For some years now, working with long-stay populations such as the mentally handicapped and elderly mentally infirm has been a “Cinderella” area with difficulties in attracting high quality staff and resources. This has resulted in poor quality of care. There may be many reasons for the relative lack of interest shown by professionals in the problems of long-term care, but two stand out as potentially important:
(a) the rate of client behaviour change and
(b) the permanency of client behaviour change.
Within the areas of out-patient neuroses and other similar nonchronic problems, it is often expected that change can be brought about relatively quickly by trained therapists (cf. Marks, 1981a, b). With chronic problems, however, the situation is quite different. Usually change is only brought about slowly, if at all.
Secondly, with an out-patient population, given new ways with which to cope with their problems, we hope that somehow the natural contingencies will “trap” (Baer and Wolf, 1970) the new repertoires. The client gets better, stays better, and does not come back. From our own experience of this type of work, the situation is rarely so sanguine and with chronic populations, there isn't usually even much reason for hope. We are all too familiar with changes occurring and then the group of clients begins rapidly to slip back to where they started from (or beyond!). We have become accustomed to blaming poor motivation, inadequate training, organizational variables, Hawthorne effects, and so on. Almost anything except ourselves.
In this paper, we look at some failures and some relative successes in achieving desired change in long-stay institutions, and ask the questions “How?” and “Why?”. It should be obvious before we go any further that we do not have definite answers, but the questions are still worth asking. Work with long-stay populations can be extremely exasperating and demanding, but appeals to abandon the large institutions where such groups reside are defeatist.