The domus philosophy: A prospective evaluation of two residential units for the elderly mentally ill

Abstract

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.

Economic impact of a specialist outreach team in residential and nursing home settings

“…These results are similar to those obtained by Dean et al, 13 who showed improvements in cognitive function after 3 months with a home based care programme for the elderly. Though the intervention group showed improved mental health functioning, no significant differences were found in the level of urinary incontinence between the groups.…”

Correlates of aggressive behavior in dementia

“…Noise, relocation to an unfamiliar place, darkness and physical restraints have all been shown to precipitate behavioral problems or aggravate old ones ( Jenike, 1986;Rabins, 1984). Many cognitively impaired patients show disturbed behavior and disorientation for at least 3 months after a move, although this is more common in those with moderate rather than severe dementia (Dean et al, 1993;Lawlor, 1996).…”

A tiered model of psychogeriatric service delivery: an evidence-based approach

“…These patients require treatment in a facility specialising in the management of old age neurobehavioural disorders that requires secure grounds, more and better trained staff than mainstream nursing homes. The facility might be formally a part of the comprehensive psychogeriatric service but frequently they are located within mainstream nursing homes as a special care unit or as a stand-alone community residence (Ritchie et al, 1992;Dean et al, 1993;Belleli et al, 1998). Sometimes the patient may require brief admission to an acute psychogeriatric unit to settle the behaviour (Kunik et al, 1996;Wiener et al, 2001).…”