• Giovanni Santone, Giovanni de Girolamo, Ian Falloon, Angelo Fioritti, Rocco Micciolo, Angelo Picardi, Enrico Zanalda, and PROGRES Group.
• United Hospitals of Ancona, Politechnic University of Marche Ancona, Italy.
• Soc Psychiatry Psychiatr Epidemiol. 2005 Jul 1; 40 (7): 540-50.

BackgroundAlthough residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics.MethodsStructured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments.ResultsMost RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients' daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables.ConclusionsThis study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients' needs.

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