FUNCTIONING AND LEVEL OF DISABILITY IN EVERYDAY LIVING
5.2.3 Functioning in the last thirty days
The WHO Disability Assessment Scale (DAS II) is a measure of functioning and disability. The scale is a 12-item questionnaire and each item is rated on a five point scale from 0 – 4. Total scores can range from 0 – 48 with a lower score indicating less disability. It assesses functioning and disabilities in the
last 30 days. The domains of functioning assessed by the DAS II include understanding and
communicating, getting around, self care, getting along with others, household and work activities and participation in society. Two DAS II questionnaires were employed in the current study. One was completed by the key worker for the resident and one was based on the self
A SURVEY AND EVALUATION OF COMMUNITY RESIDENTIAL MENTAL HEALTH SERVICES IN IRELAND 73
Item No problem Minor / mild Moderate
/ severe Overactive, aggressive, disruptive or agitated behaviour 65.9 21.0 11.6
Non-accidental self-injury 95.7 2.2 0.7
Problem drinking or drug taking 84.1 14.5 0.7
Cognitive problems 42.0 38.4 17.4
Physical illness or disability problems 60.9 27.5 10.8
Problems associated with hallucinations and delusions 47.8 34.0 16.6
Problems with depressed mood 47.8 44.2 6.5
Other mental and behavioural problems 47.8 34.0 14.4
Problems with relationships 44.9 39.1 15.2
Problems with activities of daily living 33.3 38.4 26.8
Problems with occupation and activities 37.0 34.0 26.1
Table 5.1 Percentage of residents in each category of the HoNOS individual items
Disability No Mild Moderate Severe
disability disability disability disability
Cardiovascular 84.1 10.1 5.8 0
Respiratory 85.5 5.8 8.7 0
Digestive 83.3 11.6 4.3 0.7
Urogential 92.0 2.2 4.3 1.4
Motor 89.1 5.8 4.3 0.7
Central nervous system 87.0 6.5 6.5 0
Metabolic / endocrine system 82.6 9.4 7.2 0.7
Infective system (including HIV) 100 0 0 0
report of the residents. Thus two DAS II questionnaires were completed for every resident. This allowed comparison between the resident’s perception of their own functioning and the key worker’s perception of the functioning of the resident. There was a significant positive correlation, albeit weak, between resident’s total DAS II scores and the key worker’s rating of the resident (Pearson’s r = 0.314, p < 0.001). However, it is important to note that while there was a significant correlation between the scores, the total mean scores differed between the residents’ and the key workers’ ratings (t (237.3) = -5.43, p < 0.001). The total mean score for the residents’ ratings was 6.35 (range 0 – 34) and the total mean score provided by the key workers was 12.51 (range 0 – 46). Kruskal Wallis Tests on both scores yielded significant differences between residents in high, medium and low support residences (resident ratings p < 0.01; key worker ratings (p < 0.001). In both analyses, not unexpectedly, the high support residents had greater mean scores suggesting that they experienced greater disability than the medium and low support residents.
5.3
APPROPRIATENESS OF
PLACEMENT
The key workers were asked to indicate whether they thought the resident was appropriately placed in the residence at the time of the study. Of all residents, 85% were reported as being appropriately placed and 2% of the residents’ key workers reported that they were unsure of the appropriateness of placement. A total of 17 (13%) residents were reported by key workers as being inappropriately placed. Of these, ten were in high support residences, two were in medium support residences and five were in low support residences. Only three residents (one each in high, medium and low residences) were reported as being more appropriately
placed in independent living. It was reported that four would be better placed in an independent group home (two high and two low support residents) and four (two high and two low support residents) would be better placed in a medium support home. A total of two residents would be better placed in a higher support (one high and one medium support resident) and another two would be better placed in a nursing home (two high support residents). The main barrier to appropriate placement was unavailable facilities (n = 8), while three reported that a facility was available but had a waiting list. The mental state of the resident was reported as the precluding discharge of three of the residents inappropriately placed. In two of the inappropriately placed residents, the resident’s relatives had refused transfers and in one the doctor’s opinion was considered to have been a barrier to appropriate placement. The key workers were asked where they saw the resident living in six months time. A total of 88% of the key workers reported that the residents would be living in the same residences. Only six residents were predicted to be living in lower support and only two were predicted as living in independent accommodation.
5.4
SUMMARY
A total of 138 residents participated in the interview stage of the study. This sample was 16% of the total number of residents in the three study areas. The majority of the participating sample of residents were from high support residences (59%), while 18% were from medium support and 22% from low support. The sample of residents interviewed was representative of those in all the residences in terms of gender and age. The employment question for the sample of residents interviewed enquired as to whether the resident was in training, education or retired while the question for the nursing officers only sought the total number of residents in sheltered or paid employment. When looking at the proportions in sheltered and paid
the residences and the residents that were interviewed were similar for paid
employment. For example, 7% of the sample interviewed was in paid employment compared to 5% of all residents in the residences. Of the residents interviewed, 27% were in sheltered employment compared to 15% of the total sample.
The duration of illness among the
residents interviewed ranged from three to sixty-two years. The average duration of illness was 26 years and the average age at first contact with services was 26 years. The residents had lived in their current accommodation for an average of seven years. Residents in the medium support residences were significantly longer in their current accommodation than those in high or low support. Notwithstanding the statistical significance of the result, there was little difference in the average length of time in the current accommodation, with a difference of approximately three years from the highest average length of time to the lowest. The majority of the residents had had previous
hospitalisations, but a smaller percentage had had inpatient hospitalisations in the previous five years. Only a few of the residents were reported as having an absence of symptoms in the previous five years. Of those who had symptoms, for the majority the symptoms were
persistent, but stable. This is in line with findings regarding current symptoms where the resident’s mean score indicated that symptoms were present, but mild. The majority of the residents were judged by key worker as being appropriately placed at the time of the study. Of those who were inappropriately placed, it was reported that the majority would be better placed in independent group homes or in medium support residences. The main barriers perceived by key workers to appropriate placement were unavailability of appropriate facilities. Furthermore, key workers predicted that the majority of residents would be in the same accommodation in six months’ time. There was a significant difference in the overall current level of functioning of the residents between high, medium and low
support residences, with residents from high support having poorer functioning to those in medium or low support. The residents in high support were reported as having moderate difficulties in social or occupational functioning, while those in medium and low support were reported as having mild difficulties.
Regarding clinical and social functioning in the previous two weeks, the majority of the residents were reported by key workers as having no problems. An exception to this was in relation to activities of daily living. Over one-third of the residents were reported as having mild problems and over a quarter were reported as having
moderate to severe difficulties. There was a significant difference between the groups on the total score, indicating that the high support residents had poorer functioning to those in medium and low support.
The majority of residents were reported by the key workers as having no current physical health problems and there was no significant difference between the physical health functioning of residents in high, medium and low support residences. Functioning and disability in relation to communication, self-care, social contacts, activities and participation in society over the last month were rated by key workers and by the residents themselves. The results showed that overall, the key workers rated the residents’ functioning as lower than that provided by the resident’s themselves. There was weak significant positive correlation between the scores, demonstrating that the higher the
resident’s rating of functioning, the higher the key worker’s rating also. The residents in high support were reported, both by the key workers and by themselves, as functioning at a lower level than those in medium or low support.
In most areas the high support residents were functioning at a significantly lower level than the medium and low support residents although the extent to which this lower level of functioning would affect independent living is questionable. For example, the findings highlighted that the
majority of the residents were experiencing few problems in clinical, physical and social functioning and it was only in the activities of daily living that mild to moderate problems were evident. Yet the key workers judged the majority of residents to be appropriately placed, whether in high, medium or low support facilities. This anomaly causes some concern and would suggest that the care provided to residents in community residences may over-provide for their needs.