CLINICAL HANDBOOK OF SCHIZOPHRENIA

350 V. SYSTEMS OF CARESupportive HousingThe focus of supportive housing is first to find the house for the patient in need, then toprovide psychiatric services (Tsemberis & Eisenberg, 2000). In an attempt to ensure stabilityand to prevent decompensation, supportive housing became available as a longterm,nonacute residential treatment modality that is not directly connected to psychiatricservices. In comparison to patients in transitional housing, chronically mentally ill patientsadmitted to supportive housing programs are usually more stable, and require lessstructured environments and less availability of psychiatric services. However, psychiatricsupportive services are easily accessible whenever there is a need to improve a patient’soverall condition or to prevent deterioration. Although patients enjoy considerable autonomyand independence, they may need some supportive services. In comparison to patientsin transitional housing, patients usually can stay indefinitely in supportive housing.Board and Care HomesBoard and care homes offer affordable, supportive, long-term care services in a variety ofsettings, ranging from small, adult foster care homes to larger, quasi-institutional, hotellikefacilities. These facilities can be operated either privately or by charitable nonprofitorganizations (Kalymun & Seip, 1990). These homes offer the widest range, in terms ofnumbers of patients, of all residential approaches: Some accommodate only a few patients,whereas others have more than 100 patients.These facilities provide supervised living environments, arrangements for medicalappointments, transportation, laundry and cleaning service, three meals a day, and personalassistance. Many of these homes offer care to former long-stay patients in mentalhospitals and other chronically mentally ill individuals. In the absence of family support,board and care homes are a valuable alternative to homelessness and to nursing homeplacement among older adults with mental illness.Care must be exercised in choosing board and care facilities. Many are excellent, butsome operators, faced with financial pressures (Blaustein & Viek, 1987), reduce operatingexpenses to the extent that some patients may be disadvantaged. For example, less skilled(and less expensive) caregiving staff may provide inadequate levels of support. Residents oftenlack the power to demand adequate support, especially given the lack of alternative, affordablelong-term care living environments. As a result, advocates for the mentally ill andfor older adult populations have sought increased regulation and monitoring of board andcare homes to ensure the safety and well-being of residents. However, little progress hasbeen made in either passing new legislation or increasing the monitoring and enforcement ofcurrent regulations, sometimes because of the unwillingness of Federal and state governmentdecision makers to allocate additional resources for board and care facilities.Intermediate-Care FacilitiesIntermediate-care facilities provide service for patients with chronic mental illness whohave mild medical conditions that require limited nursing care (e.g., diabetes and hypertension).Thus, patients are admitted to these facilities for monitoring and nursing supervisionof medical problems. At the same time, they receive psychosocial services, such associalization activities and supportive services, as well as psychiatric medication management,to maintain stabilization and to prevent symptom relapse.Patents can stay at the facility as long they need the provided service. However, theymay be transferred to a regular nursing facility if there is a need for skilled nursing care