Variables, Operacionalización

residential facilities

There were a number of constraints that limited the efficient running of the community residential facilities and that inhibited the rehabilitation of the residents. These constraints were not common to all areas, although some issues were relevant on a national basis.

The issue of long-term stay charges has been an active topic of debate over the last two years. The Health Amendment Act 2005 and the Health (Charges for Inpatient Services) Regulations 2005

addressed the issue of charges for long-term institutional care. Prior to 2005, residents of community residential care were charged a weekly rent by the health services. This amount varied within and between catchment areas. However, in 2005 the Supreme Court found that there was no legal basis for the charges and consequently all HSE areas had to abolish the weekly rent contributions paid by residents. Later in the year, a repayment scheme for the refund of payments made to the health service was announced. Most of the service

managers and providers reported that this caused a certain amount of upset in the residential facilities. Firstly, residents and their families were confused about the legislation. Secondly, service providers argued that the process of moving people to independent living was further impeded by the suppression of low cost accommodation previously offered in mental health residences, which limited the ability of staff to teach residents budgeting skills. In addition, one area reported that encouraging the residents to do the shopping was extremely problematic as they now had to have receipts for everything. It was felt that this further impacted on the

rehabilitation process. The situation was further exacerbated when, in July 2005, new regulations which provided for different charging arrangements depending on the level of nursing care were introduced. This caused the residents and staff more distress as the maximum charge for 24-hour nursing facilities was €120 per week, or the amount of an individual’s income that remained after €35 had been allowed for personal use. This left residents with little money to survive on and made it even more difficult to gather finances to secure deposits for independent accommodation. At the time of this study, the new regulations on long-stay charges had not been implemented, although residents in one area had received letters regarding charges and back payments.

Common to all 24-hour nursing facilities was the Hazard Analysis and Critical Control Points (HACCP) Health and Safety legislation. This legislation requires an analysis of risks associated with catering establishments, including commercial services and health services, and is carried out by environmental health officers. The analysis looks at operational hygiene

and the implementation of these controls, identifies hazards and critical controls necessary. The situation in the majority of high support residences was that

residents did not have access to the kitchen because of HACCP

legislation.

Another common problem identified was the advanced age of residents who now made up a large

proportion of the population in residential facilities; most of these residents had been relocated from large institutions. It was reported that the physical problems of this population outweighed the mental health problems and that these residents were much more in need of physical care rather than psychiatric intervention. A number of the residential facilities were unsuitable for those with physical disabilities. Community hospitals and homes for the elderly were not always willing to accept residents from mental health residential services, preferring instead to take those who were living alone. It was acknowledged that there was an ethical issue in moving residents to nursing homes away from their friends. In one catchment area, residential facilities for persons with learning disabilities were provided by the mental health services, yet the service did not have access to a consultant psychiatrist with a special interest in the psychiatry of learning disabilities. There was no funding for this post and services felt that this was a neglected area.

In all background interviews carried out, the issue of housing was raised. It was felt that provision of housing was not the responsibility of the mental health services and that housing should be provided by the local authority. It was highlighted that there was a possibility that the medium and low support facilities were becoming ‘homes for life’ as there was no alternative

independent housing available for

residents. As one service manager reported ‘group homes were homes for the homeless until they got a house of their own’. It was reported that few residents were registered on their local housing list, although in one HSE area all residents in community accommodation were registered on the housing waiting list. However, the waiting time on that list stood at seven years and the chance of acquiring local housing was reported to be slim. All areas reported that links with local housing authorities needed to be strengthened. It was felt that, while the mental health services should not be responsible for the provision of housing, they were responsible for liaison with local authorities, voluntary groups and private landlords to ensure suitable

accommodation was available. Some of the areas had already got links with voluntary groups which provided housing for those with mental health problems (e.g. Mental Health Association, Housing

Association for Integrated Living, STEER), but these could be further developed.

Another issue put forward as limiting the efficient use of

community residential facilities was the division of services by sector. It was reported that this limited choice for the service user. Comments included the need for more collaboration between sectors and catchment areas. Another concern was where the location of facilities that provided for an entire

catchment area population. One area that serviced a large

geographical area was particularly concerned about the appropriate location of services that would result in equity and accessibility for all service users.

The definition of high, medium and low support accommodation differed between and within areas and the need for a standardised definition of level of support was

noted.

3.8.6Developments for the future