The process of care in residential facilities--a national survey in Italy.
BACKGROUND
Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics.


METHODS
Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments.


RESULTS
Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients' daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables.


CONCLUSIONS
This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients' needs.
Santone
Giovanni
G
United Hospitals of Ancona, Politechnic University of Marche Ancona, Italy.
de Girolamo
Giovanni
G
Falloon
Ian
I
Fioritti
Angelo
A
Micciolo
Rocco
R
Picardi
Angelo
A
Zanalda
Enrico
E
D000203:Activities of Daily Living / Q000145:classification*; D016000:Cluster Analysis; D003431:Cross-Cultural Comparison; D006306:Health Surveys; D006801:Humans; D007558:Italy; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards; D011788:Quality of Life / Q000523:psychology*; D012112:Residential Facilities / Q000592:standards*; D013223:Statistics as Topic; D014850:Waiting Lists; D000078329:Workforce