Community Residential Settings Research Articles

The prevalence of denture loss within community residential settings.

Introduction Denture loss prevalence in community settings is unknown and results in deteriorating residents' systemic and psychosocial wellbeing.Materials and methods An electronic survey was distributed nationally through professional networks to community residential settings.Results Of the 156 responses from community residential settings, 69% of settings experienced at least one denture lost in the last two years. Sixty percent of responders reported no dentures were labelled, only 64% had received training about how to care for dentures and 86% felt they would benefit from further training on mouth care. In addition, 68% of staff found arranging dental care for their residents challenging.Discussion Extrapolated data suggest that at least 10,205 dentures are lost annually in community residential settings and are never found, costing the NHS Business Service Authority more than £3 million. A high prevalence of denture loss in community residential settings is likely due to residents with multiple comorbidities and frailty. Remaking dentures poses financial, logistical, and patient challenges, which may result in patients being unable to wear a remade denture.Conclusion The prevalence of denture loss within community residential settings needs to be understood to encourage targeted interventions, inform stakeholders, and encourage workflows that will improve service delivery and patients' oral health-related quality of life.

Clinical utility of a hybrid secondary and relapse prevention program in adults with mild intellectual disability in community residential and day habilitation settings

BackgroundDespite evidence that standard substance use disorder (SUD) treatment may be less effective in people with intellectual disability (ID), there is an absence of appropriate clinical tools with which to support them. ObjectivesThis study examined the clinical utility of an alcohol and other drug refusal skills intervention designed to be cognitively accessible to adults with ID MethodsThirty individuals at high risk for or in recovery from a SUD in developmental disability services (DDS) community residential and day habilitation settings participated in the two-week refusal skills group. Measures included pretest versus posttest improvement in refusal skill competency and baseline performance on a standardized verbal learning test. ResultsThere was a strong effect for refusal skill acquisition (p < .001); and the magnitude of skill acquisition was predicted by group attendance (p < .001) and not by individual differences in verbal learning ability (p = .074) or efficiency (p = .35). ConclusionsThe Refusal Skills Group is developmentally appropriate for people with mild ID in that: (1) they can learn and demonstrate refusal skills and (2) their skill acquisition is predicted more strongly by exposure to the intervention than by individual differences in learning characteristics. Delivering refusal skills in DDS settings familiar to clients increased their access to services and minimized disruption to their usual routines and schedules.

Wound prevalence survey in a regional integrated care organisation in the midwest of Ireland

Background/aims: The aim of this clinical audit was to determine the point prevalence of wounds over a 1-week period during April 2019 in the midwest Regional Integrated Care Organisation (RICO), which has a population of 379 452. The RICO consists of six hospitals, a public health nursing service across three counties, community residential settings, nine older person's service sites, community health centres and one prison. Method: A peer-reviewed, purpose-designed data collection tool was used to gather demographic and wound data on each patient with a wound in the midwest RICO. Anonymised data were collected by the nurse undertaking routine wound care on one occasion during the 1-week study period. There were no exclusion criteria for this study; all patients with a wound were eligible for inclusion. Ethical approval was obtained. Results: Completed data collection forms were returned for 791 patients who had a combined total of 1164 wounds. Data were analysed using SPSS version 21 to produce descriptive statistics. A point prevalence of 0.2% of the total RICO population had a wound, with a mean of 1.47 wounds per patient. Some 51% of the cohort was female. The median age was 75 years (range 3–101 years, standard deviation=19.881). Leg ulcers were the most common wound type, with a prevalence of 0.07% (33.7% of the cohort). Conclusions: This clinical wound prevalence audit supports previous studies in relation to wound statistics in Ireland and will be useful for resource planning in an ageing population.

Experiences of Tobacco Use among Chinese Individuals with Schizophrenia in Community-Based Residential Settings: A Qualitative Study.

Although there is a high prevalence of smoking among individuals with schizophrenia, no previous attempt has been made to explore experiences of tobacco use and cessation within a Chinese sample of this population. A qualitative descriptive study was conducted to explore through the use of individual and semi-structured interviews the experiences of tobacco use and quitting in a sample Chinese population with schizophrenia. Twenty-three eligible participants with schizophrenia who currently smoke were recruited from three community residential mental health service settings. Four main themes representing the experiences of the participants were uncovered in this study: (1) smoking and illness; (2) environment and culture; (3) reasons for smoking; and (4) beliefs about cessation methods. The findings indicated that the participants considered the disease to be far more harmful than smoking, and perceived many benefits to smoking. Although some thought of quitting at times, most gave up the idea or failed to quit due to internal factors such as disease-related suffering, the use of an avoidance coping strategy, and a lack of cessation support. The most notable finding concerns the use of avoidance coping by the participants, who relied on smoking as a way to avoid the suffering brought about by the disease.

Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals

BackgroundPost-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals.MethodsUsing information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care.ResultsRisk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community.ConclusionsThis study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities.

Contextual Factors Associated with Implementing Active Support in Community Group Homes in the United States: A Qualitative Investigation

AbstractAlthough numerous studies in the U.K. and Australia have shown that Active Support (AS) is an effective intervention in increasing staff assistance and engagement for people with intellectual and developmental disabilities (IDD) who live in small community residential settings, studies in Taiwan and the U.S. did not replicate these results. The mixed findings may be due to the unique challenges faced by small community group homes serving people with disabilities from different countries. The purpose of this qualitative study was to describe the views of participants in a AS implementation study about contextual factors that affected their efforts at implementing AS in a U.S. context. Interviews were conducted with Direct Support Professionals (DSPs) and AS trainers. A focus group was conducted with directors from organizations that implemented AS in the U.S. This study revealed several reported challenges to AS implementation, including the lack of leadership support, lack of buy‐in, and high staff turnover rate. Despite these difficulties, study participants identified positive impacts of AS on both DSPs and people with disabilities. Implications of these findings are discussed.

Weight loss in individuals with diabetes and psychosis: testing an intervention for community residential settings

Weight loss in individuals with diabetes and psychosis: testing an intervention for community residential settings

Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities

To evaluate the implementation of a controlled, 6-week, environmental and educational intervention to improve dietary intake and body composition, and to study the association of implementation fidelity with diet and body composition outcomes. A process evaluation documented participation, dose of nutrition education delivered, participant satisfaction, fidelity and completeness of the food environment intervention implementation, and context through observations and interviews with staff and residents. Intervention sites were scored and categorized as high or low participation and implementation and compared on essential elements of the food environment and on diet and body composition outcomes. Six urban residential drug-treatment facilities in Upstate New York. Fifty-five primarily black and white men in residential drug-treatment programmes. Participants were exposed to 94 % and 69 % of the educational and environmental elements, respectively. High implementation sites were significantly more likely to provide water and 100 % juice, offer fruit or vegetable salad, offer choices of fruits and vegetables, and limit fried foods. Mixed-model analysis of covariance revealed that participants in the high participation and implementation sites reported greater reductions in total energy, percentage of energy from sweets, daily servings of fats, oils and sweets, and BMI over the intervention period. Participants in low participation and implementation sites reported greater reductions in percentage of energy from fat. Differential implementation of environmental elements limited the intervention impact. These findings document the contribution of changes in eating environments to facilitate dietary behaviour change in community residential substance-abuse settings.

Comparison of community residential supports on measures of information &amp; planning; access to &amp; delivery of supports; choice &amp; control; community connections; satisfaction; and, overall perception of outcomes

This paper reports on some of the findings of a large-scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home. Comparisons were conducted on six domains: information and planning; access to and delivery of supports; choice and control; community connections; satisfaction; and, overall perception of outcomes. Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type. Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes. The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.

Recent Changes in Medicaid Policy and Their Possible Effects on Mental Health Services

Recent Changes in Medicaid Policy and Their Possible Effects on Mental Health Services

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Sexuality Among Chinese Mental Health Consumers in Halfway Houses of Hong Kong

Sexuality Among Chinese Mental Health Consumers in Halfway Houses of Hong Kong

Sexuality Among Chinese Mental Health Consumers in Halfway Houses of Hong Kong

This study examined the sexuality of Chinese mental health consumers in halfway houses by incorporating the perspectives of consumers and staff. A total of 193 consumers and 88 staff from 11 halfway houses in Hong Kong completed surveys about sexual needs, attitudes, and expression. Chi square analyses and t tests examined group differences. Needs related to nine sex-related activities were examined: finding a partner, dating, marriage, procreation, use of sex workers (persons who exchange sex for money), viewing pornography, masturbation, intimate physical contacts, and sexual intercourse. From 14% to 49% of consumers reported needs related to the nine activities. Acceptance of activities was higher among staff, and consumers were more conservative in sexual attitudes. Staff's members' reported level of sexual knowledge and level of comfort in addressing sexual issues were higher than consumers' reports of their own knowledge and comfort. The findings can inform the development of sexuality training programs for staff and consumers in halfway houses.

Changes in Populations of Residential Settings for Persons With Intellectual and Developmental Disabilities Over a 30-Year Period, 1977–2007

In 1976 the Administration on Developmental Disabilities (ADD) commissioned the first national survey of institutional and community services for persons with intellectual and developmental disabilities. That study had an effective date of June 30, 1977. Prior studies conducted by the U.S. Census Bureau between 1923 and 1946 and by the National Institute on Mental Health between 1947 and 1968 had gathered data on public and private institutions but did not include smaller, “community” residential settings. By the early 1970s, there was substantial interest not only in the populations of public and private institutions, which still housed the vast majority of residential services recipients with intellectual and developmental disabilities, but also increasingly in the growing number of community residential settings being developed as alternatives to institutions.The 1977 study identified a total of 9,303 community residential settings (places with 15 or fewer residents). These settings made up 84.5% of all residential settings, although they housed only 16.3% of all residents. The 1977 study was replicated in 1982 with funding from the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). In June 1982, community residential settings made up 89.0% of all residential settings and housed 26.1% of all residents. Since 1982, there has been rapid expansion of the total number of residential settings for persons with intellectual and developmental disabilities (now estimated at 168,000 in June 2007), growing sophistication of state information systems, and higher expectations of more frequent and timely data reports. These changes have contributed to states' participation in a voluntary annual residential services reporting system in which all states have participated since 1984. The most recent data collection in this series (effective date June 30, 2007) marks 30 years since the original ADD-sponsored national study of institutional and community residential services.Figure 1 shows the changing patterns of use of residential settings of different sizes at decade intervals during the 30-year period between June 1977 and June 2007. As the figure shows, there has been a rapid decrease (70%) in the number of people with intellectual and developmental disabilities living in public and private institutional settings of 16 or more residents, from 207,356 in June 1977 to 62,496 in June 2007. There has also been an even more rapid increase in the number of persons with intellectual and developmental disabilities receiving residential supports in homes of 6 or fewer persons, from 20,400 to about 316,300. In June 1977, persons in institutions made up 84% of the 247,780 persons with intellectual and developmental disabilities receiving residential services; in 2007, 14% of 437,707 residential service recipients were in institutions. In each of the 10-year periods shown in Figure 1, the total number of persons in public and private institutions decreased between 31.9% and 33.9%.Table 1 shows changes in states' use of residential settings of different sizes for persons with intellectual and developmental disabilities. In 1977, only four states (California, Hawaii, Maine, Vermont) had more than 25% of all residential service recipients in places with 6 or fewer residents and 44 had more than 70% in places with 16 or more residents. In 2007, 36 states housed 70% or more of their residential service recipients in places of 6 or fewer residents. In 2007, a majority of states housed less than 10% of residential service recipients in places of 16 or fewer residents. (Source: Prouty, R., & Lakin, K. C. (Eds.). (2008). Residential services for persons with developmental disabilities: Status and trends through 2007. Minneapolis: University of Minnesota, Research and Training Center on Community Living.)

Do persons with intellectual disability have a social life?The Israeli reality

Living in the community does not, in and of itself, guarantee social integration and inclusion for persons with intellectual disability. Social life and leisure participation can indicate the beginning of such a process and its impact on the quality of life. The present study investigated the social life quality of persons with intellectual disability who live in community settings or with foster families and its impact on their quality of life. The sample consisted of 85 adults with intellectual disability, ranging in age from 18 to 55 years. Forty-five of them lived in community residential settings and 40 lived with foster families in Israel. Five questionnaires were used: 1) a demographic questionnaire; 2) Quality of Life Questionnaire; 3) the Revised UCLA Loneliness Scale; 4) Social Relationships List; and 5) Leisure Activities List. The main findings showed no significant differences between the two groups in social life or feelings of loneliness. Foster residents were more involved and more independent in their leisure activities than were those who lived in community residences. An association between social life and quality of life was partly confirmed. The need for intervention programs and leisure education programs is discussed.

Service Use and Cost in 2002 Among Clients in Community Settings Who Were Discharged From a State Hospital in 1989

This analysis is a follow-up of a 1992 study of service use and cost of care among patients discharged from a state hospital. This study documented utilization and cost of care in 2002. Study participants were 150 former long-stay patients who were discharged from a state psychiatric hospital in 1989. An integrated database of all mental health and medical services reimbursed by Medicaid and Medicare as well as state- and county-funded services was used to construct descriptive statistics on service use and unit cost measures. Data on mortality, homelessness and criminal arrests were obtained from vital statistics, jail records and shelter admissions. During 2002, 18% of study participants had a psychiatric hospital admission, with a mean length of stay of 60 days. Almost all participants (99%) received some form of outpatient mental health care, and 66% were living in publicly funded residential housing. The total annual cost per study participant for the 2002 service package was $89,699. Residential care accounted for 54% of the total cost. Between 1989 and 2005, 3% were admitted to county jails and 9% had experienced homelessness. Of the original discharged sample of 590 patients, 37% died between 1989 and 2002; the mean age at death was 63+/-15 years. This analysis suggests that individuals discharged from state psychiatric institutions have been integrated into community residential settings and are receiving psychiatric outpatient treatment on a regular basis. Cost estimates, using the consumer price index for 2002, were $78,773 in 1992 compared with $85,850 for the exact same service package in 2002.

Dietary Intake of Adults With Mental Retardation Who Reside in Community Settings

The dietary intake of adults with mental retardation among three different community residential settings was described and compared. Two dietary screeners were administered to 325 adults. The women's Fruit and Vegetable Screener scores from group homes were significantly higher than scores from those with family members and in semi-independent settings. No significant differences were found in dietary intake across residences for men. Overall, 0% to 6% of the participants consumed the recommended 5 or more fruits and vegetables per day, and 15% to 30% consumed the recommended<or=30% or less of calories from fat. Results suggest that regardless of residential setting, men and women do not consume enough fruits and vegetables and consume too much dietary fat.

Relations Between Program and System Variables and Fidelity to the Wraparound Process for Children and Families

Relations Between Program and System Variables and Fidelity to the Wraparound Process for Children and Families

Would the real mental health nurse please stand up? The relationship between identification and professional identity

Would the real mental health nurse please stand up? The relationship between identification and professional identity

Social capital, health, and care home residence among older adults: a secondary analysis of the Health Survey for England 2000.

This secondary analysis of the Health Survey for England 2000 aimed to investigate whether individual-level social capital is associated with care home residence and with function, mental health, and self-assessed health in older adults. Older adults in both care home and community residential settings were included. Two indicators of social capital, perceived social support and group participation, were considered for both care home and community-dwelling respondents. Amongst community dwellers, trust in others was considered as a third indicator. Functional impairment, psychiatric morbidity, and self-assessed health were used as indicators of health. Multivariable modelling was undertaken using logistic or ordinal logistic regression. The results show that severe lack of social support was associated with over twice the odds of care home residence, with increased odds of psychiatric morbidity in both care home and community settings, and with more severe functional impairment and worse self-assessed health in the community but not in care homes. Participation in more groups was associated with lower odds of functional impairment in both settings, and with lower odds of psychiatric morbidity and better self-assessed health among community but not among care home respondents. High levels of trust were associated with lower severity of functional impairment, reduced odds of psychiatric morbidity, and better self-assessed health. It is concluded that individual-level social capital was associated with care home residence and with indicators of physical, mental and self-assessed health. These associations differed between community and care home settings, and were generally stronger in the community.