Improvements in medical technology and social care have led to an increased life expectancy for people with Learning Disabilities. People with Down's syndrome have an increased risk of developing dementia. A significant number will develop the condition between the ages of 40 to 50.

In the UK historically people with Learning Disabilities were cared for in large institutions. The introduction of the Care in the Community Act in the 80's led to the closure of the large institutions and people with Learning disabilities were placed in a range of settings such as Adult Placements (shared lives), residential care homes and group homes. However, these service provisions have made little or no preparation for supporting people as they grow older and in the major cases develop dementia.

To complicate the situation further there is now a huge drive by Local Authorities in England to place the majority of people with Learning Disabilities in supported living accommodation which is unsuitable for most people who go on to develop dementia.

Small care homes for between 2-3 adults would be the better option for people with Learning disabilities who go on to develop dementia. There are numerous benefits associated with this model of care.

Regulation
In the UK a care home must be registered with the Commission for Social Care Inspection (CSCI) and annual inspections are carried out ensuring that the health and well being of this group of vulnerable adults is maintained at all times. No such level of monitoring and regulation exists within supported living arrangements.

24 hour support
In residential care settings, support is provided by a core team of staff who know the residents well. Staff always work on a shift system. The benefits of this is that staff have regular respite breaks and have another college to turn to for emotional support as caring for people with dementia can be emotionally stressful. In contrast if 24 hour support is provided in supported living arrangements, it is often delivered by one member of staff over very long periods of time. Clearly in these situations, the risk of abuse may be on the increase and would be difficult to monitor.

Safety
This is easier to maintain in residential care settings in comparison to supported living accommodation. Residential care settings have the capacity to offer person centred approaches to safety whereas supported living arrangements can depend heavily on assistive technology.

Choice and Flexibility
Residential Care offers more choice and flexibility. Residents can choose to spend time with fellow residents or can choose to be alone in their own rooms. Clearly supported living accommodation offers limited choices for those individuals who may wish to spend a lot of their time with their peers.