages in the sample had between 18 and 179 residents on each site and seven or eight residents in each home.

· “NHS residential campuses,” with a sample of 133 long‐term residents living in five sites, with between 14 and 20 residents/site, and 7–10 residents/home. These were redeveloped NHS hospital sites in which the main buildings had been replaced by smaller housing units, managed by the NHS and usually staffed by employees transferred from the hospital they replaced.

· “Dispersed housing schemes,” with a sample of 281 long‐term residents in ten schemes managed either by independent agencies or the NHS. There was a maximum of eight residents/home.

The residents in the three samples had similar characteristics, although the residents in the NHS residential campuses were the most disabled, while that in village communities were the least disabled. For instance, 10% of residents in the latter were frequently incontinent, compared with 20% in dispersed housing, and 29% in residential campuses. Challenging behaviour was most common among the sample living in NHS residential campuses, but there was little variation between the three samples in the prevalence of mental illness or autism. Almost none (2%) of the residents in village communities had been resettled from hospital, compared with three‐quarters (75%) of those in NHS residential campuses and half (50%) of those in dispersed housing.

The main results of the study in terms of quality of life showed important variations between the three categories of residence. The most homely accommodation was found in the village communities and in dispersed housing. Village communities had lower staffing levels than the other samples, and only 49% of their staff had qualifications (mainly NVQ or City and Guilds). In NHS residential campuses, 95% of the staff had nursing qualifications, while in dispersed housing, 80% were qualified (mainly nursing and NVQ/City and Guilds). Village communities were the most likely of the three categories of accommodation to involve residents in case planning and to have defined procedures for planning and implementing support for residents. Their plans placed particular emphasis on acquiring educational and vocational skills. NHS residential campuses were least likely to involve residents in case planning or have effective procedures for planning care. Results from interviews using the Group Home Management Interview (designed to measure the extent to which units approximated the characteristics of a total institution) found that NHS residential campuses were the most institutional, with village communities and dispersed housing the least. Residents in village communities were those most likely to have regular health checks and sight and hearing checks, although residents in NHS residential campuses were more likely than others to be on regular anti‐psychotic medication (even after controlling for varying levels of challenging behaviour between the different categories of unit). Residents in village communities were more likely to see a social worker and therapy services, while those in NHS residential campuses were more likely to see a psychiatrist and psychologist.

The authors of the HARC study found that dispersed housing and village communities offered a better quality of care and quality of life than NHS residential campuses. Dispersed housing and village communities, however, offered distinctive patterns of benefits, with dispersed housing providing more leisure activities and contacts with nondisabled people, while village communities provided more contact with families, more hours of activities and greater personal safety. Professor Emerson and his colleagues concluded that “… given that dispersed housing schemes and village communities appear to be associated with different patterns of benefit, people with intellectual disabilities should be free to choose between these two options.” (Emerson et al., 2005 , p. 169).

The marked differences in outcome between NHS campuses and village communities indicate that there is no scientific justification for coupling them together in a single group as “clustered housing” or “congregate housing.” As noted above, Mansell & Beadle‐Brown justify this in their review by discounting the positive outcomes for village communities because they “only serve a population with lower support needs” (p. 321). Yet the HARC study found that 10% of their sample of residents in village communities were frequently incontinent, while levels of mental illness and autism were similar to the other two samples in their study. The association between support needs and outcome is not explored in the review, and Mansell and Beadle‐Brown do not consider the implications of any such association for NHS campuses. These had a higher proportion of residents with severe incontinence and challenging behaviour than in dispersed housing, which could, by a similar argument, account for their poorer outcome.

The association between the severity of disability and quality of life for people with a learning disability is explored in a later study. Fahey, Walsh, Emerson, and Guerin ( 2010 ) compared 29 residents in two Camphill communities with data from an earlier study by the same authors of 65 residents in community‐based group homes and 60 in campus‐type accommodation (all in the Republic of Ireland). The two Camphill communities included one of four houses located at a single site in a rural setting, and one comprising three adjacent houses in a small town with a fourth house on a farm two miles away. The research used similar methods to the HARC research and found that residents in the Camphill communities had higher mean scores than residents in the other types of accommodation on the questionnaires measuring adaptive behaviour, but had higher rates of challenging behaviour and mental health problems than residents in group homes. Camphill residents lived in smaller, more homely settings than the other residents and were less likely than residents in campus settings to experience the rigid routines and block treatment characteristic of institutional life. Camphill residents were also less likely than residents in the other two categories of accommodation to experience “social distance”: a term designating the extent to which they live separate lives from the nondisabled people they live with (co‐workers in Camphill and support staff in group homes and campuses). The research team also measured the extent of “reciprocity” in relationships between residents and co‐workers in the Camphill communities and found that 71% of interactions involved exchanges of help and information, rather than the simple transmission of information from staff to residents.

For all three samples as a whole, the authors found a significant association between adaptive behaviour and activity levels, personal health and the exercise of choice. They then used an analysis of covariance to assess the extent to which mean differences in these outcomes between the different types of accommodation can be attributed to variation in adaptive behaviour among their residents. They found that, controlling for differences in adaptive behaviour, activity levels did not differ between the three types of accommodation, while the Camphill homes had higher levels of personal health and residents in group homes had greater opportunity to exercise choice. This result is confirmed by a recent study by Beadle‐Brown et al. ( 2015 ). They measured the quality of life of people with severe learning disability living in a sample of small units and in supported housing selected from units judged “good” by their managing agency. The authors found that activity levels in these units were in some cases similar to those in larger units and even in the old mental handicap hospitals and that activity levels were unrelated to numbers of staff in each unit.

3 ETHOS AND DAY‐TO‐DAY ORGANISATION

This analysis of comparative research studies indicates that the size of a residence and its location does not, by itself, determine the quality of life of people with a learning disability. Research by Bigby, Knox, Beadle‐Brown, and Clement ( 2015 ) suggests that a more important factor in maintaining quality of life is the ethos and day‐to‐day organisation of a residence. They found that a high quality of care occurs where staff regard residents positively, as members of a common but diverse humanity. Their relationships with their clientele were “characterized by warm feelings, which for many extended to a deep emotional bond” (Bigby et al., 2015 , p. 291). Such relationships can of course occur in different types of facility, but may be more common in shared‐life communities, many of which have strong religious and ethical foundations, attracting volunteers with a personal commitment to sharing their lives with disabled people. This probably results in a greater sense of community and more egalitarian social relationships than are typically found in residential care which conform to the capitalist mode of care, and in which residents are subordinated to care staff who are employed and remunerated to carry out officially specified duties during designated hours of work (Randell & Cumella, 2009 ).

A study of social relationships in a shared‐life community was completed by Randell and Cumella ( 2009 ). They studied Botton Village, which is part of the Camphill Movement. At the time of the research, the Village had 300 community members (members with learning disabilities and co‐workers) in over 30 households. Each household comprised an extended family of co‐workers (often a family with children) and members with disabilities. Household tasks and meals were shared, and co‐workers provided support as required. The researchers used a combination of participant observation and qualitative interviews with a sample of 15 residents. The interviewees had lived a median of 25 years in the Village, and all but one had lived in more than one household.

With the exception of one elderly resident who had retired, interviewees were all engaged in work (usually in three or four different workplaces each week). They appreciated the diverse range of employment and leisure opportunities and regarded their work as a means of sustaining the daily life and economy of the village. Interviewees reported widespread participation in leisure activities, which included a range of activities which they were able to plan and organise themselves. They particularly valued their wide network of friendships with other residents, which in many cases were intense and mutually supportive. Interviewees also expressed a strong sense of inclusion within a community, determined mainly by taking part in shared activities in a variety of roles, their involvement in the management of the Village, and the events organised around the nondenominational church.

This study suggests the ways in which shared‐life communities can facilitate a high quality of life for their residents with a learning disability:

· High levels of meaningful employment. The lack of formal employment contracts in shared‐life communities obviates the barriers to formal employment encountered by many people with a learning disability (Beyer, 2001; Wistow & Schneider, 2003). As a result, residents are able to work full time in a range of unskilled and skilled work essential to the daily life and economy of the community, while also exercising choice over where they are able to work. The personal benefits of employment for people with a learning disability compared with traditional day services have been identified in research by Beyer, Brown, Akandi, and Rapley (2010). “Employment” in shared‐life communities (whether for people with a learning disability or nondisabled people) does not involve work for an employer in exchange for wages, but is rather a shared enterprise vital to the economic success of the community (Lyons, 2016).

· Opportunities for friendship. People with a learning disability typically make friends with other people with a learning disability (Emerson & McVilly, 2004), although they often encounter obstacles in sustaining friendships when living in dispersed housing schemes because of the cost of transport and problems with communication. By contrast, a shared‐life communities provide a larger clustering of potential friends with the opportunity to meet in workplace and informal settings, while ease of communication enables friendships to be sustained.

· Long‐term relationships. Living in extended families in a long‐term social relationship with co‐workers/assistants enables both groups to become familiar with each others’ pattern of communication: an essential step if a person with a learning disability is to learn of the world and express choices about what they want to do in it. It also helps generate a sense of community in which they feel part of a readily available, supportive and dependable social structure.

Since this study was completed, Camphill Village Trust has proposed to introduce significant changes in the organisation of Botton Village, following a critical report by the Care Quality Commission (Fearn, 2014 ). This involves replacing unpaid co‐workers by paid employees, and hence moving closer to the capitalist mode of care. The GP for residents at Botton Village found that the changes had resulted in a major increase in levels of obesity and psychiatric disorders which had previously been at levels well below those in the general population (Van Dam, 2015 ).

4 CHOICE AND COMPULSION

This review of research on shared‐care communities indicates that they offer a viable alternative to the capitalist mode of care for people with a learning disability and that public policy should accept that they are one of a range of appropriate living options for people with a learning disability. As noted by Professor Emerson and his colleagues, shared‐life communities and dispersed housing schemes each have a distinctive profile of benefits, and thereby provide an element of choice for people with a learning disability and their families.

There has been very little research on the housing preferences of people with a learning disability, but one study of older people with a learning disability found they preferred models of housing that provide an opportunity for people with a learning disability “to live in close proximity to their peers and in large groups in the community rather than in small, dispersed community housing” (Shaw, Cartwright, & Craig, 2011 , p. 895). It is probable, however, that people with a learning disability, just like the general population, do not all wish to live in the same way. An increasing number of unattached adults now choose to share houses, particularly in areas of high property values. Elsewhere, groups of (mainly elderly) people prefer to live in gated “retirement communities.” In other words, there are many different ways in which people lead an “ordinary life.” The right of disabled people to choose their place of residence is specified by Article 19 of the United Nations Convention on the Rights of Disabled People (United Nations, 2006 ). This requires public agencies to ensure that a diverse range of residential provision is available for people with a learning disability and give priority to their preferences when they assess, commission, fund and regulate residential support.

Nevertheless, this choice has usually been denied. Public policy has instead specified what pattern of life people with a learning disability ought to lead (Stancliffe et al., 2011 ), while research has often discounted their expressed preferences (Jackson & Irvine, 2013 ). The commitment by some public authorities and academics to promote only one type of residence for people with a learning disability can be compared with the evangelical aims of reformers in the early 20th century who believed that mental handicap hospitals were the only appropriate accommodation for this group of people. In both cases, the wishes of people with a learning disability and their families were discounted (Walmsley, 2008 ). This form of authoritarian social engineering was common in the 19th and much of the 20th centuries for populations that were objects of social concern, from slum dwellers (Hall, 2014 ) to people with mental disorders. Research in learning disability has often mirrored this ethos, with a commitment to one type of “dispersed” accommodation, usually contrasted with the now mainly defunct large public institutions. Much less attention has been paid to the rise of the new privately managed hospitals which have often replaced them, usually specialising in the residential care of people with a learning disability who have behavioural and/or mental health problems (Brown, James, & Hatton, 2017 ).

There has also been an assumption in much research that geographical dispersal is equivalent to local autonomy, even though many such small staffed homes are managed by large organisations which apply a standard set of policies for the residences they control. There is therefore an urgent need for social research which explores the day‐to‐day lives of people with a learning disability, how they interact with support workers, and how this interaction shapes the quality of life of both groups. This interaction is in turn shaped by the political economy of residential care, using this term to include the funding streams, corporate organisation, and financial transactions that determine the working practices of individual residential units and the quality of life of those who depend on them.