Residential care for elderly people: policy implications from an exploratory study

The Association of Directors of Social Services, in response to the Burgner review, has called for joint health and local-authority inspection of residential homes (Community Care, 8.1.97, p. 1). Yet there is little agreement about what constitutes good residential care (Gibbs and Sinclair, 1992). Without such information, we cannot make valid comparisons between homes or set meaningful standards. The study described below tested a wide range of possible measures of quality of care. It adopted an eclectic approach, including the perspectives of residents, health and social care professionals, home staff, managers, and relatives. Full details of the instruments used are given in the final report, which is available from the Personal Social Services Research Unit, University of Kent at Canterbury, CT2 7NF, as Discussion Paper 1245

Home truths

A study testing the quality of care measures in residential homes has come to some surprising conclusions, among them, that there are no associations between costs and quality. Discusses the evidence

Depression and the response of residential homes to physical health needs

Objective. To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response: and the prevalence of depression. Design and sample, Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent 'excellent' and 'standard' cart: resident sample sufficient to detect difference between 20% and 30% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed. Setting. Seventeen residential homes in different areas of England. Methods. Data were collected about aspects of the carl provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems. Results. Seventy-nine per cent of the sample were suffering from dementia: 40% of 194 residents who could be assessed for depression were depressed. OF residents assessed by research nurses. 72% had problems with mobility, 67% with stability. 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents. Discussion. The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of cure provision might reduce depression and thus improve quality of life