RESIDENTIAL CARE IN-HOSPITAL AND IN THE COMMUNITY - QUALITY OF CARE AND QUALITY-OF-LIFE

Background. The reduction of beds in long-stay hospitals has led to co ncerns over the quality of care offered to the remaining residents as well as that provided in the community. This study seeks to compare th e quality of care and quality of life (reported satisfaction) from res idents in both types of setting.Method. A cross-sectional comparison w as made of community residential homes and hospital wards drawn random ly from lists provided by local authorities in the outer London area. Samples were drawn from all the main provider types (local authority, housing association, private and joint NHS/voluntary sector). Measures were taken of the quality of the physical environment, staff and resi dent characteristics, external management arrangements and internal ma nagement regimes, resident satisfaction and staff stress. Direct obser vations were also made of the amount and quality of staff-resident int eractions. Results. In general, the most disabled residents were found to be still living in hospital in the worst conditions and receiving the poorest quality of care. Although there were some problems with mi ssing data, hospital residents also seemed most dissatisfied with thei r living situation. There were few differences between community provi ders regarding either the quality of care provided or the levels of re ported satisfaction. Quality of care in the community homes seemed to be much more determined by the personality and orientation of project leaders. Conclusions, Purchasers and providers still need to give atte ntion to the problems of selectively discharging the most able residen ts to the community, leaving the most disabled being looked after in p rogressively deteriorating conditions. All residential providers need to review their internal management practices and try to ensure that r esidents are offered, as far as possible, the opportunity to make basi c choices about where and how they will live. Staff training and quali ty assurance practices need to be reviewed in order to improve the dir ect quality of care offered to the most disabled individuals.