Hostname: page-component-77c89778f8-gq7q9 Total loading time: 0 Render date: 2024-07-19T08:58:02.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Community and hospital residential care: a comparative evaluation

Published online by Cambridge University Press:  13 June 2014

Jerome Carson ,
Deborah Cullen ,
Frank Holloway ,
Aisling Towey ,
Angela Jumbo ,
Norma Smellie  and
Tony Glynn
Jerome Carson
Affiliation:
Institute of Psychiatry, De Crespigny Park, London SE5 8A, England.
Deborah Cullen
Affiliation:
University of East London, England
Frank Holloway
Affiliation:
The Maudsley hospital London, England
Aisling Towey
Affiliation:
Navan, Co. Meath, Ireland
Angela Jumbo
Affiliation:
Hexagon Housing, London, England
Norma Smellie
Affiliation:
Townley Road, London, England
Tony Glynn
Affiliation:
London, England
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.

Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.

Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.

Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.

Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 14 , Issue 3 , September 1997 , pp. 92 - 98
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Sharkey, S, Barna, S eds. Community care: people leaving longstay hospitals. London: Routledge, 1991.Google Scholar
2.Shepherd, G. Psychiatric rehabilitation for the 1990s. In: Watts, F, Bennett, D. Theory and practice of psychiatric rehabilitation. Chichester: Wiley, 1991.Google Scholar
3.Doyle, H, Craig, T. Setting up a community support team for the severely mentally ill. Psychiatric Bulletin 1995; 19: 223–5.CrossRefGoogle Scholar
4.Simpson, S, Middleton, N. Fast stream psychiatric rehabilitation after recent hospital closure. Psychiatric Bulletin 1994; 18: 613–4.CrossRefGoogle Scholar
5.Dayson, D, Gooch, C, Thornicroft, G. The TAPS Project 16: Difficult to place long term psychiatric patients: Risk factors for failure to place longstay patients in community facilities. BMJ 1992; 305: 993–5.CrossRefGoogle Scholar
6.National Health Service Executive. 24 hour nursed care for people with severe and enduring mental illness. London: NHSE, 1996.Google Scholar
7.Carson, J, Shaw, E, Wills, W. Which patients first? A study from the closure of a large psychiatric hospital. Health Trends 1989; 21: 117–20.Google Scholar
8.Garelick, A. The decision to close an area mental hospital: An inside view. Bull RCP 1988; 12: 52–4.Google Scholar
9.Knapp, M, Beecham, J, Anderson, Jet al.The Taps Project 3: Predicting the community costs of closing psychiatric hospitals. Br J Psychiatry 1990; 157: 661–70.CrossRefGoogle ScholarPubMed
10.Shepherd, G. The ‘ward-in-a-house’ - residential care for the severely disabled. Community Ment Health J 1995; 31: 53–69.CrossRefGoogle ScholarPubMed
11.Shepherd, G, King, C, Fowler, D. Outcomes in hospital hostels. Psychiatric Bulletin, 1994;18:609–12.CrossRefGoogle Scholar
12.Wylces, TA hostel ward for ‘new’ longstay patients: an evaluative study of a ‘ward in a house’. In: Wing, J ed. Long term community care: Experience in a London Borough. Psychological Medicine Monograph Supplement 2. Cambridge: Cambridge University Press, 1982.Google Scholar
13.Garety, P, Morris, I. A new unit for longstay psychiatric patients: organisation, attitudes and quality of care. Psychol Med 1984; 14: 183–92.CrossRefGoogle ScholarPubMed
14.Reid, Y, Garety, P. A hostel ward for new longstay patients: 16 years progress. J Mental Health 1996; 5(1): 77–89.CrossRefGoogle Scholar
15.Gibbons, J. Care of new longstay patients in a district general hospital psychiatric unit: the first two years of a hospital hostel. Acta Psychiatr Scand 1986; 73: 582–8.CrossRefGoogle Scholar
16.Bridges, K, Staufenberg, E, Moss, G. High, Elms (1985–1989). The first hostel ward in Central Manchester. In: Young, R ed. Residential needs of severely disabled psychiatric patients. The case for hospital hostels. London: HMSO, 1991.Google Scholar
17.Creighton, F, Hyde, C, Faragher, B. Douglas House: Seven years experience of a community hostel ward. Br J Psychiatry 1991; 159: 500–4.CrossRefGoogle ScholarPubMed
18.Hyde, C, Bridges, K, Goldberg, Det al.The evaluation of a hostel ward: A controlled trial using modified cost benefit analyses. Br J Psychiatry 1987; 151: 805–12.CrossRefGoogle Scholar
19.Allen, H, Baigent, B, Kent, Aet al.Rehabilitation and staffing levels in a new look hospital hostel. Psychol Med 1993; 23: 203–11.CrossRefGoogle Scholar
20.Gibbons, J, Butler, H. Quality of life for new longstay psychiatric inpatients: the effects of moving to a hostel. Br J Psychiatry 1987; 151: 347–54.CrossRefGoogle ScholarPubMed
21.Mc Connell, P. Hospital to hostel: what benefit? Psychiatric Bulletin 1995; 19: 148–50.CrossRefGoogle Scholar
22.Simpson, C, Hyde, C, Faragher, B. The chronically mentally ill in community facilities: a study of quality of life. Br J Psychiatry 1989; 154: 77–82.CrossRefGoogle ScholarPubMed
23.Kaye, N, Khoosal, D. A ward in a street. Psychiatric Bulletin 1994; 18: 271–3.CrossRefGoogle Scholar
24.Donabedian, A. Evaluating the quality of medical care. Millbank Q 1966; 44: 166–206.CrossRefGoogle ScholarPubMed
25.Brugha, T, Lindsay, F. Quality of mental health service care: the forgotten pathway from process to outcome. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 89–98.CrossRefGoogle ScholarPubMed
26.Ranes, N, Pratt, M, Roses, S. Organisational structure and the care of the mentally retarded. London: Croom Helm, 1979.Google Scholar
27.Shepherd, G, Richardson, A. Organisation and interaction in psychiatric day centres. Psychol Med 1979; 9: 573–9.CrossRefGoogle ScholarPubMed
28.Braisby, D, Echlin, R, Hill, S, Smith, H. Changing futures: housing and support services for people discharged from psychiatric hospitals. London: King Edward's Hospital Fund, 1989.Google Scholar
29.Brown, H, Smith, H. Normalisation: a reader for the nineties. London: Routledge, 1992.CrossRefGoogle Scholar
30.Carson, J, Dowling, F, Luyombya, Get al.Normalisation and now for something completely different. Clinical Psychology Forum 1992; 49: 27–30.Google Scholar
31.Carson, J, Dowling, F, Glynn, T, Oliver, N. The role of normalisation in psychiatric rehabilitation: an empirical investigation. Care in Place 1994; 13: 231–43.Google Scholar
32.Shepherd, G, Muijen, M, Dean, Ret al.Inside residential care – the realities of hospital versus community settings. London: Sainsbury Centre for Mental Health, 1995.Google Scholar
33.Wolfensberger, W, Glenn, L. Program Analysis of Service Systems-PASS. Toronto: National Institute on Mental Retardation.Google Scholar
34.Clifford, P, Wolfson, P. Assessment of Care Environments (ACE). Brighton: Pavilion Publishing, 1992.Google Scholar
35.Lavender, A. Improving the quality of care on psychiatric rehabilitation wards: a controlled evaluation. Br J Psychiatry 1987; 150: 476–81.CrossRefGoogle ScholarPubMed
36.Caine, T, Smail, D, Wijesinghe, O, Winter, D. The Calybury Selection Battery Manual. Windsor: NFER-Nelson, 1982.Google Scholar
37.Baker, R, Hall, J. Users manual for rehabilitation evaluation Hall and Baker. Aberdeen: Vine Publishing.Google Scholar
38.Ager, A. The Life Experience Checklist manual. Windsor: NFER-Nelson, 1990.Google Scholar
39.Holloway, F. The RDP Cane Hill closure research project: An Overview. J Mental Health 1994; 3: 241–8.CrossRefGoogle Scholar
40.Holloway, F, Faulkner, A. Psychiatric hospital reprovision and the long stay patient: clinical outcome and the user perspective. Journal of Mental Health, 1994, 3, 241–248.CrossRefGoogle Scholar
41.Perkins, R, Repper, J. Working alongside people with long term mental health problems. London: Chapman and Hall, 1996.Google Scholar
42.Shepherd, G. Research in service planning and evaluation. In: Parry G, Watts, F. Behavioural and mental health research: a handbook of skills and methods. Brighton: Lawrence Erlbaum, 1989.Google Scholar
43.Thomas, B. Principles of evaluation. In: Watkins, M. Hervey, N. Carson, J, Ritter, S. Collaborative Community Mental Health Care. London: Edward Arnold, 1996.Google Scholar
44.Shepherd, G, Muijen, M, Dean, R, Cooney, M. Residential care in hospital and the community — quality of care and quality of life. Br J Psychiatry 1996; 168; 448–56.CrossRefGoogle ScholarPubMed