Residential care in the community for long-term patients

Since the front doors of the mental hospital have been partially closed since 1978 and completely closed from 1982 onwards, an important aspect of our community-based service has been the provision of residential care for long-term patients.

Two residential facilities are available in South-Verona, as part of the CPS. One is a 24-hour-staffed supervised hostel, opened in 1990, with six places for users in need of continuous supervision. It consists of two apartments in a residential block of flats: a large one for the hostel itself, and a smaller adjoining one, used as a base by the staff. The other, a group home with four places, also located in a residential block, provides six-hours of staff supervision on working days.

Each facility is co-ordinated by an educatore (counsellor), assisted by two operatori di assistenza per shift (one overnight). Community nurses visit daily to administer medication and are on call overnight and on weekends for medical and psychiatric emergencies. The psychiatrist in charge of the Mental Health Centre assures medical supervision, assisted by a resident physician. Goals of the programme in both facilities are to provide accommodation, care, supervision and rehabilitation in daily living and social skills to the residents. In fact, while they are assured they may remain indefinitely if they want to, they are also involved in activities to develop those daily living skills and social capabilities required for more independent living.

Residents graduating from the supervised hostel may move to the group home, while those of the group home may move on to independent living. As an alternative, in order to avoid dislocation, a plan is under discussion to gradually withdraw staff supervision and assign the flat where the group home is based to the residents themselves, who will eventually assume full responsibility for it. Staff will continue to visit occasionally, while nurses will be on call overnight and during weekends. In effect, the group home will be converted into supervised housing. Instead of displacing residents, the service will move out to start another group home elsewhere.

All residents are engaged in household duties and some of them participate in day-time rehabilitation or vocational activities outside the home. A self-care group teaches personal hygiene and grooming, while a weekly joint meeting (staff and residents) provides the opportunity for discussing interpersonal issues and making group decisions for everyday life and recreational activities. The staff of the supervised hostel organize weekend social and recreational activities and residents of the group home are also invited. Summer, and occasionally winter vacations are usually very successful and very much appreciated by the residents.

More recently, two interesting additional services have expanded the role of these facilities. The service module of the hostel now includes a place for a patient independent enough to require supervision only in a 'next-door' way. Also the group home now accepts day patients, i.e. users living independently, who may benefit from participating in group rehabilitation activities. This day care service has proven very successful, probably because of the stability and harmony of the residential group.

Both facilities are funded by the ULSS (the local health authority) and residents are not required to contribute in any way, except for recreational activities and vacations.