Background to the Research

• As the number of older people needing social care rises, and residential care homes account for a significant proportion of social care resources, the quality of the services provided by these homes has come under greater scrutiny. Alongside this process, understanding and treatment of dementia is growing. This report seeks to find out if the quality of care, and life in residential care, is better for older people with dementia in a small group-living home or in a larger home.
  

Research Approach

• A sample of 4 new residents, male and female, who had been diagnosed with dementia were selected in each home using a cluster sample. In October 1996 a baseline was established using the Revised Elderly Persons' Disability Scale. After 6 months, the same residents were reassessed using the same scale and the two sets of data analysed using computer software to test for significant behavioural differences between the two groups.
• An ethnographic study was carried out in which staff in the homes completed time sampling forms on 2 successive days, record of behaviour forms and monitoring forms on signs of well-being. The researcher also carried out interviews with a sample of residents.
  

Main Findings

• *Newson House was opened in 1990, it is a one-storey building with 24 single bedrooms and 3 double beds and accommodates 32 people older people with dementia. *Merrion House was re-opened in 1996 and has four small group living units comprising nine residents each.
• Dementia causes increased 'confusion' (deterioration in mental ability). Analysis of the data from Newson House showed a slight increase in the level of confusion among residents over the 6 month period, there were slight improvements in all other areas - physical abilities, self-help, sociability, dependency and psychiatric problems.
• Analysis of the data showed there was significant deterioration in all areas among the sample from Merrion House, except for their physical abilities which improved. In Merrion House, improved physical abilities did not appear to lead to improved quality of life, rather there was an interplay with deterioration in all other areas.
• However, individual profiles of 2 of the Merrion House residents in the sample show that the physical abilities and psychiatric behaviours of one improved and the self-help abilities and psychiatric behaviours of the other improved.
• In Newson house, two of the residents' confusion lessened, one's sociability improved and the nursing dependency of two lessened. Therefore, on an individual basis, there were more signs of improvement (rementia) in Newson house.
• There were some signs of institutionalisation in Merrion House where the individual is lost to the conformity of the group. When a resident did not conform to the norms of the group, staff in Merrion House appeared to perceive this behaviour as more problematic than staff in Newson House.
• In Newson House, staff endeavour to adapt the home to meet the needs of individual residents instead of residents needing to adapt to the existing culture in the home. Hence the mean scores of all residents in Merrion House after 6 months indicate higher levels of problems except in the area of physical ability. Yet residents became less agitated, had fewer psychiatric problems and had learned more self-help skills during their stay in Merrion House.
• In relation to Signs of Well Being, residents in both homes experienced a broad range of emotions and asserted themselves, therefore it is seen that quality of life is experienced by all residents. There is some evidence that enabling each individual resident to maintain their past activities, interests and relationships may maintain and enhance their current quality of life.
• Residential care in both homes provides quality of care and quality of life for the residents. This repudiates the idea that institutions inevitably increase dependence and have an adverse effect on the life experiences of their residents.

Conclusions

• The quality of care and of life is not significantly different in either home because the critical factor in residential homes is seen to be the culture developed by residential staff.
• Progress has been made through the application of the concept of 'the new dementia culture' which has personhood at the centre. In this culture it is the responsibility of staff to empower residents so that they can develop working alliances to resolve problems together and in this way, older people with dementia can regain skills (rementia).

Recommendations

• It is important to see dementia as a disability and to focus on rehabilitation.
• Staff need to see carers and people with dementia as the individual experts of their/relations condition.
• The Labour Government approach to Health and Social Services of 'best value' is helpful.
• Care staff need to recognise that they create the culture in residential homes and quality of care and life occur in the interactions between care staff and residents.
• The key element in promoting quality of care and life, and consequently rementia, is to train Care Assistants to work as reflective practitioners and not in a reactive role.
• A further study should be undertaken to explore the effectiveness of residential care in various homes with a larger sample and Home Carers and Care Assistants should be the 'research assistants' in this study.