ABSTRACT
Independent-sector provision of residential care in the UK has grown considerably over the past ten years, from a very low (DHSS 1975) and, some would argue, inadequate baseline (House of Commons 1994a). Much of the growth in provision has been in private homes for elderly people (OPCS 1987), but there has also been a growth in community residential facilities for mentally ill people in the UK (Huxley 1993a) and in the USA (Randolph et al. 1991). Large institutions have been reduced in size and smaller units developed in community settings, along with independent living for less dependent people. There has been considerable controversy about the place of residential units in community care (Huxley 1992) and great concern, particularly in the USA, about the inappropriate placement of mentally ill people in nursing homes (these are not the same as nursing homes in the UK because relatively little nursing care is provided in them, and many residents are not in need of physical care) (Warner 1985). Geller and Fisher’s (1993) argument that mentally ill people move, over time, through a series of residential settings, from the more restrictive to the less restrictive, is not supported by the evidence. Segal and Liese (1991) also found that though service providers assumed a continuum of care was provided, residents were, in fact, obtaining residential care at critical periods in their lives (perhaps for long periods) rather than progressing through a continuum. Lelliot and others (1993) suggest that the provision of residential services in the UK still remains below recommended levels, and that more, not less, residential accommodation is required. The House of Commons Health Committee (House of Commons 1994a) recommended that the Department of Health issue instructions on minimum acceptable levels of provision for ‘staffed community houses’ and that services should be inspected every three years and rated against these national minimum standards.
