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Background: Previous research identifies organisational culture as one of a number of factors associated with the quality of life outcomes of group home residents' with intellectual and developmental disabilities. This study aims to elaborate on the dimensions of group home culture in settings in England. Method: Participant observations and semi‐structured interviews with staff were carried out in two group homes. Field‐notes, interview notes and transcripts were analysed using inductive thematic analysis by a researcher naïve to the project and the previous literature. Initial coding was re‐examined after sensitisation to theorised models in previous literature to identify the most parsimonious fit. The two settings were rated and compared using a five‐point Likert scale for each of the dimensions. Results: The findings describe group home culture across seven dimensions. There were mixed ratings across the different dimensions reflecting inconsistencies in culture that were reflected in staff practice. The challenge in assigning a global rating of culture in group homes, which includes interactions across multiple staff and multiple residents over time, was highlighted. Conclusion: The development of an observational measure of culture is highlighted as potentially helpful in understanding and responding to culture in services for individuals with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Background: Respiratory tract infections are readily transmitted in care homes. Airborne transmission of pathogens causing respiratory tract illness is largely unmitigated. Portable high-efficiency-particulate-air (HEPA) filtration units capture microbial particles from the air, but it is unclear whether this is sufficient to reduce infections in care home residents. The Air Filtration to prevent symptomatic winter Respiratory Infections (including COVID-19) in care homes (AFRI-c) randomized controlled trial will determine whether using HEPA filtration units reduces respiratory infection episodes in care home residents. Methods: AFRI-c is a cluster randomized controlled trial that will be delivered in residential care homes for older people in England. Ninety-one care homes will be randomised to take part for one winter period. The intervention care homes will receive HEPA filtration units for use in communal areas and private bedrooms. Normal infection control measures will continue in all care homes. Anonymised daily data on symptoms will be collected for up to 30 residents. Ten to 12 of these residents will be invited to consent to a primary care medical notes review and (in intervention homes) to having an air filter switched on in their private room. The primary outcome will be number of symptomatic winter respiratory infection episodes. Secondary outcomes include specific clinical measures of infection, number of falls / near falls, number of laboratory confirmed infections, hospitalisations, staff sickness and cost-effectiveness. A mixed methods process evaluation will assess intervention acceptability and implementation. Discussion: The results of AFRI-c will provide vital information about whether portable HEPA filtration units reduce symptomatic winter respiratory infections in older care home residents. Findings about effectiveness, fidelity, acceptability and cost-effectiveness will support stakeholders to determine the use of HEPA filtration units as part of infection control policies. [ABSTRACT FROM AUTHOR]

Residential care services are under increasing pressure to lower service provision costs while maintaining quality of care. Using a translog cost function, this paper examines the relationship between cost, quality and output in England's learning disability (LD) residential care sector. It finds genuine but diminishing economies of scale in LD residential care services vis-à-vis output (i.e., care weeks). However, some variation exists: higher-quality LD residential care homes appear to have larger economies of scale than lower-quality ones. Supplementary regression analysis, examining quality-size, further finds quality (a) is negatively associated with LD care homes of six or fewer beds; (b) shows no association with homes of more than six beds. These findings enhance residential care literature and raise the possibility that, by promoting the establishment of larger high-quality care homes, cost savings may be achieved without sacrificing quality. [ABSTRACT FROM AUTHOR]

Intergenerational practice, where children and older adults come together for shared activities, has grown in popularity in many Western countries. However, research about intergenerational practice, particularly in the UK, is limited. This paper reports on the findings from an exploratory case study about a small intergenerational project between a maintained nursery school and a residential care home for older adults with dementia in the South-East of England. The methodology was informed by a narrative dialogic approach drawing on the work of Bakhtin. Data was collected using naturalistic observations of children's weekly visits to the care home and qualitative interviews with nursery school practitioners. The analysis explores how meaningful interactions were created between the children, the older adults, and the nursery school practitioners. Our findings suggest that singing, unstructured moments, continuity, context (open spaces/flexible sessions), and objects contribute to meaningful interactions between young children and older adults. The ability to be flexible and "go with the moment" were identified as key skills for practitioners supporting children and older adults. We conclude that intergenerational projects afford benefits not just for children and older adults, but also for practitioners in the form of "emotional rewards". The importance of re-establishing intergenerational practice is recognised, as well as the ways in which barriers created by social distancing might safely be addressed through the use of outdoor spaces and digital technologies. [ABSTRACT FROM AUTHOR]

This is a small-scale case study set out to explore a unique role within children's residential care in England, that of the Placement Family Support Worker and the family support work they conduct for the children in placement. This subject was explored through semi-structured interviews with seven Keyworkers and two Placement Family Support Workers in a children's therapeutic residential care service consisting of four children's homes. It was found that not every home had a Placement Family Support Worker, often due to staff resources and funding, and so often the children's Keyworker would manage the family support work themselves. In either case, family support work was seen to be highly valuable and significant for the children's development and relationships. It was found, however, that it would be more beneficial to have an independent Placement Family Support Worker managing family support work for each child in the home rather than Keyworkers for objectivity, healthy relationship management, organization, workload, multi-agency manageability, and the specific skills required. In addition to this, it was felt that emotional and practical support from the other staff in the home and management improved the quality of this work. Practice Implications Children's residential care homes are recommended to employ a dedicated placement family support worker to manage family support work and contacts for children in placement. Independent placement family support workers will be a resource in developing, maintaining and strengthening relationships between children in placement and their family, alternatively, through objective observations of contact they can advise on continued contact as beneficial or detrimental or even reunification. There needs to be a drive toward consistent practice (initially through standardised data collection methods) and appropriate training for those conducting family support work (including social work skills or prior experience in social work). Due to the complexity of the role and relationship management involved, dedicated spaces for reflection are needed for those conducting family support work. [ABSTRACT FROM AUTHOR]

Rehabilitation services have a key role in ensuring integrated and comprehensive mental health (MH) care in the community for people suffering from long-term and severe mental disorders. MH-supported accommodation services aim to promote service users' autonomy and independence. Given the complexity associated with MH-supported accommodation services in England, a comparative evaluation of critical performance indicators, including service provision and quality of care, seems to be necessary in designing evidence-informed policies. This study aims to explore the influence of service quality indicators on the performance of MH-supported accommodation services in England. The analysed sample includes supported accommodation services from 14 nationally representative local authorities in England from the QuEST study grouped by three main types of care: residential care homes (divided into two subgroups: move-on and non-move-on oriented), supported housing and floating outreach. EDeS-MH (efficient decision support-mental health) was used to assess the performance indicators for the selected services by combining a Monte Carlo simulation engine, data envelopment analysis and a fuzzy inference engine for integrating expert knowledge. Depending on the type of care, six/seven quality domains were sequentially included after a baseline scenario (only technical) was analysed. Relative technical efficiency scores for the baseline scenarios revealed high performance in all the selected supported accommodation services, but the statistical variability was high. Quality domains significantly improved performance in every type of care. The inclusion of quality indicators has a positive impact on the global performance of each type of care. Remaining at the corresponding services more than expected for two years has a negative impact on performance. These findings can be considered from a planning perspective to facilitate the design of pathways of care with more realistic expectations about gaining autonomy in two years. [ABSTRACT FROM AUTHOR]

Background: Shared housing for adults with intellectual disabilities with staff support, is a common housing model internationally. We explored an overlooked aspect of group homes, namely the extent to which they enable a sense of 'feeling at home' for residents., Method: A diverse group of 19 housemates participated in a photovoice study. Participants took photos in their homes and discussed them in individual interviews and in groups. Data was analysed using reflexive thematic analysis., Results: Residents' experience of home was multi-dimensional. 'Feeling at home' related to home as a site of identity cultivation (personal home); physical comfort or 'misfitting' (physical home) and home as the locus of key relationships (social home)., Conclusion: Achieving a sense of 'feeling at home' requires engagement in practices of home-making. Many of our participants required support from staff to engage in these practices. For some housemates their experience of home was conditional and precarious., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

The abuse and neglect of older people in care homes is widespread across England, but current causative explanations are limited and frequently fail to highlight the economic and political factors underpinning poor care. Informed by social harm and state–corporate crime perspectives, this study uses ethnographic data gathered through a nine-month period of working in an older person's residential care home to show how neglect is embedded in working routines. Three aspects of care are interrogated to reveal the embedded nature of harm in the home; all reveal the rift between official, regulatory rules and informal working practices shaped by material constraints of the labor process. This article explores the role of regulatory regimes in actively legitimizing sectors, such as the residential care industry, even in the face of routine violence, by bureaucratically ensuring the appearance of compliance with formal rules. While the harms of contemporary institutionalized care for older people have its roots in material conditions, performative compliance through regulation guarantees that these injurious outcomes are concealed. This article contends that malpractice (and harm) can be explained with reference to conjoint state–corporate relationships and practices. [ABSTRACT FROM AUTHOR]

Background: Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. Methods: We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Results: Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). Conclusions: The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT. [ABSTRACT FROM AUTHOR]

Background: Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS) about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods: A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care) were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621) in England in 2009. Responses were analysed using quantitative and qualitative methods. Results: The survey achieved an overall response rate of 15.8%. Most care homes (78.7%) worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs) had visited the care homes in the last six months (SD 5.11, median 14); a mean of .39 (SD.163) professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60%) managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low levels of respect for the experience and knowledge of care home staff. Conclusions: Care homes are a hub for a wide range of NHS activity, but this is ad hoc with no recognised way to support working together. Integration between care homes and local health services is only really evident at the level of individual working relationships and reflects patterns of collaborative working rather than integration. More integrated working between care homes and primary health services has the potential to improve quality of care in a cost- effective manner, but strategic decisions to create more formal arrangements are required to bring this about. Commissioners of services for older people need to capitalise on good working relationships and address idiosyncratic patterns of provision to care homes.The low response rate is indicative of the difficulty of undertaking research in care homes. [ABSTRACT FROM AUTHOR]

The abuse of disabled women is an issue that has not historically been given a great deal of attention. More recently, efforts to raise awareness of this particular set of needs have been ongoing but largely limited to the specialised spheres of domestic violence and disability activism. This paper explores the types of discourse being put forward in these efforts, using Fraser's categorisation of needs talk within the process of politicisation. It finds evidence of oppositional, expert and reprivatisation discourses and suggests that these have emerged in a way that reflects the distinctive histories of disabled people as well as feminist explanations of domestic violence and abuse. [ABSTRACT FROM AUTHOR]

Background In England and Wales, the Mental Capacity Act 2005 ( MCA) provides a new legal framework to regulate substitute decision-making relating to the welfare of adults who lack the capacity to make one or more autonomous decisions about their care and support. Any substitute decision made on behalf of an adult lacking capacity must be in his/her ‘best interests’. However, the value of adopting established principles and procedures for substitute decision-making in practice is uncertain, and little is known about the legal or ethical dynamics of social care support, including the day-to-day residential support provided to adults with intellectual disabilities (ID). Methods This paper reports a qualitative, grounded theory analysis of 21 interviews with support workers working in residential care homes for adults with ID, and observations of care practices. Results In contrast to the narrow legal responsibilities placed upon them, it is argued that support workers interpret substitute decision-making within a broad moral account of their care role, orientating their support towards helping residents to live ‘a life like ours’. In so doing, support workers describe how they draw on their own values and life experiences to shape the substitute decisions that they make on behalf of residents. Conclusions Support workers' accounts reveal clear discrepancies between the legal regulation of substitute decision-making and the ways that these support workers make sense of their work. Such discrepancies have implications both for the implementation of the MCA, and for the role of support workers' values in the conceptualisation and delivery of ‘good’ care. [ABSTRACT FROM AUTHOR]

Deinstitutionalisation in England has not been a unified policy. Leading up to 1980, deinstitutionalisation primarily involved the movement of those individuals with the least severe disabilities to a range of often pre-existing services including hostels, semi-supported group homes, family placement schemes, bed and breakfast arrangements and independent living. In the early 1970s attention turned to developing community-based supports for people with more severe disabilities. Initially, this involved the development of 20-24 place locally-based hospital or community units to serve a defined geographical area.

This study investigates the professional characteristics of care staff working in group homes for the mentally ill in a north London region. Opportunities for training and staff attitudes with respect to training and career prospects are examined. The majority of care staff are unqualified and in many cases the training needs of staff are not being met. Staff viewed their career prospects as limited. Training that is on offer to staff in principle is often not accessed, possibly owing to budget restrictions. The need for more stringent guidelines on staff training to maintain standards across agencies is highlighted. [ABSTRACT FROM AUTHOR]

Reports on the attitudes of neighbors of London, England supported group homes for long-stay psychiatric patients about psychiatric care as published in the February 1996 issue of `Psychiatric Bulletin.' Negative perception of psychiatric treatment in hospitals; Ignorance about the opening of the houses; Concerns of possible danger.

Background: Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach., Method: The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement., Results: All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1-year follow-up., Conclusions: Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.

Recent research suggests that person centred planning (PCP) can have a positive impact on the lives of people with intellectual disabilities. This article presents data from open-ended comments collected during research on the impact of PCP on the life experiences of 65 people with intellectual disabilities living in England. These comments addressed the goals set prior to and during PCP, and the main benefits of PCP for participants. The results suggest that PCP led to increased goal setting in a range of goal categories. This was reflected in the most common main benefit of PCP of ;increased activities and opportunities' reported for 57 percent of participants. For 48 percent of participants, a main benefit of PCP was that they felt better in themselves, in terms of happiness or self-esteem. This must surely be the ultimate aim of those seeking to improve the quality of life of people with intellectual disabilities.

Recent research distinguishes the belief in a just-world for the self (BJW-self) from that for others (BJW-others), showing BJW-self to be associated with subjective well-being and BJW-others to be associated with harsh social attitudes. The present research examines the implications of these two types of just-world belief for aspects of motivation and ideation about the future. A sample of 100 young British adults living in assisted accommodation completed measures of BJW-self, BJW-others, life satisfaction and intention to engage in delinquent behaviour. They also listed their personal goals and indicated their confidence that they would attain them. In partial correlation and hierarchical regression analyses, BJW-self predicted confidence in the realization of goals, but was inversely related to delinquent intentions. In contrast, BJW-others was directly related to delinquent intentions but inversely related to confidence in achieving socially legitimate personal goals. These results were not attributable to variations in life satisfaction or in the achievability of participants' goals.

Aim: This study assessed the goals 'new' long-stay clients aim to achieve by being in supported housing (SH), compared the goals stated by clients and staff, and tested whether subgroups of clients can be identified on the basis of their goals, quality of life and psychopathology., Method: Interviews were conducted with 41 clients and 39 staff of supported houses in London and Essex, UK. Descriptive, content and cluster analyses were used to analyse the results., Results: Clients' most frequently reported goal was moving to independent housing, followed by staying healthy, and increasing living skills. A comparison of goals reported by clients and staff showed poor or no agreement between them. Cluster analyses identified two clusters of clients. Cluster A (n = 23) contained those with no stated goals (or with the aim of staying healthy), lower quality of life, and more psychopathology; cluster B (n = 18) included those with an aim to move to independent housing, better quality of life, and less psychopathology., Conclusion: In the UK, more staff training may be needed to identify and achieve the goals of the 'new' long-stay clients. For a subgroup of these clients, SH may still be a long-term care setting; while for another subgroup, new forms of rehabilitation in SH and better opportunities to leave SH may have to be developed. More conceptual and practical efforts are needed to manage the transformation of many settings from homes for life to transitional places where residents receive specific interventions.

Forty-nine adults with learning disabilities living in 13 small staffed homes in England were studied as part of larger projects in 1997 and again in 2000. A pre-test/post-test comparison group design was used to assess differences in staff implementation of "active support," service user engagement in meaningful activities and adaptive behaviour. Homes which adopted active support showed significantly increased engagement in meaningful activity and adaptive behaviour between 1997 and 2000. A comparison group showed no significant change.

Drawing from the Social Model of disability, six people with learning difficulties participated over 18 months in researching their own lived experiences. The method involved weekly group discussions supplemented by participant observation. The study's value stems from in-depth inquiry, which included the participants in the data collection, analysis, dissemination and consequences that they found meaningful. The participants lived in nurse managed community homes. They described how they had faced social and economic exclusion, for example, concerning marriage, child rearing and decently paid employment. With the assistance of nursing staff, the participants had overcome many other social barriers and were enjoying a wide range of activities and choices. Consequently, the participants lived varied lives which they described as interesting and worthwhile. Contemporary models of nursing had successfully directed nursing staff to support 'ordinary living'. However, some disabling assumptions were evident within contemporary nursing. Hence, models of nursing and service delivery were helping both to create lifestyles that the participants valued, whilst simultaneously contributing to their disempowerment.

Two hundred and five people with intellectual disability, aged 18 years or over, and living in health- or social-services-managed community housing, completed sleep and behaviour questionnaires. An 85.7% return rate was achieved. Settling problems were present in 26.8% and night waking in 55.6% of the subjects. Parasomnias were present in 14% of subjects and 15% of the sample showed some features associated with sleep-related breathing problems. Factors associated with sleep-related problems included gender, aetiology of intellectual disability, epilepsy, treatment with antiepileptic medication, evening caffeine consumption, nocturnal urinary incontinence and ability to communicate. Significant sleep-related problems were demonstrated in this population; some of these problems might be avoided by simple measures.

Background: The baseline findings from a controlled study of the effect of a public education campaign on community attitudes to mental illness are presented., Method: A census of attitudes to mental illness was conducted in two areas, prior to the opening of supported houses for the mentally ill. Factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory revealed three components: Fear and Exclusion, Social Control and Goodwill., Results: The only determinant of Fear and Exclusion was having children. The main determinants of Social Control were social class, ethnic origin, age, having suffered mental illness and having children. The main determinant of Goodwill was educational level. The attitude factors were predictive of respondents' behavioural intentions toward the mentally ill. Respondents with children and non-Caucasians were more likely to object to the mentally ill living in their neighbourhood., Conclusions: Any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children and non-Caucasians, as these groups are more likely to object.

Background: We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge., Method: A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness., Results: Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account, age had no effect on Social Control, and the effect of social class and ethnic origin was diminished. Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness., Conclusions: The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

This paper is concerned with the care of the most difficult and severely disabled new patients presenting to mental health services in the U.K. Questions of definition will be examined and the clinical and social characteristics of the population discussed. Since the defining characteristics (and prevalence) of this group are strongly affected by the overall service context, the range of community provisions within one health district (Cambridge) will be described. Examples of a new kind of institutional solution-the 'ward-in-a-house'-will then be presented, together with the underlying principles of management and care. The benefits and limitations of the model will be discussed.

Thirteen people with severe or profound mental retardation identified by their local service agencies as presenting the most serious problem behaviour were transferred from institutional care to specialized group homes. A multiple time-series design and direct observation were used to evaluate whether there was any change in their level of participation in meaningful activity; social interaction and problem behaviour were also observed. Participation increased significantly on transfer and included a wider range of activities. The majority of participants did not increase their major problem behaviour. The results support the view that individualised community-based placements can replace institutions for this group of clients.

This paper offers a comprehensive framework for service evaluation relevant to a new respite care unit, and reports some results of its application. On existing evidence the planning assumption of a preventive effect of respite care, in avoiding admission to institutional care, is argued to be unjustifiable. The results indicate that this unit had a high non-attendance and fall-out rate, and no incentives to co-operate with alternative services or to operate efficiently. Broad estimates of cost parities revealed that attenders at the unit sacrificed considerable amounts of alternative forms of care.

Data were collected on abortion referral rates, single young maternity rates and uptake of contraceptive services in order to identify specific areas of unmet need in the Nottingham Health District. Comparisons were made between boroughs and in the City of Nottingham between electoral wards. There was a direct relationship between abortion rate, single young maternity rate and social disadvantage. Analysis of contraceptive usage suggested a more ineffective service in the inner city, which has implications for the more efficient use of resources in the future. Targeting of consumer acceptable services to residents of the inner city and teenagers in general was recommended as a result of the study. For future planning a more useful routine data set was developed to record the activity at family planning clinics.