The process of care in residential facilities

Santone, Giovanni; Girolamo, Giovanni de; Falloon, Ian R. H.; Fioritti, Angelo; Micciolo, Rocco; Picardi, Angelo; Zanalda, Enrico

doi:10.1007/s00127-005-0922-1

Cited by 28 publications

(26 citation statements)

References 39 publications

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“…Patients who require long-term residential care are now catered for by RFs. Detailed information about the quantity and quality of these facilities has been obtained through a nationwide survey of all RFs (the PROGRES study) conducted in 2000-2002 [15][16][17][18][19]. On 31 May 2000, there were 1,370 RFs with 17,138 beds, an average of 12.5 beds each and a rate of 2.98 beds per 10,000 inhabitants.…”

Section: The Italian System Of Residential Carementioning

confidence: 99%

Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy

Girolamo

Candini

Buizza

et al. 2013

Soc Psychiatry Psychiatr Epidemiol

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Background A growing number of severely ill patients require long-term care in non-hospital residential facilities (RFs). Despite the magnitude of this development, longitudinal studies surveying fairly large resident samples and yielding important information on this population have been very few. Aims The aims of the study were (1) to describe the socio-demographic, clinical, and treatment-related characteristics of RF patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at the 1-year follow-up; (3) to evaluate clinicians' predictions about each patient's likelihood of home discharge (HD). Methods A prospective observational cohort study was conducted involving all patients staying in 23 mediumlong-term RFs of the St John of God Order with a primary psychiatric diagnosis. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered and standardized assessments (BPRS, HO-NOS, PSP, PHI, SLOF, RBANS) were administered to each participant. Logistic regression analyses were run to identify independent discharge predictors. Results The study involved 403 patients (66.7 % male), with a mean age of 49 years (SD = 10). The participants' average illness duration was 23 years; median value for length of stay in the RF was 2.2 years. The most frequent diagnosis was schizophrenia (67.5 %). 104 (25.8 %) were discharged: 13.6 % to home, 8.2 % to other RFs, 2.2 % to supported housing, and 1.5 % to prison. Clinicians' predictions about HD were generally erroneous. Conclusions Very few patients were discharged to independent accommodations after 1 year. The main variables associated with a higher HD likelihood were: illness duration of \15 years and effective social support during the previous year. Lower severity of psychopathology and higher working skill levels were also associated with a significantly greater HD likelihood.

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Section: The Italian System Of Residential Carementioning

confidence: 99%

Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy

Girolamo

Candini

Buizza

et al. 2013

Soc Psychiatry Psychiatr Epidemiol

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“…Three quarters of RFs did not formally set any limit to the length of in-stay, resulting in a low turn-over of patients [5,6]. De Girolamo and colleagues found that low turnover was mainly related to higher number of residents, higher number of former mental hospital patients, older age of the patients and fewer full-time staff [5,11].…”

Section: Current Situation and Issues Raisedmentioning

confidence: 99%

“…About 7 percent occupied the space of a former mental hospital [11]. However, the environmental characteristics suggested a home-like atmosphere in many RFs [6]; there was often a garden available, and residents generally lived in two-bed rooms. The quality of life that was observed can be comparable to that of a psychotic outpatient's [21].…”

Section: Current Situation and Issues Raisedmentioning

confidence: 99%

“…In synthesis, Law 328/2000 provided an integrated vision of social and health needs for residency and indicated that rehabilitation programs related with these needs have to be of limited duration, in sharp opposition to the total and perennial institutionalization in the asylum [6]. However, these goals have been only partially realized; many authors pointed out that there is a risk of creating new forms of institutionalization [13,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…As a result of the Reform, a community-based model of mental health care was developed and the first nonhospital residential facilities were implemented, following specific principles which had been formulated for therapeutic communities [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Residential Care in Italy: Critical Issues and Future Perspectives

Ghio

Favaretto²,

Rocca

et al. 2016

International Journal of Mental Health

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As a result of law 180/78, a community-based model of mental health care was developed and the first nonhospital residential facilities were implemented, following specific principles that had been formulated for therapeutic communities in Italy. Taking into account the new national guidelines in this field, the purpose of this article is to describe the development over the years of residential facility care in Italy, to address the critical issues that have emerged, and to outline the future developments. The main critical issues that have emerged are: the gradually increasing of the number of facilities from 2000 to present, the low rate of discharge with the consequent risk of institutionalisation, the high variability of resources and interventions provided by facilities, the low adherence to national guidelines, and the poor differentiation of levels of intensity of care offered. In relation to this critical data, a national plan of recommendations was set up by the Ministry of Health in 2013. The aim was to promote a move from the logic of long-term stays to that of individualized and project-based care pathways and to distinguish residential facilities based on the level of rehabilitation intervention and intensity of assistance offered. The new plan should promote an improvement of the quality of care of residential facilities; however, more efforts should be addressed to the understanding of what are the factors related to a successful conclusion of residential treatments.

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