Long-stay Facilities Research Articles

Assessing Gaps Between Policy and Practice in Medicaid Disenrollment of Jail Detainees With Severe Mental Illness

Assessing Gaps Between Policy and Practice in Medicaid Disenrollment of Jail Detainees With Severe Mental Illness

The effect of Perasafe ® and sodium dichloroisocyanurate (NaDCC) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and polyvinyl chloride surfaces

Clostridium difficile is an important cause of nosocomial diarrhoea. The aim of this study was to evaluate the potential for Perasafe ®, a recently introduced biocide, to contribute to control of C. difficile spores in the patient environment, in comparison with the chlorine-releasing agent sodium dichloroisocyanurate (NaDCC). These agents were evaluated against a water control, in a surface test on stainless steel and polyvinyl chloride (PVC) floor covering, materials commonly found in the hospital environment. The organisms studied were a toxigenic clinical isolate of C. difficile, and Bacillus atrophaeus (formerly B. subtilis var niger). The data indicate that in our in vitro system, Perasafe was significantly more active than NaDCC (1000 ppm available chlorine) against C. difficile spores dried on stainless steel surfaces, and against B. atrophaeus on PVC floor covering material, achieving mean log 10 reduction factors in viable counts of 6 and 5.5, respectively, at 10 min exposures. Perasafe appeared to be less lethal in 10 min exposures to C. difficile spores fixed on PVC floor covering material. In general, 1000 ppm chlorine generated from NaDCC showed lower log 10 reduction factors in viable counts at 10 min, ranging from 0.7 to 1.5, than Perasafe which ranged from 2.7 to 6.0. The potential efficacy of Perasafe in reducing the density of C. difficile spores in the patient environment in hospitals, nursing homes or other long-stay facilities should be evaluated in field studies.

Old age psychiatry: a speciality in transition

Aims and methodsWe aimed to update Information on the development of old age psychiatric services using a postal survey of consultants.ResultsThe response rate (51%) was lower than previous surveys in the 1980s. Senior academic appointments showed little increase and academic posts were largely National Health Service (NHS) funded. Services had smaller catchment areas and increased numbers of staff in medicine, nursing and social work, but not in occupational therapy, physiotherapy and psychology. Relative workload was increasing and most services included early-onset dementia. There was a decrease in provision of NHS long-stay beds with only marginal changes in other facilities.Clinical implicationsServices were offering more to patients than previously. Weakness in academic development may cause problems for the future; the results suggested that recruitment in some disciplines may already be problematical. There is a need to develop the role of NHS long-stay facilities.

Nosocomial Urinary Tract Infections

Nosocomial urinary tract infections (UTls) are the most common cause of nosocomial infection, and are an important cause of septicaemia and mortality. The problem occurs in both acute-care and long-stay facilities. Despite improvements in the understanding of nosocomial UTls and infection control practices, the incidence has remained fairly constant over the past two decades.

Psychogeriatric organization in the medico-social network: the experience of the canton of Vaud, Switzerland.

In Switzerland (7 million inhabitants), the organization of health care is in the hand of the cantons and not of the Confederation. The canton of Vaud (600,000 inhabitants), in the south-west part of the country, counts 4 psychiatric sectors, each with a psychogeriatric service. Otherwise the canton has 146 long-stay facilities with a total of 6,000 beds, of which 600 are for psychogeriatric cases. Home care is in charge of a network of 38 medico-social centres with multidisciplinary teams including psychiatric nurses. Several nursing homes, some specialized in psychogeriatrics, are equipped, besides long-stay beds, by units for temporary care, for medico-social emergencies and for medico-social observations. Moreover, in Lausanne (250,000 inhabitants) an 'Orientation Office of Medico-Social Emergencies', with psychiatric nurses, assumes emergencies at home and by-passes hospitalizations of medico-social cases in the General Hospital, by the resource of medico-social emergency beds in the nursing homes. The medico-social network thus designed in this way is profoundly permeated with the reality of psychogeriatrics.

The landladies of Fishponds

Over the last four decades there has been a substantial reduction in the number of psychiatric hospital beds. Alternative residential facilities in the community have been developed. These include staffed hostels, group homes and supportive lodgings providing bed and breakfast. While hostels and group homes are often integrated with psychiatric services and run by experienced staff, this may not be the case with the small privately run homes. Anstee (1978, 1985) described two supportive lodging schemes and suggested that such facilities were particularly helpful for people with schizophrenia. However, there has been little further research in this area even though supportive lodgings may constitute a significant proportion of long-stay residential facilities. We know little about the landladies, their background, training, experience and particularly the rewards and frustrations of their work. The extent of psychiatric morbidity and the overall burden of care for these landladies is also unknown.The aim of the present study was to gather information about the carers, the residents and the level of care provided in these facilities.

The Fanon Project: A day centre in Brixton

‘Community Care’ has become the psychiatric catch phrase of the eighties. With this burgeoning interest go the difficulties of working not just with a multi-disciplinary team but with Social Services and voluntary agencies, a move from our ‘ivory towers’ which not all psychiatrists will view with relish. Despite initial antipathy more psychiatrists are coming to accept the fact that moving patients out of long-stay facilities is a reality and new ways of working have to be found for these patients as well as acute patients.

A STUDY OF THE NEED FOR ALTERNATIVE TYPES OF HEALTH CARE FOR CHILDREN IN HOSPITALS

A study at the Health Centre for Children of the Vancouver General Hospital was undertaken to determine the need for alternative care facilities for a population of children in hospitals. The alternative facilities were a day-care medical unit, a short-stay surgical unit, an extended custodial unit, and a longer-stay rehabilitation unit. Predetermined criteria for the utilization of alternative facilities were prepared in advance. Two thirds of the children in the hospital were found to require conventional hospital care. Nearly one quarter of the children required facilities for short-stay surgery, with admission and discharge the day of surgery. Day-care medical facilities were also required, but to a lesser extent (7%). A small number of children (3%) required the longstay facilities, and they occupied a disproportionately large number of conventional hospital days (20%). It was estimated that the availability of alternative facilities could result in a saving of approximately 27% of hospital days. The number of patients and days in the various alternative care patterns for the medical and surgical subspecialties were also studied.