Disability Service Providers Supporting Adults with Intellectual Disabilities and Dementia Living in Group Homes: A Qualitative, Exploratory Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this qualitative research study on the experience of Australian service providers working with people with intellectual disability and dementia living in group homes. Ongoing scholarly work in this area is important, and overall, you present a logical study with clear methods and relevant results. In addition to the study itself, I also appreciated a clear description and integration of the Australian context in this work. My one major suggestion is to expand your strengths and limitations section. I would like to see a discussion of the strengths and limitations of having such a wide variety of job roles in your sample. The insights and perspectives from executive administration to direct support workers are potentially vast and should be accounted for, given the small sample size.  I would also want to see more insight from you, as the researchers, as to the impact of not including people living with intellectual disability as participants in this study. 

Author Response

We would like to thank the reviewer for the time and effort they have taken to review the manuscript and are appreciative of the feedback provided which has helped to improve our work. 

Comment 1: Thank you for the opportunity to review this qualitative research study on the experience of Australian service providers working with people with intellectual disability and dementia living in group homes. Ongoing scholarly work in this area is important, and overall, you present a logical study with clear methods and relevant results. In addition to the study itself, I also appreciated a clear description and integration of the Australian context in this work.

Thank you for this feedback.

Comment 2: My one major suggestion is to expand your strengths and limitations section. I would like to see a discussion of the strengths and limitations of having such a wide variety of job roles in your sample. The insights and perspectives from executive administration to direct support workers are potentially vast and should be accounted for, given the small sample size.  I would also want to see more insight from you, as the researchers, as to the impact of not including people living with intellectual disability as participants in this study. 

Thank you for this feedback. We agree with the reviewer and have now expanded the 'Strengths and limitations' section to include discussion regarding both the diversity of roles included in the study and the exclusion of people with intellectual disability and dementia as participants.

Reviewer 2 Report

Comments and Suggestions for Authors

This is an important paper, on a topic that has been largely ignored.  I have a few comments that I believe will strengthen the paper.

First, unless the authors and editor believe otherwise, I think  the links to aged care and disability policy would be greatly strengthened if that link was clarified.  For readers not familiar with how these systems operate, the links were not always clear. For example, it was not clear to me how an earlier diagnosis of dementia would be helpful to residents and staff until the link to increased funding was mentioned.  And readers' knowledge about the complexities of dealing with two systems is assumed.  For international readers, and those in Australia who might not be familiar with these complexities, some explanation, albeit brief, would be very helpful.

2. middle of the paragraph under the table... Do you mean role rather than roll?

3. I am wondering about the use of 'pathway' as an organizing concept.  I dont hear much from the participants in terms of going down a pathway.  This term implies moving forward, making progress, generally a straight line. But that is not the sense I get from the interviews which suggest inability to move forward in many instances: lack of knowledge, unresponsive system. delays.  This doesnt sound like a pathway to me

4. You mention, in the same paragraph, the significance diagnosis in the dementia care pathway.  Do you mean receiving a diagnosis of dementia?  I assume this does not refer to ID related diagnosis. Might want to clarify

5. can you provide an example of how levels of care are affected by having a diagnosis? Diagnosis and changes in care dont seem to trickle down to the care workers

6. The paragraph starting with "Diagnosis is the first step to accessing additional funding" could come earlier. That would provide some clarity for readers not familiar with the system

7. Section 3.3.  Can you link the sentence about following the care plan to having a diagnosis. 

8. can you provide an example about how funding influences quality of care at the group home level?

9. what sort of policy changes would you recommend?

Author Response

We would like to thank the reviewer for the time they have taken to review our manuscript. We appreciate their feedback and for assisting us to improve the manuscript.

Comment 1: First, unless the authors and editor believe otherwise, I think  the links to aged care and disability policy would be greatly strengthened if that link was clarified.  For readers not familiar with how these systems operate, the links were not always clear. For example, it was not clear to me how an earlier diagnosis of dementia would be helpful to residents and staff until the link to increased funding was mentioned.  And readers' knowledge about the complexities of dealing with two systems is assumed.  For international readers, and those in Australia who might not be familiar with these complexities, some explanation, albeit brief, would be very helpful.

We agree with the reviewer and have provided further clarification in the second paragraph of the introduction, lines 45-67.

Comment 2: 2. middle of the paragraph under the table... Do you mean role rather than roll?

Thank you - this has now been corrected.

Comment 3: I am wondering about the use of 'pathway' as an organizing concept.  I dont hear much from the participants in terms of going down a pathway.  This term implies moving forward, making progress, generally a straight line. But that is not the sense I get from the interviews which suggest inability to move forward in many instances: lack of knowledge, unresponsive system. delays.  This doesnt sound like a pathway to me

Thank you for this insight. We agree with the reviewer and have replaced the word 'pathway' throughout the manuscript or deleted it where appropriate.

Comment 4: You mention, in the same paragraph, the significance diagnosis in the dementia care pathway.  Do you mean receiving a diagnosis of dementia?  I assume this does not refer to ID related diagnosis. Might want to clarify.

Thank you - this has now been clarified.

Comment 5: Can you provide an example of how levels of care are affected by having a diagnosis? Diagnosis and changes in care dont seem to trickle down to the care workers

Thank you for this feedback. Additional information has been added at lines 292-294.

Comment 6: The paragraph starting with "Diagnosis is the first step to accessing additional funding" could come earlier. That would provide some clarity for readers not familiar with the system.

Thank you for this suggestion. This sentence has now been moved to lines 252-253.

Comment 7: Section 3.3.  Can you link the sentence about following the care plan to having a diagnosis. 

Thank you for the suggestion - this has now been done at lines 302-303.

Comment 8: Can you provide an example about how funding influences quality of care at the group home level?

Thank you for the suggestion - a clarifying statement has now been made and an additional example provided at lines 402-413.

Comment 9: What sort of policy changes would you recommend?

Thank you for this suggestion. We have included a consideration of policy implications in the final paragraph of the discussion.