Does living with people who have challenging behaviour result in poorer quality of care and outcomes?

Following earlier findings that people with intellectual disability and challenging behaviour received poorer care when they lived in a grouped setting (75% or more residents also having challenging behaviour), this study aimed to investigate whether people without challenging behaviour also experienced different care or lower engagement in meaningful activity when living with people with severe or potentially severe challenging behaviour. Kruskal-Wallis analysis revealed no effect of living in homes where residents had challenging behaviour, either on care practices or on engagement in meaningful activity. This was also true for sub-groups selected because they might be more vulnerable. Further Mann-Whitney analyses revealed no differences between those living in homes where no-one had severe or potentially severe challenging behaviour compared to those living in homes where anyone had challenging behaviour, and no differences between those people living in homes where less than 75% of the residents had challenging behaviour compared to those where 75% or more had challenging behaviour. Using a narrower definition of challenging behaviour, as severe and frequent aggression, also produced no significant effects. Possible explanations for these somewhat surprising results are discussed and suggestions for future research are presented.