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Biomedical subjects

W R Shadish

Publications and source records attributed to W R Shadish.

31 records · Page 2Linked to original sources
PubMed1984

The social integration of psychiatric patients in nursing homes.

The authors explored self-reports of the social integration of 163 chronically ill psychiatric patients who were admitted to 12 nursing homes over a 1-year period. Results suggest that nursing home care for psychiatric patients is custodial and institutional in character and that the social integration of such patients is generally low. Nursing home patients had lower scores than outpatients but not inpatients on a measure of social participation; they were similar to both these groups on measures of spending and employment. Levels of social integration changed little over 1 year, either for better or for worse.

Adolescent↗
PubMed1984

Mental patients in nursing homes: their characteristics and treatment.

Nursing homes have become a primary care site for chronic mental patients. The present study reports an empirical investigation of the characteristics of 163 mental patients in nursing homes in a large midwestern city and of the treatment they receive. These mental patients tended to be chronic schizophrenics with an established history of poor social coping. Their average age was 48 years, and they had no obvious physical ailments that would account for their nursing-home placements. These patients received an average of three or four medications each, a figure that tended to increase over a 1-year period. Conversely, relatively little psychosocial treatment is provided these patients, and such treatment tends to decrease over a year. Results are discussed in terms of the relative emphasis in nursing homes on custodial care versus active psychosocial treatment.

Custodial Care↗
PubMed1984

Nursing homes: the new total institution in mental-health policy.

Recent opinion suggests that the facto mental-health policy in this country is institutionalization, rhetoric to the contrary notwithstanding. The nursing-home industry is the center of that policy. More patients with chronic psychiatric disorders may reside in, and more mental-health money may go to, nursing homes than to any other mental-health setting. Starting from Goffman's classic definition of the central feature of a total institution, the present study documents, through a random sample of mental-health facilities, that nursing homes are virtually indistinguishable from hospitals on some characteristics that define a total institution and that both hospitals and nursing homes are clearly distinguishable from a variety of outpatient mental-health settings. In view of the magnitude of the role played by nursing homes in the care of mental patients, it is concluded that the nursing home is the new total institution of mental-health policy.

Health Policy↗
PubMed1982

Criteria for success in deinstitutionalization: perceptions of nursing homes by different interest groups.

Studies of deinstitutionalization often use a limited set of criteria by which to judge success. Social integration and recidivism, for example, are particularly popular criteria. Yet such criteria may not reflect the diverse settings in which community care occurs, nor the diverse views of success held by different interest groups. The present study presents a methodology for developing more comprehensive criteria for evaluating social programs, including deinstitutionalization. The methodology is illustrated by analyzing the perceptions of different interest groups about the nature of successful care for mental patients in nursing homes.

Attitude of Health Personnel↗
PubMed1981

Nursing home care for mental patients: descriptive data and some propositions.

Nursing homes play an important role in the community-based care of chronic mental patients, yet there is little research in that setting. The present study gathered and analyzed descriptive data on 20 nursing homes in a large urban area, including data about structure, staffing, policy, treatment, residents, discharge, psychosocial climate, and neighborhood characteristics. Results suggested a clear difference between skilled nursing versus intermediate care facilities, with the latter playing a larger role in caring for mental patients. More important, data suggested such facilities play primarily a custodial rather than treatment role, and that managers expect patients in nursing homes to stay indefinitely. In view of this, our justifications for community care, such as social integration, need to be examined anew.

Chronic Disease↗
PubMed1981

Nursing homes and chronic mental patients.

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us recognize problems in the rationales for deinstitutionalization and community care. Problems with three concepts that were central to deinstitutionalization are examined--the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization--custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more constructive role in mental health policy.

Chronic Disease↗
PubMed1981

Long-term community care: mental health policy in the face of reality.

Nursing homes play an important role in the care of chronic mental patients, and they could be used as one base on which to build a better system of care. Carling, in his article "Nursing Homes and Chronic Mental Patients: A Second Opinion," appears to question aspects of this contention. His efforts in this regard are interesting but unconvincing, though his thoughtful comments usefully elaborate the problems inherent in trying to incorporate nursing homes into the mainstream of mental health care. He more successfully uses his article to describe the National Plan for the Chronically Mentally Ill, a recent policy proposal of great merit that may some day significantly benefit metal patients. Meanwhile, mental health policy must face the reality that nursing homes are providing useful services to many chronic mental patients who have been inadequately served by current community care programs. This is not likely to change in the foreseeable future. Policy advocates need to attend to practical alternatives, not just to idealized possibilities.

Chronic Disease↗