It was reported by management and clinical staff that, initially, the
community residences were viewed as ‘homes for life’ by both staff and residents. However they felt that as the deinstitutionalisation
programme advanced and within the current climate of change in the mental health services, the aims and functions of the residences were changing to one of rehabilitation and recovery. There was concern voiced as to the situation of those who have lived in community residences for long periods of time. It was felt that moving them, possibly away from familiar friends and neighbourhoods, would cause unnecessary distress to this ageing population. The concept of a ‘home for life’ was also seen as an
the staff working in them. These findings reflected the dual role of the residences as one of long term care for some and as a rehabilitation and as a stepping stone to more independent living for others. This was evident also in the comments by residents, with some hoping to complete the remainder of their lives in the residences while others had hopes of moving to more
independent living and getting a place of their own. This begs the question – can these facilities perform this dual role effectively to meet the needs of those concerned? Does the prolonged care of some residents hinder the intensive rehabilitation required by others to move to lower levels of support? It is possible that having such a diverse group of people with different needs in the same residence does not help to tailor the treatment and care provided to individuals. In addition, the role of the nursing and care staff is divided between
providing continuing care to some and intensive rehabilitation to others. The lack of a co-ordinating rehabilitation team further increases the difficulty, a point made in the recent report of the Inspector of Mental Health Services (MHC, 2006c). There is a need to redefine the aims and functions of
community residential facilities. While there is a need for a national definition of the type of care
provided, within this definition, local need should determine the use of the current residential facilities. 10.4.2Internal environment
The current study assessed the internal environment of the residences in terms of the staffing levels, sleeping arrangements and number of bathrooms. On average, there were 15 residents in high support residences, six in medium support residences and four in low support residences. Within the high support residences there was on average a ratio of staff to residents
of one to seven for daytime and one to nine at nighttime. In line with previous research, this nursing level would seem particularly high, especially as residents psycho-social functioning and psychopathology was not problematic (Donnelly et al., 1997). The employment of highly skilled nursing staff for
administrative or basic tasks may not be the best way in which to deploy valuable resources. While it may be necessary to have two staff present in the residences at any time in case of emergency, one nursing staff member and one care staff member may be sufficient. In addition, with an average of 15 residents in high support residences, it is more likely to resemble a large institution as opposed to a small residence that creates a more home-like
environment (MHC, 2006c). A Vision for Change recommended that residences should cater for a maximum of 10 residents. Picardi et al., (2005) argued that the size and staffing pattern and skill mix can influence the residents’ quality of life. For example, similar to this Picardi et al., (2005) found that many of the residential facilities in Italy did not have access to those professionals that would be expected to have more skill in providing psychosocial
rehabilitation. Many of the nursing staff in the residences in this study were providing these rehabilitative interventions without the proper training. This can cause stress both for the nursing staff and residents, which can impact negatively on mental health.
The size of the residence appeared to be related to the possibility of having a single room. The smaller, medium and low support residences had a greater number of single rooms than the high support residences. In most cases, residents shared twin rooms. Whenever possible, residents were able to choose who they shared with, but this was often not possible. This
inability to provide residents with a single room impacted on their privacy and was reflected in comments by the residents. One resident made reference to the fact, that while the community residence was better than the streets, there was no privacy. However some residents also commented that they liked having a room-mate. This highlighted the different needs of residents and the importance of choice. The importance of choice in mental health services was also made in a recent report of service –users’ views (Schizophrenia Ireland, 2006). The lack of bathrooms and showers was also highlighted in the current study. The high ratio of residents to bathrooms is unacceptable and en-suite
bathrooms should be available, as is now the norm in many homes. The privacy of en-suite bathrooms is even more imperative for people who are unrelated and who share accommodation. The planning of smaller residences with single rooms and en-suites will improve the privacy and comfort of the residents. In this study 29% of the residences did not provide residents with access to public phones making
communication with family and friends difficult. It was reported that residents could use the office phone; however, this again was detrimental to the privacy of the resident and increased their dependency on staff. The ownership of mobile phones was not addressed in the study and a number of residents may have owned a mobile phone.
Service managers, clinical directors and directors of nursing pointed out that residential accommodation was mainly purchased on an ad-hoc basis during the
deinstitutionalisation programme and renovated as necessary. During site visits the researcher came across only one specially designed high support residence. This explained the less than ideal situation of many
of the residences. Many of the residences were not suitable for those with mobility problems. This was especially problematic for the ageing population, with nearly a third of all residents being over the age of 65 years. This was
highlighted on many of the site visits. Many of the bedrooms in the residences were upstairs and many of the residences, especially the older ones, could not be fitted with lifts. During site visits, the researcher was informed in one instance that the visiting room in one of the residences was currently being used as a bedroom for a resident who was quite ill.
Very few of the residences had evaluation and review plans that monitored the quality of services or the satisfaction of the service users or their families. A Vision for
Change highlights the importance of service evaluation, especially in terms of quality of life measures and the impact of services on service users and their families. One method for evaluating quality has been the FACE (Functional Assessment of Care Environments) tool which has been used in Northern Ireland as a formal quality evaluation procedure in mental health services (Mc Gilloway et al., 1999).
10.4.3External environment –