Health and Social Care in the Community 8(6), 406 – 416 406 © 2000 Blackwell Science Ltd Abstract This paper reports on variation in the cost and social outcomes of provision for clients with learning disabilities, resettled across different models of community accommodation; identifying personal and service-related characteristics influential on such variation. The study was conducted to inform the community reprovisioning strategy associated with the phased closure of the Gogarburn and Tornaveen learning disability hospitals in the Lothian region, Scotland. Total mean service costs, quality of life and community integration outcome data were collected and compared. Total mean service costs ranged between £16 438 and £74 097 per year (mean £42 023; SD = £16 712). Cost estimates varied by age and dependency group, with costs for elderly clients comparatively low. Overall, there was an inverse relationship between total mean costs and size of accommodation. There was no evidence of a direct relationship between costs and changes in social outcomes. Services with the lowest mean costs were, however, associated with the smallest increases in social outcomes. The most expensive services did not realise proportionally greater gains in social outcomes. The paper concludes that clients generally benefited from the transition from hospital to community accommodation. However, some experienced better outcomes than others. In the absence of a clear link between levels and type of resource use and social outcomes, it is difficult to identify which service features are more or less efficacious in achieving positive outcomes. Broader evaluation perspectives, embracing a fuller range of costs and benefits, will be required to unpack exactly what it is about different models of community care provision that leads to positive outcomes, or otherwise, for learning disability clients. A more sound evidence base is required before effective strategies can be designed to ensure that key policy outcomes are realised and social integration truly achieved. Keywords: community care, community integration, economic analyses, learning disability, quality of life Accepted for publication 12 April 2000 Blackwell Science, Ltd Moving home: costs associated with different models of accommodation for adults with learning disabilities Susan Myles 1 BA PgDip MSc, A. Ager 2 BA MSc PhD, P. Kerr 2 BSc PhD, F. Myers BSc MSc 3 and J. Walker 1 MA MSc 1 Department of Community Health Sciences, University of Edinburgh, UK, 2 Queen Margaret University College, Edinburgh, UK and 3 Unit for the Study of Government in Scotland, University of Edinburgh, UK Correspondence Susan Myles John Hopkins University School of Hygiene and Public Health 624 North Broadway Third Floor, Room 312 Baltimore MD 21205 USA E-mail: susanmyles@hotmail.com Introduction In 1994, Edinburgh Healthcare Trust, alongside partner health and social care agencies, embarked upon the phased closure of the Gogarburn and Tornaveen learning disability hospitals, and began reprovisioning services for clients within the community (KPMG 1993, Lothian Health 1994, PACT 1995, Lothian Learning Disabilities Strategy Team 1996). Their resettlement strategy rep- resented the concrete expression of long-standing policy objective, aimed at changing the balance of care for people with learning disabilities (Royal Commission 1957, Department of Health for Scotland 1958, 1961, SHHD/ SED 1972, 1979, Jay 1979, Scottish Health Service