Nursing homes
An examination of the appropriateness of nursing home placements.
About one-quarter of older people living in nursing homes do not need to be there. This finding, from a multi-disciplinary study conducted in Glasgow, suggests that nursing home care is too often seen as the only option. The authors argue that community care assessments and other processes should be more geared to rehabilitation, and better knowledge among medical and nursing staff would help avoid misuse of nursing home resources.
The study was conducted in eight nursing homes, with 304 residents. Of these, some 80 people were assessed as having low-level dependency needs. This description needs to be taken in its context, however, for a majority had some confusion. In this study, while a person might have dementia, he or she was seen to have low level of need if there were no medical or behavioural problems.
The circumstances of 63 individuals were examined, with the research team looking at their community care assessments. They found these did not always contain sufficient information to explain the choice of nursing home placement, and that medical details were limited, although their content in terms of dementia was generally accurate.
The researchers conclude that many people with a low level of need may be misplaced in nursing homes. They suggest that social workers are uncertain about what constitutes nursing care, and over-estimate need at times. They also suggest that insufficient assessment and support mean that some people who come into nursing homes on a temporary basis may stay there because it seems the easiest option.
This work makes a substantial case for closer attention to be paid to placement decisions - although it appears that only community care paperwork was examined and that residents were not able to make their views available in this instance. These, and the social workers' opinions, would be a useful addition to the research.
Source: G Penrice, et al, "Low dependency residents in private nursing homes in Glasgow," Health Bulletin 59 (1), Scottish executive, 2001Ê
Jill Manthorpe is a senior lecturer in community care at the University of Hull.
Mental health
A study of the mental health services required for 16-25 year olds.
This is a useful report highlighting a major gap in service provision for 16-25 year olds. For far too long, the needs of people in this age group - who are emerging uncertainly from their childhood into adult life - have been overlooked and poorly serviced.
This report is based on interviews and discussions with 45 young people who have experienced a mental health crisis, together with the views of mental health professionals, and those in voluntary sector organisations supporting vulnerable young people.
The key finding that emerges from the young people themselves is that many could not find the support that they needed. They didn't know where help was, they faced long delays in receiving it, and they were passed around a variety of services and agencies.
The professionals in the report identified a serious lack of resources, poor communication and co-operation between agencies, and a lack of specialist knowledge.
Many of these young people simply requested someone to talk to and to listen to them - to care, to be available, to take them seriously. Too often they met with adult denial of their difficulties. The report makes a number of recommendations to reverse the low priority given to such services. A variety of provision is clearly needed to meet the different needs of young people - some for counselling and psychotherapy, some for practical, financial and career advice, and others for information. The authors strongly recommend that the government set up a national service framework for children and young people's mental health.
As the report makes clear, adolescent services should no longer be tagged on to the end of services for children and conveniently ignored within adult services. New services need to be designed, which draw upon the experiences of young people, and recognise the value of what they have to say. These words will be well received by all practitioners in the broad field of child and adolescent mental health, and need to be heeded by commissioners of services.
Karen Smith and Lucy Leon, Turned Upside Down, Mental Health Foundation, 2001
Peter Wilson is director of YoungMinds.
