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Residential Care in Hospital and in the Community – Quality of Care and Quality of Life

Published online by Cambridge University Press:  02 January 2018

Geoff Shepherd ,
Matt Muijen ,
Rachel Dean  and
Margaret Cooney
Geoff Shepherd
Affiliation:
The Sainsbury Centre for Mental Health
Matt Muijen*
Affiliation:
The Sainsbury Centre for Mental Health
Rachel Dean
Affiliation:
Academic Department (4th Floor North Wing), St. Thomas' Hospital, London SE1 7EH
Margaret Cooney
Affiliation:
Research Centre, University of Greenwich, Bow Arrow Lane, Dartford DA2 6PJ
*
Dr Matt Muijen, The Sainsbury Centre for Mental Health, 134–138 Borough High Street, London SE1 1LB
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 4 , April 1996 , pp. 448 - 456
Copyright
Copyright © Royal College of Psychiatrists, 1996 

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References

Audit Commission (1986) Making a Reality of Community Care. London: HMSO.Google Scholar
Carson, J., Shaw, L. & Wills, W. (1989) Which patients first: a study from the closure of a large psychiatric hospital. Health Trends, 21, 117–120.Google Scholar
Davidge, M., Elias, S., Jayes, B., et al (1993) Survey of English Mental Illness Hospitals. University of Birmingham; Birmingham: Health Services Management Centre.Google Scholar
Dean, R., Proudfoot, R. & Lindesay, J. (1993) The Quality of Interactions Schedule (QUIS): Development, reliability and use in the evaluation of two domus units. International Journal of Geriatric Psychiatry, 10, 819–826.Google Scholar
Department of Health (1990) NHS and Community Care Act. London: HMSO.Google Scholar
Endicott, J., Spitzer, R. L., Feiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.Google Scholar
Faulkner, A., Field, V. & Lindesay, J. (1992) Who is Providing What? – Information about UK Residential Care Provision for People with Mental Health Problems. London: RDP Publications.Google Scholar
Folstein, M. F., Folstein, S. & McHugh, P. R. (1975) Minimental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Garety, P. A. & Morris, I. (1984) A new unit for long stay psychiatric patients: organisation, attitudes and quality of care. Psychological Medicine, 14, 183–192.Google Scholar
Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and other Inmates. New York: Anchor Books.Google Scholar
Goldberg, D. P. & Hillier, V. F. (1979) A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145.Google Scholar
Knapp, M., Beecham, J., Anderson, J., et al (1990) The TAPS Project. 3: predicting the community costs of closing psychiatric hospitals. British Journal of Psychiatry, 157, 661–670.CrossRefGoogle ScholarPubMed
Leff, J. (1993) The TAPS Project: evaluating community placement of long-stay psychiatric patients. British Journal of Psychiatry, 162 (Suppl. 19).Google Scholar
Moore, E., Ball, R. A. & Kuipers, L. (1992) Expressed emotion in staff working with the long term adult mentally ill. British Journal of Psychiatry, 161, 802–808.CrossRefGoogle Scholar
Oliver, J. P. J. (1991) The social care directive: development of a quality of life profile for use in community services for the mentally ill. Social work and Social Services Review, 3, 5–45.Google Scholar
Onyett, S., Pillinger, T. & Muijen, M. (1994) Making Community Mental Teams Work. London: Sainsbury Centre for Mental Health.Google Scholar
Ritchie, J. H., Dick, D. & Lingham, R. (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis. London: HMSO.Google Scholar
Shepherd, G. (1995) The ‘ward-in-a-house’ – residential care for the severely disabled. Community Mental Health Journal, 31, 53–69.Google Scholar
Shepherd, G. & Richardson, A. (1979) Organisation and interaction in psychiatric day centres. Psychological Medicine, 9, 573–579.Google Scholar
Shepherd, G., Muijen, M., Dean, R., et al (1995) Inside Residential Care – The Realities of Hospital versus Community Settings. London: Sainsbury Centre for Mental Health.Google Scholar
Simpson, C. J., Hyde, C. E. & Faragher, E. B. (1989) The chronically mentally ill in community facilities – a study of quality of life. British Journal of Psychiatry, 154, 77–82.Google Scholar
Weiss, D. J., Davies, R. V., England, G. W., et al (1967) Manual for the Minnesota Satisfaction Questionnaire. Minnesota Studies in Vocational Rehabilitation: Monograph 22. University of Minnesota.Google Scholar
Wykes, T. (1982) A hostel-ward for ‘new’ long-stay patients: An evaluation study of a ‘ward-in-a-house’. In Long Term Community Care: Experience in a London Borough. Psychological Medicine. Monograph Supplement 2. (ed. Wing, J. K.). Cambridge: Cambridge University Press.Google Scholar
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