The process of care in residential facilities

Background Although Residential Facilities (RFs) have largely replaced mental hospitals 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 with standardised 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.While a home-like atmosphere was found in many RFs, most facilities had restrictive rules about patients’ daily life and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardised assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardisation 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 mental hospital residents. No significant inter-cluster differences were associated with 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.