Objective: Deinstitutionalization policy in the Netherlands has given rise to new living arrangements for elderly long-term psychiatric patients. Most involve accommodation in mainstream residential homes for elderly persons. Housing is either concentrated in a specialized care unit or dispersed throughout the facility.
Design: We compared the community integration and (changes in) behavior of elderly psychiatric patients in such residential housing facilities with those residing in a psychiatric hospital.
Material and Methods: Three subsamples were selected: 49 residents in six units of concentrated housing, 47 residents in 12 units of dispersed housing, and 78 patients in 24 psychiatric hospital units, for a total sample of 174 participants. We compared these samples in a quasi-experimental, post test-only design that used four measures of community integration: amount of perceived influence over one’s daily life, involvement in social activities, social network size, and frequency of visits received from members of the network. Both the six-month prevalence of psychotic symptoms and adjustment of psychotropic medications due to worsening of psychopathology were measured as an indicator of the stability of the psychiatric disorder. To adjust for differences in the populations, we matched the hospital patients to the residential home residents and controlled for confounding factors.
Results: Residential homes afforded more privacy, were closer to public services, and had a more diversified population than psychiatric hospitals. Participants in dispersed housing experienced more influence over their lives. Concentrated-housing participants were less enterprising and had smaller social networks. The three groups did not differ in the frequency of visits received from network members. There was no difference in the six-month prevalence of psychotic symptoms between residents in elder care home and residents in the psychiatric hospital (33% and 34%). Nevertheless adjustment of psychotropic medication occurred in 38% of the residents in the elder care home and in 26% of those in the psychiatric hospital.
Conclusions: From a psychiatric point of view housing of elderly psychiatric patients in facilities for the elderly seems not to pose serious problems, though possibly at the cost of use of more medication. However community-integrated facilities do not necessarily imply community-integrated residents. Only dispersed-housing residences were an improvement over hospitals, and then solely in terms of residents’ influence over their own daily lives. The advantage of the dispersed-housing model is that it resembles independent living while its institutional nature offers structure and protection.
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