A comparison of care in private nursing homes, geriatric and psychogeriatric hospitals

There is considerable debate about who should provide long‐term institutional care for the elderly. We describe and compare care in three private nursing homes, 12 long‐term geriatric and 10 psychogeriatric hospital wards which service a Scottish city using measures of patient dependency, patient morale, regime, environment and staff morale. There was overlap of phsyical dependency between geriatric and psychogeriatric wards but lower dependency in nursing homes. There was a high prevalence of cognitive impairment in all sectors (<80%) limiting the use of patient self‐report measures, but nursing home patients were more satisfied with staff than geriatric patients ( p < 0.05). Nursing home staff had greater job satisfaction than geriatric ( p <0.01) or psychogeriatric ( p < 0.05) staff. There were large variations between homes and between wards in measures of regime and environment, with overlap of most measures between the three settings, suggesting that where care is provided is less important than how it is shaped at the level of individual homes and wards.