SUMMARYThis article reports the findings of a prospective study of the first year of operation of two residential domus units for elderly people with dementia (domus A) and chronic schizophrenia (domus B). Residents, staff and the process of care were assessed at baseline in long-stay mental hospital wards, and at 3 months, 6 months and 12 months after the move to a domus. At 12 months, both domuses were providing more policy choice, resident control, provision for privacy and availability of social and recreational activities than a baseline psychogeriatric ward. Residents' cognitive function improved steadily over the follow-up period in both domuses, significantly so in domus A. There was also some improvement in residents' self-care (ADL) skills at follow-up in both domuses. Residents' communication skills were rated as significantly improved by staff in domus A at all follow-up assessments, and by staff in domus B at 6 months. Compared to baseline, substantially higher levels of activities and interpersonal interactions were observed at follow-up in both domuses. There was no evidence that staff suffered from low job satisfaction or psychological impairment at either domus.KEY wows-Domus, nursing home environments, quality of care, dementia, schizophrenia.The domus philosophy of residential care for elderly people with dementia was developed in the Lewisham and North Southwark Health District in inner London, UK by Elaine Murphy and Alastair Macdonald to replace traditional long-stay mental hospital provision for this group, and also to cater for those with particularly challenging behaviour. It is based on four assumptions: that the domus is the residents' home for life; that the needs of the staff are as important as those of the residents; that the domus should aim to correct the avoidable consequences of dementia, and accommodate those that are unavoidable; and that the residents' individual psychological and emotional needs may take precedence over the physical aspects of their care. Overall, the emphasis of the domus is on maintaining residents' independence and residual capacities as far as possible through active participation in life in the domus.