There are quality of life scales that we've used in the past. There are strengths and weaknesses to each of them. But certainly if we look at the outcomes in studies, some of the things one typically looks at are the satisfaction people have with services—both the clients and the caregivers—and the quality of life of the individual.
What one typically finds is that both satisfaction and qualify of life are comparable, and sometimes better, for people living in the community. It varies a bit from study to study and whether you're looking at one or the other of those factors, but generally that seems to be the pattern of findings.
The other part of your question really relates to something that would be done more in a longitudinal study, where you would look at people over time and perhaps look at time to institutionalization and so on when you do comparisons. There has been limited research in that area, as far as I'm aware, at this point in time. But it's certainly an important area.
Longitudinal studies are a bit more difficult, particularly if you're using the outcome measures that we're talking about, because you want to do that over time. Their levels of satisfaction may change over time, and so on.
These are not studies that are easy to do, but certainly it's an important point that you make, and certainly one would want to see satisfaction and outcome included as outcomes. If you're doing cost-effectiveness, you need to look at both the outcomes and the cost.