The domus philosophy: A comparative evaluation of a new approach to residential care for the demented elderly

Abstract

SUMMARYThis study reports a cross-sectional comparison between three continuing care facilities for severely disturbed elderly demented people: two mental hospital psychogeriatric wards and a unit run according to the domus philosophy of care. The domus was characterized by greater expectations for residents' functioning, policy choice, resident control and availability of social and recreational activities. The level of staffing was higher on the domus than on the two wards. The residents on the three settings were broadly comparable with regard to age, diagnosis, length of stay, objectively assessed cognitive impairment and depression, but the domus residents were rated by the staff as less disabled in self-care tasks, orientation and communication. Direct non-participant observation using the Short Observation Method demonstrated significantly higher levels of activities and staff-resident interaction on the domus compared to the hospital wards. There were no differences between the settings with regard to staff absenteeism, job turnover or psychological impairment, but the domus staff expressed higher levels of job satisfaction. These findings are discussed in the context of the limitations of study design and method.KEY woms-Domus, nursing home environments, dementia, quality of care.

The TAPS project 40: quality of care provisions for the elderly mentally ill?traditional vs alternative facilities

“…Strict nursing tasks, such as taking blood pressure or giving enemas, are far more likely to This study, while focusing on principal dierences between EMI wards and the alternative community facilities, has also drawn attention to dierence between community facilities managed by the NHS and those managed by Social Services. It was observed that the two facilities run by Social Services provided no on-site nursing or medical servicesÐa practice which is common in many other`domus' type facilities in the UK (Lindsey et al, 1991;Dean et al, 1993). Apparently, these care environments are driven by a concept which gives precedence to the psychological and emotional well-being of the residents over the physical aspects of care.…”

Group-Living Care: An Alternative for the Demented Elderly

“…Many highlighted assumptions are recognized in the GL program in e.g. the British Domuses [16] and the French Cantous [42]. In these settings, the intention is however to care for the patient throughout the progress of the de menting disease.…”

“…To a great extent, this criticism concerns 'the institutional maintenance', whereby procedures and rou tines become geared to the needs of the institution rather than to the needs of the resident [16], The heterogeneity of patients brought together may also counteract the restitu tion of the patient as a social individual [17][18][19], In insti tutional settings, the hospital routines and equipment are usually developed to meet the needs of somatic medical care. In many aspects, the main characteristics of Goffman's [20] total institutions are still valid.…”

An Attempt to Determine the Benefits of a ‘Home-for-Life’ Principle in Residential Care for People with Dementia and Behavioural Problems: A Comparative Cohort Study

“…However, these pressures may arguably increase the risk to older people with dementia of less personcentred care, as well as that of excess relocation morbidity and mortality. These risks helped shape the 'Domus' model of care for people with dementia and behavioural problems in South London [1], with respite and day-care proscribed, and emphasizing a 'home for life' principle. Quite apart from ethical concerns, the latter was predicated on the fear that moving someone with dementia to a less intensive form of care when behavioural problems had settled might well produce a resurgence of these problems -as might even planning such a move.…”

“…This model is widespread in the UK, and can be considered as a variant of the UK Government's preferred policy of 'intermediate care' [2], but has not been evaluated. The less common Domus model has been evaluated in comparison with traditional long-stay wards and similar units [1,3,4]. We decided to compare the outcome for newly admitted residents to each model of care with the aim of quantifying any excess behavioural decline in those admitted to the MPNHs with the intention of ultimate placement elsewhere ('intermediate care', IC group), over that in those admitted to the Domus or MPNH with the intention that it was to be their home for the rest of their life ('HFL' group).…”