Rehabilitation and institutionalisation in community care in West Germany.

This study examines the quality of residential care in non-psychiatric nursing homes and psychiatric group homes for a representative epidemiologically-based sample of patients discharged from a psychiatric hospital in West Germany. There were twice as many chronically ill patients in sheltered accommodation as in hospital, 85% of them in nursing homes, which scored badly on all measures of therapeutic environment. This poverty of social environment was correlated with severity of symptoms for schizophrenics, especially with flatness of affect and poverty of speech. Nursing homes were just as likely as hospitals to promote chronic illness and hinder rehabilitation.