An observational study was carried out in order to measure the quality of life of elderly people in two different types of long-stay care (two NHS nursing homes and a hospital ward). This formed part of a wider evaluation study of these two forms of institutional care. Qualitative techniques provided insights into the behaviours, moods, interactions and atmospheres in the settings, which were difficult to measure using traditional survey approaches. The observational study showed that it is.essential not to rely solely on interview material, and assessments of mental and physical functioning, when evaluating long-stay care. Characteristics of ‘total institutions’ clearly emerged from the analyses of the hospital ward, although the inclusion of the hospital patients' Club in the study revealed that these need not be inevitable, and that both the ward and the homes could be improved if modelled on the more autonomous and flexible philosophy of the Club.
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