Question

What long term care faciltiites are available for older people with psychiatric problems who are unable to live on their own in the community without specialised care ?

Answer

Specific details about the different care settings in your own country can be obtained from your local psychiatric department, and particularly from your local community psychiatric social worker.

The emerging principles in Great Britain are that hospital care should be as brief as possible and should occur at psychiatric units in general hospitals rather than in psychiatric hospitals. Wherever practical patients should be treated as outpatients or day patients. Rehabilitation should aim to help people to progress to independent living or more importantly perhaps to prevent further deterioration.

Community care has been hampered by two considerations; firstly the cost of resources and secondly, some of the most vulnerable patients may be unwilling to make use of the available care. It is agreed that the best form of care involves a team including psychiatrists, community nurses, clinical psychologists and social workers, as well as members of voluntary groups.

The care of these patients must meet a number of requirements. There must be suitable good support from carers, suitable accommodation, arrangements to ensure the patients collaborate with treatment, regular assessment including assessment of physical health, effective collaboration among carers, continuity of care and rapid response to crisis. Group living is favoured in the UK with some private facilities if possible. The groups may be specifically chosen to perform essential tasks of running the house together, with each using their skills and abilities, so that together they can complete all required tasks. They will however still require regular support and supervision.

Alternative accommodation in Britain outside hospitals would be in lodgings or hostels. Most people able to live in this sort of accommodation would be fairly independent with only a minimal call on extra care.

More recent developments in the UK have increased the focus on private care, especially for the elderly. This may provide a variety of facilities but cost is often unfortunately a constraint. Ideally there should be some form of graded accommodation so that patients who become less able could be moved to more sheltered accommodation without moving away from their existing environment. Provision of this kind of home is much more available within Europe and the United States. The change from long term care in nursing homes in US to a wider range of provision is hampered by the fact that many of these provisions are privately funded and available therefore less widely to those who are less well off.

You might be interested in the following references:

Gurland B et al. 1979. A cross-national comparison of institutionalised elderly in cities of New York and London. Psychological Medicine. 9, 781-8.

Grundy E. 1987. Community care for the elderly. 1976-84. British Medical Journal. 294, 626-9

Bhugra D, Leff J. 1993. Principals of social psychiatry. Blackwell. Oxford

Tyrer P, Creed F 1995. Community psychiatry in action. Cambridge University Press

Links

• factsheets on care issues