The characteristic features of institutional life can be found in all types of long-term hospitals and homes for old people. They occur in all countries despite radical differences in the structure of health and social care provision. This paper draws upon data from a study of British residential homes to present an account of institutional life from the consumers' perspective. Residents' views are drawn from open-ended interviews with 60 residents. They convey a complex mixture of feelings: gratitude, resentment, resignation, powerlessness, acceptance and dependence. The common expressions of boredom and loneliness reflect a poor quality of life for many residents. A surprising degree of tolerance was shown by lucid people towards those who had become confused. The authors argue that elderly residents are faced with a choice between an unpleasant battle to survive in their own homes and an equally unpleasant enforced dependence in the institution. The views of residents ought to be an important factor in the evaluation of institutional care.
SYNOPSISThis study compares the clinical and social outcome for 2 cohorts of patients who had a first admission for schizophrenia 4 years earlier. One cohort was treated in a psychiatric unit attached to a teaching district general hospital (DGH(T)), while the other was treated at an area mental hospital (AMH) with modern rehabilitation facilities. The clinical outcome for the 2 cohorts was broadly similar, but the DGH(T) imposed less of a strain on relatives, and was associated with less unmet need. The DGH unit tended to have significantly shorter durations of stay for its patients, so that its total hospital costs were less than those for the AMH despite higher unit costs. The cost benefit analysis shows that, where these particular patients are concerned, the DGH(T) unit is economically superior to the AMH despite the fact that it supports a large teaching staff, and that these economic advantages are accompanied by various non-monetary advantages.
This article proposes that the quality of physical care is an important determinant of quality of life for dependent people. It begins by reporting the findings of a qualitative analysis of physical care in six local authority homes and suggests a framework for understanding the ways in which physical care practices evolved. The paper concludes by illustrating how the same framework can be used as a basis for improving the quality of physical care.
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