Original Article

Benefits of Boarding Home Placement in Patients with Schizophrenia

Authors: Robert G. Bota, MD, J Stuart Munro, MD, Kemal Sagduyu, MD

Abstract

Objective: To determine if boarding home placement of patients with schizophrenia decreases the need for acute inpatient treatment, during and after the placement.


Method: Data was collected from the medical records of 74 patients initially diagnosed with schizophrenia in our hospital from July 2001 to June 2002. The progress of these patients was then tracked until February 2005. Data gathered was analyzed for standard deviation, correlations, paired sample test and t test two-tailed analysis.


Results: Of those patients, 35 had no boarding home (BH) placement and used our inpatient services with a frequency of 1.1 day a month on average. Another 20 patients were placed in a BH after an average period of ten months without placement in a BH. During the pre-BH period they needed more acute inpatient care (3.3 versus 1.1 day/month) than patients that did not receive BH services (P < 0.0003). Following BH placement, these 20 patients spent an average of 14 months in a BH requiring only 0.34 days/month of inpatient treatment. On discharge from the BH, for the next eleven months they needed only 0.22 days/month of inpatient services. This rate of hospitalization was less than that of the same patients before BH placement (P = 0.0003) and patients that were not placed in a BH (P < 0.001). The remaining 19 patients were lost to follow-up, likely as result of their travel patterns.


Conclusion: The patients who received BH care required fewer days of hospitalization than the same patients in the pre-BH period and fewer days of hospitalization than the patients who did not receive BH care. This effect persisted for at least 11 months after leaving the boarding home.


Key Points


* From all the factors postulated to influence schizophrenia, family environment, substance abuse and duration of untreated psychosis are the most important modifiable predictors of outcome.


* A structured environment can positively influence some of the modifiable factors.


* Patients with psychiatric disabilities are more likely to prefer living in a setting with less behavioral demands, such as living alone, or in a state of homelessness. These environments are not conducive to their mental well being, and lead to less desirable situations, such as long-term psychiatric hospitalizations and crisis placement.


* In terms of cost, boarding homes (BH) and group homes are at the lower end when compared with extended hospital care. The disadvantages of BH, such as lack of support and stimulation, can be overcome by appropriately training the staff and creating a better therapeutic environment.

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