The costs and quality of four different service models for 40 adults with multiple disabilities were compared. The four service models were: specialised institution-based units; a specialised, campus-style, further education service; specialised community-based group homes; and “ordinary” community-based group homes. Some information was also available from five adults with multiple disabilities living in traditional institutions for people with mental retardation. On almost all measures of service outcome the specialised group-home model was the “preferred” service model, although this model was not associated with particularly high service costs. There was, however, considerable variation in quality within, as well as between, service models, with some residents in all service models experiencing levels of support and engagement similar to those found in traditional institutions. The results of the study are discussed in relation to notions of typical practice and normative standards. The implications of the findings are discussed.