Article

Residential care in hospital and in the community - Quality of care and quality of life

University of Greenwich, Londinium, England, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.34). 05/1996; 168(4):448-56. DOI: 10.1192/bjp.168.4.448
Source: PubMed

ABSTRACT The reduction of beds in long-stay hospitals has led to concerns over the quality of care offered to the remaining residents as well as that provided in the community. This study seeks to compare the quality of care and quality of life (reported satisfaction) from residents in both types of setting.
A cross-sectional comparison was made of community residential homes and hospital wards drawn randomly from lists provided by local authorities in the outer London area. Samples were drawn from all the main provider types (local authority, housing association, private and joint NHS/voluntary sector). Measures were taken of the quality of the physical environment, staff and resident characteristics, external management arrangements and internal management regimes, resident satisfaction and staff stress. Direct observations were also made of the amount and quality of staff-resident interactions.
In general, the most disabled residents were found to be still living in hospital in the Worst conditions and receiving the poorest quality of care. Although there were some problems with missing data, hospital residents also seemed most dissatisfied with their living situation. There were few differences between community providers regarding either the quality of care provided or the levels of reported satisfaction. Quality of care in the community homes seemed to be much more determined by the personality and orientation of project leaders.
Purchasers and providers still need to give attention to the problems of selectively discharging the most able residents to the community, leaving the most disabled being looked after in progressively deteriorating conditions. All residential providers need to review their internal management practices and try to ensure that residents are offered, as far as possible, the opportunity to make basic choices about where and how they will live. Staff training and quality assurance practices need to be reviewed in order to improve the direct quality of care offered to the most disabled individuals.

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    • "Some authors have argued that residential care has merely replaced large institutions with small asylums. However, several studies have shown that patients in RFs report a higher quality of life than those in traditional hospital settings (Warner & Huxley, 1993; Shepherd et al. 1996 ; Chan et al. 2003). In the 5-year TAPS (Team for the Assessment of Psychiatric Services) study, the most dramatic changes reported by patients discharged to a variety of community residences were their greatly increased freedom and their satisfaction with the community homes. "
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    ABSTRACT: In Italy, Residential Facilities (RFs) have completely replaced Mental Hospitals (MHs) for the residential care of mentally ill patients. We studied all patients resident in 265 randomly sampled Italian RFs (20% of the total). Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the GAF, and comprehensive information about their sociodemographic and clinical status and care history were gathered. Of the 2962 patients living in the sampled facilities, most were males (63.2%) who had never married, more than 70% were over 40 years; 85% on a pension, most commonly because of psychiatric disability. A substantial proportion (39.8%) had never worked and very few were currently employed (2.5%); 45% of the sample was totally inactive, not even assisting with domestic activities in the facility. Two-thirds had a diagnosis of schizophrenia; co-morbid or primary substance abuse were uncommon. Twenty-one per cent had a history of severe interpersonal violence, but violent episodes in the RFs were infrequent. The managers judged almost three-quarters appropriately placed in their facilities and considered that very few had short-term prospects of discharge. Italian RFs cater for a large patient population of severely mentally ill requiring residential care. Discharge to independent accommodation is uncommon. Future studies should attempt to clarify how to match residential programmes with patients' disabilities.
    Psychological Medicine 04/2005; 35(3):421-31. DOI:10.1017/S0033291704003502 · 5.43 Impact Factor
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    • "Some authors have argued that residential care has merely replaced large institutions with small asylums. However, several studies have shown that patients in RFs report a higher quality of life than those in traditional hospital settings (Warner & Huxley, 1993; Shepherd et al. 1996 ; Chan et al. 2003). In the 5-year TAPS (Team for the Assessment of Psychiatric Services) study, the most dramatic changes reported by patients discharged to a variety of community residences were their greatly increased freedom and their satisfaction with the community homes. "
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    ABSTRACT: An open access copy of this article is available and complies with the copyright holder/publisher conditions. Background. In Italy, Residential Facilities (RFs) have completely replaced Mental Hospitals (MHs) for the residential care of mentally ill patients. We studied all patients resident in 265 randomly sampled Italian RFs (20 % of the total). Method. Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the GAF, and comprehensive information about their sociodemographic and clinical status and care history were gathered. Results. Of the 2962 patients living in the sampled facilities, most were males (63.2%) who had never married, more than 70 % were over 40 years; 85 % on a pension, most commonly because of psychiatric disability. A substantial proportion (39.8%) had never worked and very few were currently employed (2.5 %); 45 % of the sample was totally inactive, not even assisting with domestic activities in the facility. Two-thirds had a diagnosis of schizophrenia; co-morbid or primary substance abuse were uncommon. Twenty-one per cent had a history of severe interpersonal violence, but violent episodes in the RFs were infrequent. The managers judged almost three-quarters appropriately placed in their facilities and considered that very few had short-term prospects of discharge. Conclusions. Italian RFs cater for a large patient population of severely mentally ill requiring residential care. Discharge to independent accommodation is uncommon. Future studies should attempt to clarify how to match residential programmes with patients' disabilities.
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    • "Psychotropic medications have the greatest effects on symptoms such as hallucinations and delusions, but have less impact on social and instrumental deficits. As a result, even individuals who respond well to pharmacotherapy are at risk for interpersonal distress, chronic unemployment, and a diminished quality of life (Anthony and Blanch 1987; Cresswell et al. 1992; Browne et al. 1996; Shepherd et al. 1996). Psychosocial skills training , which targets problems of social adaptation and role functioning in schizophrenia, represents an essential ingredient in a coordinated, comprehensive, biobehavioral approach to treatment (Liberman et al. 1994a). "
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