Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Client engagement

Systematic observational measures of the minute-to-minute behaviour of severely and profoundly mentally handicapped people of comparable levels of dependency were taken in two types of residential unit to establish the level of engagement in activity. Higher engagement levels were found among those clients living in Wessex locally-based hospital units compared with those living in villas of a traditional mental handicap hospital. Thus, concern that such small “domestic” units, sited in the community among the people they serve, would not be a feasible alternative to traditional campus-type hospitals appear to be unfounded. Moreover, the prediction that traditional practices, such as grouping clients by clinical or diagnostic criteria and grouping living units to provide peer “support” to staff and supposed better access to specialists, are essential to the maintenance of high quality residential care is not borne out by the evidence. More attention needs to be paid to the important variables of staff deployment and scheduling of activities in the maintenance of high levels of client engagement in activity

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Family contact

A number of small locally-based hospital units for severely and profoundly mentally handicapped people requiring residential care have been provided in Wessex, each sited within a catchment area considerably smaller than the territory served by any of the large mental handicap hospitals in the region. A comparison of the rates of contact between clients and their families in the first five locally-based hospital units to be provided and in five villas on a large mental handicap hospital campus showed that the provision of locally-based hospital units resulted in greater family contact with the handicapped residents

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Staff recruitment and continuity

Data on daytime staffing levels and turnover were abstracted from the personnel records of small locally-based hospital units for severely and profoundly handicapped children or adults and from the nursing report books of five villas of a large mental handicap hospital. These were compared to evaluate predictions that difficulties in staff recruitment would be found in the locally-based hospital units and that they would suffer much higher staff turnover than in a large hospital. The data showed that full staff establishment was substantially maintained in the locally-based hospital units and that, due to the frequency of staff transfer between villas of the large hospital, the continuity of staff in the locally-based hospital units was considerably greater than the continuity of staff on any of the villas. Thus, concern that small “domestic” residential units sited in the community among the people they serve would not be a feasible alternative to traditional large mental handicap hospitals for the care of severely and profoundly mentally handicapped people, because such units could not be satisfactorily staffed, appear to be unfounded

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Revenue costs

The revenue costs of small locally-based hospital units for the severely and profoundly mentally handicapped in Wessex were compared with those of traditional mental handicap hospitals. Contrary to expectations, the revenue costs in such units were not excessively greater than average costs in many large mental handicap hospitals. Indeed, estimates of the cost per inpatient day in wards of two large hospitals in Wessex with clients of comparable degrees of dependency showed that revenue costs in the locally-based hospital units were competitive. Rationales of the inevitable presence of “economies of scale” should not be used in the perpetuation of large residential complexes; unsupported assertions of greatly increased running costs should not prevent development of small locally-based residential alternatives