[Homes for the aged: a source of increasing concern (3). The effect of organizational changes]

The decline of residents of the old people's home we published about in this journal in 1983 and 1985 appears to be able to slow down both by adaptation of the organisation (scaling down the wards and simultaneously increasing the number of them) and the working methods of the staff (oriented towards the residents). The measures we suggested were meant to give the residents more hold of their own lives and to stimulate social contacts. After some changes in the organisation there was no further increase of physical and psychosocial problems of the residents. The newly admitted people benefitted most of the changes. Those who were admitted after these changes did function on a better level than those who were admitted before. Furthermore there was no question of a decline during the first year of stay at the former group, unlike the latter. Even in the group that participated from the start in this research there was an improvement of the physical and psychosocial functioning. Those who died or those who were relocated to a nursing home did not show any change in physical and psychosocial functioning after the measures that were taken in the organisation. But in the last period less people were relocated to nursing homes. Our conclusion is that merely by adaptation of organisation and working methods positive effects can be reached. The next question is whether we can achieve more by giving extra individual stimulation of the people.