MethodThis carer led qualitative study examined working practices in 24 hour long term care settings, including hospitals, nursing and residential homes with the aim of finding out and making recommendations about such settings. Using semi-structured interviews managers, nurses and care assistants were asked about work practices such as how they coped with difficult behaviour, and about their own shifts, staffing levels, retention and training. Relatives were asked about their perceptions of care and their role, and residents with dementia about their care. ResultsStaff reported that residents presented with increasingly challenging behaviour compared to the past, and sometimes staffing levels and skills were inadequate.Hospital settings had most problems with staffing levels, retention, staff-relative relationships and staff support systems. Relatives saw their own role as positive.People with dementia of varying severity could usefully evaluate some of the service they received. DiscussionDementia specific training and education of staff in all long term care settings including induction should address managing problem behaviour in dementia and improve staff fulfilment and relatives' satisfaction. We recommend that long stay hospitals may not be appropriate as a home for life, and that homes should be able to cater flexibly for a range of needs.

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