Administrative and financial responsibilities for sheltered housing for mentally ill and handicapped persons in Germany and its impact on housing supply.

BACKGROUND: The integration of mentally ill and handicapped persons in the society requires the availability of various forms of sheltered housing in the community, most important ambulatory (supported) housing facilities. In Germany the administrative and financial responsibility for sheltered housing for mental ill and handicapped persons is usually assigned to two authorities: the welfare authorities at Lander (state) level are responsible for hostels, the welfare authorities on community and district level are responsible for ambulatory housing. However some Lander have distributed these responsibilities differently and other Lander offer subsidy programmes to promote the implementation of ambulatory housing. OBJECTIVE: To evaluate the different modes of distributing the responsibilities for administration and financing of sheltered housing for their impact on the supply with ambulatory and stationary housing in the 16 German Lander. METHOD: (1) Analysis of the practise of distributing the responsibilities for housing between Lander and community welfare-authorities in the 16 Lander. Analysis of the subsidy programmes in the Lander that aim to promote the implementation of ambulatory housing. (2) Assessment of the capacities in housing for mentally ill and handicapped persons in the Lander. (3) Comparing (1) and (2). RESULTS AND DISCUSSION: Lander that have the responsibilities for ambulatory housing and for hostels organised on the same authority-level, offer generally more housing in ambulatory facilities and less in hostels than Lander that do not. However, three Lander, despite having all responsibilities for housing at one authority level, provide accommodation for mentally ill and handicapped persons predominantly in hostels. There are so far no indications whether it would be more favourable to have a unique authority for housing based on Lander or on community level. Subsidy programmes to promote the implementation of supported housing are successful if they sponsor at least 50% of costs and if they exist for a considerable duration of time. CONCLUSION: Organising the responsibilities for housing for mental ill and handicapped persons on one authority level and the availability of subsidy programmes have a positive impact on the supply with ambulatory housing. However other factors also have to be considered to influence the supply with ambulatory housing, such as political will, attitudes towards the mentally ill, interests of hostel operators, pre-existing hostel infrastructure, available funds. These factors need to be researched further.

[Patient suitability for discharge from psychiatric hospitals]. / Uber die Entlassbarkeit von Patienten in psychiatrischen Krankenhäusern.

OBJECTIVE: To assess the possibility of discharging psychiatric inpatients of two large Mental Hospitals in Lower Austria. METHODS: A point prevalence study was performed in 1992. Treating psychiatrists were asked to evaluate the possibility to discharge patients under the hypothetical assumption that a broad range of residential facilities were available. RESULTS: The inpatient proportion had decreased from 2179 in 1974 to 1032 in 1992. Of the 1992 population 75.7% might be discharged. Most patients (41.5%) were regarded as needing a permanently staffed home. CONCLUSIONS: Although the inpopulation of the two large Mental Hospitals studied had decreased over a period of 18 years already by over 50 percent, the results of this study show that there is a large potential for further reform. Since the evaluation was carried out by the treating psychiatrists in the hospital, who might have been in a conflict of interests or might have preferred the treatment they are providing themselves, this finding is particularly remarkable.

Problems encountered in home health service delivery to persons with AIDS.

This paper discusses the problems encountered in delivering home health services to persons with AIDS (PWAs), based on telephone interviews conducted with administrators of 68 home care agencies located in 10 high AIDS prevalence areas nationwide. Lack of adequate insurance mechanisms was cited as a major barrier to serving PWAs. Some respondents indicated a greater potential for stress among staff treating PWAs, given the youth of this population, the intensity of illness manifestations, and the complexity of treatment regimens. Other difficulties that are especially prevalent among PWAs include the absence of informal caregivers, residence in unsafe areas, and patient and family drug abuse. Although many of the reported patient problems are not unique to PWAs, the frequency with which they occur in this population suggests a need for expanded public and private insurance coverage for custodial care, and for expanded availability of AIDS-specific housing, if excessive hospitalization is to be avoided.