Quality of life in boarding houses and hostels: a residents' perspective

In the last forty years deinstitutionalization has transferred the care of people with a serious mental illness from the psychiatric hospitals to community based facilities. More recently it has been questioned whether these new facilities offer the anticipated benefits of quality of life. This study examines the Quality of Life (QOL) of people diagnosed with schizophrenia living in two different accommodation facilities, hostels and boarding houses. QOL is examined from the resident's perspective. Lehman's (1988b) QOL Interview was used to measure objective, subjective, and global QOL of 60 participants in three hostels and two boarding house clusters. Hostel and boarding house data were compared and results showed that residents preferred boarding house accommodation. Overall, residents of both accommodation facilities reported satisfaction with QOL, and indicated that they regard them as asylum or sanctuary from the outside world.

Trauma-informed approaches to housing

Supportive housing providers can play a vital role in the recovery of persons exposed to abuse and violence. Specific modifications for delivering housing support services are recommended based on an emerging trauma-informed perspective.

An audit of drug incidents in learning disability group homes

The implementation of clinical governance (Department of Health, 1997) requires the review of practice by consideration of complaints and clinical incidents. A systematic review of the clinical incident forms in group homes for those with learning disabilities, within an NHS community trust, highlighted issues for concern. This led to an audit being conducted of drug administration procedures involving examination of records and observation of practice. It demonstrated that there was general adherence to the trust's policies. The audit stimulated debate, and a number of potential areas for action were identified. The review of drug administration with clients who have learning difficulties raised wider questions about the scarcity of evidence in this area to support practice, the culture of client-centred homes and whether monitoring systems are sufficiently robust.

Fair play on the housing front

People with disabilities are treated unfairly in many community-based housing programs. Forcing a person to participate in a program simply because he or she is a tenant is discriminatory and many advocacy groups are questioning the legality of the practice. People with disabilities must be able to choose where they wish to live and the services they need.

Housing placement and subsequent days homeless among formerly homeless adults with mental illness

OBJECTIVE

The study examined the influence of group or individual housing placement and consumer characteristics on the number of days subsequently homeless among formerly homeless mentally ill persons.

METHODS

A total of 303 homeless shelter residents with severe mental illness were screened for dangerousness, 118 were randomly assigned to either independent apartment or staffed group living sites, and 110 were followed for 18 months. Study participants' sociodemographic characteristics, diagnosis, and residential preferences and the residential recommendations made by clinicians were measured at baseline.

RESULTS

Overall, 76 percent of the study participants were housed at the end of the 18-month follow-up period, although 27 percent had experienced at least one episode of homelessness during the period. The number of days homeless was greater for individuals assigned to independent apartments than for those placed in staffed group homes, but only for members of minority groups. Substance abuse was the strongest individual-level predictor of days homeless. Individuals whom clinicians identified as needing group living experienced more days homeless, irrespective of the type of housing they received. Consumers who stated a strong preference for independent living had more days homeless than those who were amenable to staffed group homes.

CONCLUSIONS

Although consumers more frequently prefer independent living, placement in staffed group housing resulted in somewhat fewer days homeless for some groups of consumers. Further experience of homelessness by formerly homeless mentally ill individuals may be reduced by providing effective substance abuse treatment and by paying special attention to consumers identified by clinicians to be at particular risk for housing loss.

Serving the dually diagnosed homeless: program development and interventions

In this paper the authors present the specific characteristics of the dually diagnosed (severely mentally ill and substance abusers) population and describe a hybridized program and interventions which have been empirically shown to be effective in working with these multiply impaired individuals. The article is based upon a three-year federally funded demonstration project. The following interventions were found to be effective: engagement, care and nurturing, structure, limit setting and the development of responsibility, positive reinforcement, and self esteem. The authors describe these interventions and highlight their impact in both staff management and working with funding sources.

Comparison of two community alternatives to incarceration for chronic juvenile offenders

The relative effectiveness of group care (GC) and multidimensional treatment foster care (MTFC) was compared in terms of their impact on criminal offending, incarceration rates, and program completion outcomes for 79 male adolescents who had histories of chronic and serious juvenile delinquency. Results show that boys who participated in MTFC had significantly fewer criminal referrals and returned to live with relatives more often. Multiple regression analyses showed that assignment to a treatment condition (i.e., GC or MTFC) predicted official and self-reported criminality in follow-up beyond other well-known predictors of chronic juvenile offending (i.e., age at 1st offense, number of previous offenses, age at referral).

Comparative outcomes and costs of inpatient care and supportive housing for substance-dependent veterans

OBJECTIVE

This study examined the differential effectiveness and costs of three weeks of treatment for patients with moderately severe substance dependence assigned to inpatient treatment or to a supportive housing setting. Supportive housing is temporary housing that allows a patient to participate in an intensive hospital-based treatment program. Type and intensity of treatment were generally equivalent for the two groups.

METHODS

Patients were consecutive voluntary admissions to the substance abuse treatment program of a large metropolitan Veterans Affairs medical center. Patients with serious medical conditions or highly unstable psychiatric disorders were excluded. Patients in supportive housing attended the inpatient program on weekdays from 7:30 a.m. to 5 p.m. They were assessed at baseline and at two-month follow-up.

RESULTS

Baseline analyses of clinical, personality, and demographic characteristics revealed no substantive differences between the 62 patients assigned to inpatient treatment and the 36 assigned to supportive housing. The degree of treatment involvement and dropout rates did not differ between groups. Of the 55 inpatients completing treatment, 29 were known to be abstinent at follow-up, and of the 35 supportive housing patients completing treatment, 22 were abstinent. The proportion was similar for both groups, about 70 percent. The cost of a successful treatment for the inpatient group was $9,524. For the supportive housing group, it was $4,291.

CONCLUSIONS

Given the absence of differential treatment effects between inpatient and supportive housing settings, the use of supportive housing alternatives appears to provide an opportunity for substantial cost savings for VA patients with substance dependence disorders.

A matter of distinction

Two years after moving into a specialist unit, clients with autism displayed a significant reduction in antisocial behaviours. Services for people with autism should be distinct from those for people with learning disabilities. The accreditation process of the National Autistic Society proved a vital element in developing the new service.

The TAPS project 38: level of training and its availability to carers within group homes in a London district. Team for the Assessment of Psychiatric Services

This study investigates the professional characteristics of care staff working in group homes for the mentally ill in a north London region. Opportunities for training and staff attitudes with respect to training and career prospects are examined. The majority of care staff are unqualified and in many cases the training needs of staff are not being met. Staff viewed their career prospects as limited. Training that is on offer to staff in principle is often not accessed, possibly owing to budget restrictions. The need for more stringent guidelines on staff training to maintain standards across agencies is highlighted.

Impact of regulation and financing on small board-and-care homes in Maryland

States use forms of regulation in small board-and-care homes to control quality; however, quality varies in spite of these efforts. This study of 94 small facilities compared quality of care measures in homes regulated by a state-administered program with those in nonregulated homes. It also compared homes on those variables using average payment for services as the independent variable. Results indicate that higher payments for services had a greater impact on quality than did participation in a regulatory program. Adequate funding may be key to maintaining reasonable quality in these homes.

Team for the Assessment of Psychiatric Services (TAPS) Project 33: prospective follow-up study of long-stay patients discharged from two psychiatric hospitals

OBJECTIVE

The purpose of this study was to evaluate the policy of closing psychiatric hospitals and replacing their functions with community-based services.

METHOD

All long-stay nondemented patients in two U.K. hospitals scheduled for closure were assessed with a series of schedules. All patients in one hospital and a proportion of those in the other hospital were reassessed 1 year after discharge to community facilities.

RESULTS

Of the 737 patients discharged from the two hospitals, 24 died before follow-up, two by suicide. Follow-up was successful for 94.6% of the survivors. Only seven patients were lost to follow-up and are presumed to have become homeless. Only two patients went to prison, one briefly. There was very little change in patients' psychiatric symptoms or social behavior problems. The community homes provided a much less restrictive environment than the hospital wards. Discharged patients were very appreciative of their increased freedom, and over 80% wished to stay in their community homes. There was an increase in the proportion of patients with incontinence and immobility. The patients' social lives were enriched by an increase in friends, and some made contact with neighbors and others in the community. However, there was a decrease in contact with relatives following discharge.

CONCLUSIONS

When the capital and revenue resources of a psychiatric hospital are reinvested in community services, based on staffed houses, there are few problems with crime or homelessness. With such well-resourced services, the benefits greatly outweigh the disadvantages for both old and new long-stay patients.

Nutritional quality of foods served in contracted second level lodging homes

The food served in contracted Second Level Lodging Homes (SLLH) in Hamilton-Wentworth was studied to assess compliance with current by-law standards, make recommendations about nutrition standards and identify educational needs. Dietitians collected food frequency data in 62 SLLH and recorded food served during one day. Only 44% of homes provided the minimum servings recommended by 1982 Canada's Food Guide. Recommended nutrient intakes for ten nutrients were met by 20% of homes. Provision of therapeutic diets was inconsistent. The study indicates the need for better nutritional standards and strategies to ensure SLLH residents access to sufficient, nutritious and personally acceptable food.

Effectiveness of two training methods to improve the quality of foodservice in small facilities for adult care

OBJECTIVE

Community-based adult-care facilities (ACFs) with fewer than 25 beds provide homes for persons with disabilities who cannot live independently. The staff in these facilities are not required to have any formal foodservice training, yet they provide meals for the residents. The objective of this study was to evaluate the quality of foodservices before and after a foodservice training program.

DESIGN

Forty-six ACFs from six health-unit areas throughout the province of British Columbia were enrolled in the study, which involved a pretest-posttest design over a 5-month period. The health units were randomly assigned to one of three programs.

INTERVENTION

The ACFs received either a training workshop plus foodservice manual developed specifically for ACFs, the manual only, or no intervention.

MAIN OUTCOME MEASURES

Facilities were audited on performance in food purchasing, menu planning, food safety, and food storage. These areas were rated according to established minimum government regulations and other foodservice standards. Differences between the two audit scores (postintervention score minus preintervention score) were analyzed for each program section. Group comparisons were done using analysis of covariance procedures, with the initial score being the covariable.

RESULTS

No treatment effect was found on performance for food purchasing and food storage. Training via workshop plus manual resulted in a significant improvement in audit scores for menu planning and food safety compared with training via the manual alone.

APPLICATION

Dietitians should consider providing foodservice training workshops for similar types of facilities. The benefits of providing a manual alone are negligible.

Determinants of direct-care staff turnover in group homes for individuals with mental retardation

A model of direct-care human service staff turnover was proposed and tested with 236 direct-care staff members in nine private, nonprofit New Jersey agencies. A path analysis of the data was conducted. Four variables were found to contribute to current job satisfaction: agreement of the job with personal goals and values, burnout, satisfaction with supervision, and employment history. In turn, current job satisfaction led to intention to quit, which led to actual turnover. Implications for the human service field and future research were explored.

Personal characteristics and competence of people with mental retardation living in foster homes and small group homes

In this 1986-1987 study, the demographic and diagnostic characteristics, problem behaviors, self-care skills, community living skills, domestic expectations, and program goals for personal competence of 336 persons with mental retardation living in a national sample of 181 foster care and small group care settings with 6 or fewer residents was assessed. The findings indicated relatively more severe cognitive impairment among persons in small ICFs-MR, less severe cognitive impairment and fewer functional limitations among non-ICF-MR group home residents, and more functional limitations among residents in foster homes. Neighborhood integration was relatively high for foster home residents, but there were fewer expectations for their development of home and community living skills. Implications for future research and program development in small, community-based residential settings were discussed.

Patients' perceptions of their quality of life 11 years after discharge from a state hospital

OBJECTIVE

Fifty-three state hospital patients discharged to group homes in the community in 1978-79 were followed up at three and 11 years to assess their quality of life and several other dimensions of their community experience.

METHODS

A structured interview was used to obtain data on patients' perceptions of and degree of satisfaction with aspects of their lives one month before hospital discharge and at three and 11 years after. Group home staff rated patients' functioning at follow-up. Data on rehospitalizations over the 11-year period were collected.

RESULTS

At 11-year follow-up, 30 of the surviving 40 patients were living in noninstitutional settings: nine in independent or semi-independent settings and 21 in group homes. The 30 patients perceived that their quality of life outside the hospital had improved in several ways, including the extent of their social networks, the quality of their living environment, and their capacity to meet basic needs. When data were averaged over the 11 years and corrected for the shorter time in the study of subjects who died, patients spent only 2.6 percent of the follow-up period in the hospital. Only one patient at 11 years wanted to return to the hospital.

CONCLUSIONS

The finding that even the small minority of patients who required multiple rehospitalizations preferred community life may have important clinical and policy implications for setting the threshold of hospital discharge.