Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation.

OBJECTIVES: We explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes. METHOD: We undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation. RESULTS: Two pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members. CONCLUSION: Funding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers' long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer's and other dementias plan.

In-kitchen aerosol exposure in twelve cities across the globe.

Poor ventilation and polluting cooking fuels in low-income homes cause high exposure, yet relevant global studies are limited. We assessed exposure to in-kitchen particulate matter (PM2.5 and PM10) employing similar instrumentation in 60 low-income homes across 12 cities: Dhaka (Bangladesh); Chennai (India); Nanjing (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Akure (Nigeria); Blantyre (Malawi); Dar-es-Salaam (Tanzania) and Nairobi (Kenya). Exposure profiles of kitchen occupants showed that fuel, kitchen volume, cooking type and ventilation were the most prominent factors affecting in-kitchen exposure. Different cuisines resulted in varying cooking durations and disproportional exposures. Occupants in Dhaka, Nanjing, Dar-es-Salaam and Nairobi spent > 40% of their cooking time frying (the highest particle emitting cooking activity) compared with âˆ¼ 68% of time spent boiling/stewing in Cairo, Sulaymaniyah and Akure. The highest average PM2.5 (PM10) concentrations were in Dhaka 185 ± 48 (220 ± 58) µg m-3 owing to small kitchen volume, extensive frying and prolonged cooking compared with the lowest in Medellín 10 ± 3 (14 ± 2) µg m-3. Dual ventilation (mechanical and natural) in Chennai, Cairo and Sulaymaniyah reduced average in-kitchen PM2.5 and PM10 by 2.3- and 1.8-times compared with natural ventilation (open doors) in Addis Ababa, Dar-es-Salam and Nairobi. Using charcoal during cooking (Addis Ababa, Blantyre and Nairobi) increased PM2.5 levels by 1.3- and 3.1-times compared with using natural gas (Nanjing, Medellin and Cairo) and LPG (Chennai, Sao Paulo and Sulaymaniyah), respectively. Smaller-volume kitchens (<15 m3; Dhaka and Nanjing) increased cooking exposure compared with their larger-volume counterparts (Medellin, Cairo and Sulaymaniyah). Potential exposure doses were highest for Asian, followed by African, Middle-eastern and South American homes. We recommend increased cooking exhaust extraction, cleaner fuels, awareness on improved cooking practices and minimising passive occupancy in kitchens to mitigate harmful cooking emissions.

Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review.

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

The evident and the hidden factors of vitamin D status in older people during COVID-19 pandemic.

Purpose: Considering the COVID-19 pandemic, vitamin D is a target of research and speculation. Lockdown or home isolation reduces sunlight exposition and increases the risk of vitamin D deficiency. Special attention is needed for older people at risk of both severe forms of COVID-19 and vitamin D deficiency. This review aims to highlight the association of vitamin D and COVID-19 in two instances, the direct influence of vitamin D on the immune system, and the indirect risks for other vitamin D deficiency-related diseases, such as musculoskeletal properties in older persons. Methods: We performed a narrative review. Results: Whether vitamin D deficiency is associated with COVID-19 poor prognosis, and if vitamin D supplementation may improve the post-infection outcomes is still unclear. In any case, the pandemic generates indirect burden, such as the sequence: home isolation, low sunlight exposition, vitamin D deficiency, and fragility fractures. Conclusion: Therefore, it is time to debate how to optimize vitamin D status in older people, especially during the COVID-19 pandemic.

The association between nutritional status, advanced activities of daily living, and cognitive function among Brazilian older adults living in care homes.

Institutionalized older adults are at greater risk of malnutrition, which is associated with cognitive impairment. This study investigated the association between nutritional status, advanced activities of daily living (AADL), and cognitive function among Brazilian older adults living in care homes. This cross-sectional study was conducted on 95 older adults (73.3 ± 12.5 years). Socio-demographic variables, cognitive function (measured by Mini Mental State Examination - MMSE), AADL, Mini Nutritional Assessment (MNA), and anthropometric variables were assessed. Regarding MNA, 37.8% were malnourished, 47.3% were at risk of malnutrition, and 14.9% were well-nourished. Malnourished participants (37.8%) and those with fewer number of AADL (82.3%) showed cognitive decline (MMSE < 24) (p = 0.000 and 0.030, respectively). Inadequate waist-hip ratio was associated with cognitive decline (OR 9.3; 95% IC, 9.06 - 9.85; p = 0.03). Nutritional status and AADL were associated with cognitive function. Nutritional assessment helps to early identify malnutrition and possibly to prevent cognitive impairment.

Mild cognitive impairment in older adults: Analysis of some factors.

Mild cognitive decline is a feared aspect of aging associated with frailty experienced by individuals. OBJECTIVE: To determine the number of elderly people with mild cognitive impairment (MCI); to determine the relationship of sociodemographic and clinical variables by group of individuals with or without MCI and to determine the relationship between MCI assessed by 6CIT and the cognitive domains assessed by the MoCA. METHODS: A correlational study was conducted of 44 elderly individuals attending a day-care center or residing in a care home, with an average age of 88.9 ± 8.8 years who answered a structured interview collecting sociodemographic and clinical data. RESULTS: The elderly living at home had higher average body mass index and number of pathologies than those living in an institution for the elderly (p < 0.01). 63.6% of the elderly did not have MCI, and no differences were found between residential settings. The comparison between 6CIT and MoCA yielded differences in the general domain and in visual, attention, abstraction and, orientation subdomains. CONCLUSION: Cognitive stimulation interventions should be optimized according to the residential setting at the level of comorbidities and nutrition.

O declínio cognitivo leve é um aspecto temido do envelhecimento associado à fragilidade vivenciada pelos indivíduos. OBJETIVO: Determinar o número de idosos com comprometimento neurocognitivo leve; determinar a relação das variáveis sociodemográficas e clínicas por grupo de indivíduos com ou sem comprometimento neurocognitivo leve e determinar a relação entre o comprometimento neurocognitivo leve avaliado pelo 6CIT e os domínios cognitivos avaliados pelo MoCA. MÉTODOS: Estudo correlacional realizado em 44 idosos de instituições de creche e residência permanente, com idade média de 88,9 ± 8,8 anos, que responderam a uma entrevista estruturada composta por dados sociodemográficos e clínicos. RESULTADOS: Os idosos que residem em casa apresentam maior índice de massa corporal médio e número de patologias que os idosos que vivem em uma instituição para idosos (p < 0,01). 63,6% dos idosos não apresentam comprometimento neurocognitivo leve e não são encontradas diferenças ao atravessar o contexto da residência. Na comparação entre 6CIT e MoCA produz diferenças no domínio geral e subdomínios visuais, de atenção, abstração e orientação. CONCLUSÃO: É necessário otimizar as intervenções de estimulação cognitiva de acordo com o contexto de residência no nível de comorbidades e nutrição.

Mild cognitive impairment in older adults: Analysis of some factors / A perturbação neurocognitiva ligeira em idosos: análise de alguns fatores

ABSTRACT Mild cognitive decline is a feared aspect of aging associated with frailty experienced by individuals. Objective: To determine the number of elderly people with mild cognitive impairment (MCI); to determine the relationship of sociodemographic and clinical variables by group of individuals with or without MCI and to determine the relationship between MCI assessed by 6CIT and the cognitive domains assessed by the MoCA. Methods: A correlational study was conducted of 44 elderly individuals attending a day-care center or residing in a care home, with an average age of 88.9 ± 8.8 years who answered a structured interview collecting sociodemographic and clinical data. Results: The elderly living at home had higher average body mass index and number of pathologies than those living in an institution for the elderly (p < 0.01). 63.6% of the elderly did not have MCI, and no differences were found between residential settings. The comparison between 6CIT and MoCA yielded differences in the general domain and in visual, attention, abstraction and, orientation subdomains. Conclusion: Cognitive stimulation interventions should be optimized according to the residential setting at the level of comorbidities and nutrition.

RESUMO O declínio cognitivo leve é um aspecto temido do envelhecimento associado à fragilidade vivenciada pelos indivíduos. Objetivo: Determinar o número de idosos com comprometimento neurocognitivo leve; determinar a relação das variáveis sociodemográficas e clínicas por grupo de indivíduos com ou sem comprometimento neurocognitivo leve e determinar a relação entre o comprometimento neurocognitivo leve avaliado pelo 6CIT e os domínios cognitivos avaliados pelo MoCA. Métodos: Estudo correlacional realizado em 44 idosos de instituições de creche e residência permanente, com idade média de 88,9 ± 8,8 anos, que responderam a uma entrevista estruturada composta por dados sociodemográficos e clínicos. Resultados: Os idosos que residem em casa apresentam maior índice de massa corporal médio e número de patologias que os idosos que vivem em uma instituição para idosos (p < 0,01). 63,6% dos idosos não apresentam comprometimento neurocognitivo leve e não são encontradas diferenças ao atravessar o contexto da residência. Na comparação entre 6CIT e MoCA produz diferenças no domínio geral e subdomínios visuais, de atenção, abstração e orientação. Conclusão: É necessário otimizar as intervenções de estimulação cognitiva de acordo com o contexto de residência no nível de comorbidades e nutrição.

Conocimiento en higiene oral de cuidadores establecimientos geriátricos de larga estadía, Valparaíso / Caregivers knowledge on oral hygiene in elderly residents in geriatric establishments of longterm care, Valparaíso

RESUMEN: Los Adultos Mayores en Chile son el sector de la población con más daño en su salud oral, encontrándose un porcentaje de ellos institucionalizados y al resguardo de cuidadores, muchas veces sin capacitación. Propósito: Determinar el nivel de conocimientos sobre higiene oral en cuidadores de Adultos Mayores institucionalizados en ELEAM de Valparaíso. Materiales y Métodos: Estudio descriptivo transversal, con una muestra de 75 cuidadores voluntarios que cumplieron los criterios de inclusión. Se aplicó una encuesta validada para determinar su nivel de conocimiento. Se analizaron mediante frecuencias, prueba exacta de Fisher y coeficiente de correlación. Resultados: Los cuidadores presentan un nivel de conocimientos medio, sin relación con su edad, experiencia o capacitación. Muestran un alto nivel de conocimiento en frecuencia del cepillado y cuidados protésico dental, y un bajo nivel en la técnica y recambio del cepillo. No se aprecian diferencias estadísticamente significativas entre el nivel de conocimiento y años de experiencia, educación formal o capacitación. Conclusión: Los cuidadores requieren mayor conocimiento de las características del cepillo, uso de coadyuvantes y frecuencia de control odontológico. La mayoría del conocimiento es empírico, basado en su experiencia y percepción del tema. Es fundamental una capacitación formal y constantes actualizaciones sobre el tema.

ABSTRACT: Older adults are the age group with worst oral health in Chile, a large percentage of them being institutionalized and often under the care of untrained or unqualified personnel. Purpose: To determine the level of knowledge in caregivers on oral hygiene in elderly residents, institutionalized in the ELEAM of Valparaíso. Materials and methods: A cross-sectional descriptive study with a sample of 75 volunteer caregivers who met the inclusion criteria. A validated survey was applied to determine their level of knowledge. They were analyzed using frequency measures, Fisher's exact test and Pearson correlation coefficient. Results: Caregivers have a mid-level of expertise, unrelated to age, experience or training. They have a high level of knowledge regarding brushing frequency, dental prosthesis care, and low level in technique and toothbrush replacement. No statistically significant differences were found between the level of knowledge and years of experience, formal education or training. Conclusion: Caregivers require greater knowledge on toothbrush characteristics, use of adjuvants and frequency of dental visits. Most of the knowledge demonstrated is empirical, based on their experience and perception on the subject. Training and constant updates on the topic are essential.

The Admission of Older People Into Residential Care Homes in Argentina: Coercion and Human Rights Abuse.

BACKGROUND AND OBJECTIVES: There is very little information about the appropriateness of procedures for admitting older people into care homes in low and middle-income countries like Argentina. This study provides the first systematic study of practice and assesses the extent to which current practice respects fundamental human rights. RESEARCH DESIGN AND METHODS: We apply different methods, including document review and national survey analysis. The study also includes a case study of a single city, La Plata, which draws on local key informant interviews, focus group discussions in different neighborhoods, and a clandestine surrogate patient survey led by local pensioners. This innovative design provides a highly triangulated and contextualized data set. RESULTS: Many older people admitted to care homes did not have high levels of care dependency. Care homes did not usually require or even seek the informed consent of older people, regardless of their cognitive status. There were indications of coercive admission by family members, sometimes in order to obtain access to older people's homes and other property and finances. DISCUSSION AND IMPLICATIONS: The study indicates the widespread abuse of the fundamental human rights of tens of thousands of older people in Argentina. There is a need for researchers, policy-makers, and civil society to acknowledge the scale of abuse and develop safeguards.

Multisensory exercise programme improves cognition and functionality in institutionalized older adults: A randomized control trial.

AIM: The aim of this study was to verify the effects of a multisensory exercise programme on the cognition and functionality of institutionalized older adults. METHODS: Forty-five volunteers were randomly allocated to 2 groups, the multisensory exercise programme (n = 24) and the control group that received no treatment (n = 21). The programme consisted of 3 50-min sessions of progressive exercises per week for 16 weeks that challenged their strength, balance, coordination, multisensory stimulation, and flexibility in different tasks. Cognition (Montreal Cognitive Assessment), balance (Berg Scale), mobility (Timed Up and Go), and functional performance (Physical Performance Test) were measured preintervention and postintervention. Statistical analyses were performed using Student's t test and 2-way ANOVA. RESULTS: The multisensory exercise programme showed statistically significant improvements (p < .05) on cognition (effect size [ES]: 0.92), balance (ES: 0.77), mobility (ES: 0.51), and functional performance (ES: 0.86) as compared with the control group, which showed no statistical significant differences at the postintervention time point. CONCLUSIONS: The multisensory exercise programme improved the cognition and functionality of institutionalized older adults. The introduction of a motor and multisensory-based approach in care routines may improve residents' health and engagement to the environment.

Intervenciones positivas en residencias de larga estadía / Intervenções positivas em residências de longa permanência / Positive interventions in long-stay residences

En el campo de la gerontología, existe un acuerdo que puede ser expresado sintéticamente bajo la premisa "evitar o retrasar la institucionalización". Esta premisa es la base de muchos esfuerzos e intervenciones que surgen, y deberán seguir surgiendo, para tal fin. Sin embargo, cuando esto no es posible, y la persona mayor no puede seguir viviendo en su casa se pretende que la atención tenga lugar en centros que, además de proporcionar los cuidados necesarios permitan el desarrollo personal. Para ello, la tendencia actual, a nivel nacional e internacional, es la de modificar la noción que se tiene acerca de estas instituciones, sus metas y objetivos, evolucionando hacia un modelo de alojamiento que constituya una clara alternativa a la residencia de tipo institucional. Dentro de ese marco, el objetivo de éste capítulo es sistematizar una serie de prácticas que por su orientación pueden ser caracterizadas como positivas. Con este término se hace alusión a aquellas intervenciones tendientes a promover el desarrollo de las capacidades, habilidades y recursos de los que disponen las personas alojadas en dichas residencias. Las mismas fueron clasificadas según los diferentes momentos que puede transitar una persona en su paso por la residencia, siendo el mayor objetivo que pueda encontrarse con aquello que le otorgue identidad y mayor autonomía posible, más allá de la condición de institucionalización.

In the gerontology field, there is a motto, "to prevent or delay institutionalization," which summarizes gerontologists' tacit consent. This premise is the basis of many efforts and interventions that arise, and should continue emerging, for that purpose. However, when this is not possible, and most people cannot continue living at home, the intention is to provide care centers, which can not only give the necessary care but also allow for the personal development of the elderly. In order to do this, the national and international current trend, is to change the notion that one has about these institutions, their goals and objectives, evolving towards a model of accommodation that constitutes a clear alternative to the typical institutions. Within this framework, the aim of this chapter is to systematize a series of practices with a positive orientation. This term refers to those interventions aimed at promoting the development of skills, abilities and available resources for people staying in these long-term care homes. They were sorted out according to the different moments/stages a person may go through in nursing homes, with the main objective being to find greater autonomy for the elderly and a possible identity beyond the condition of institutionalization.

No campo da gerontologia, existe um consenso que pode ser expresso sinteticamente sob a premissa "evitar ou atrasar a institucionalização." Esta premissa é a base de muitos esforços e intervenções que possam surgir, e devem continuar a surgir, com tal finalidade. No entanto, quando isso não é possível, e a pessoa idosa é incapaz de continuar a viver em casa, pretende-se que a atenção a ela se dê em centros de atendimento que, além de lhe proporcionar o cuidado necessário, permita-lhe o desenvolvimento pessoal. Para isso, a tendência atual, nacional e internacionalmente, é modificar a noção que se tem sobre tais instituições, suas metas e objetivos, evoluindo-se para um modelo de acolhimento que constitua uma clara alternativa para a residência institucional. Nesse contexto, o objetivo deste artigo é sistematizar uma série de práticas que, tributariamente a sua orientação, podem ser caracterizadas como positivas. Com este termo se faz alusão a intervenções que tendem a promover capacitação, habilidades e recursos disponíveis às pessoas acolhidas nessas residências. Elas foram classificadas de acordo com os diferentes momentos com que se move uma pessoa idosa no interior da residência, sendo o principal objetivo que se possa atingir é aquele que lhe dá identidade e a maior autonomia possível, para além da condição de institucionalização.

Intervenciones positivas en residencias de larga estadía / Intervenções positivas em residências de longa permanência / Positive interventions in long-stay residences

En el campo de la gerontología, existe un acuerdo que puede ser expresado sintéticamente bajo la premisa “evitar o retrasar la institucionalización”. Esta premisa es la base de muchos esfuerzos e intervenciones que surgen, y deberán seguir surgiendo, para tal fin. Sin embargo, cuando esto no es posible, y la persona mayor no puede seguir viviendo en su casa se pretende que la atención tenga lugar en centros que, además de proporcionar los cuidados necesarios permitan el desarrollo personal. Para ello, la tendencia actual, a nivel nacional e internacional, es la de modificar la noción que se tiene acerca de estas instituciones, sus metas y objetivos, evolucionando hacia un modelo de alojamiento que constituya una clara alternativa a la residencia de tipo institucional. Dentro de ese marco, el objetivo de éste capítulo es sistematizar una serie de prácticas que por su orientación pueden ser caracterizadas como positivas. Con este término se hace alusión a aquellas intervenciones tendientes a promover el desarrollo de las capacidades, habilidades y recursos de los que disponen las personas alojadas en dichas residencias. Las mismas fueron clasificadas según los diferentes momentos que puede transitar una persona en su paso por la residencia, siendo el mayor objetivo que pueda encontrarse con aquello que le otorgue identidad y mayor autonomía posible, más allá de la condición de institucionalización.(AU)

In the gerontology field, there is a motto, "to prevent or delay institutionalization," which summarizes gerontologists' tacit consent. This premise is the basis of many efforts and interventions that arise, and should continue emerging, for that purpose. However, when this is not possible, and most people cannot continue living at home, the intention is to provide care centers, which can not only give the necessary care but also allow for the personal development of the elderly. In order to do this, the national and international current trend, is to change the notion that one has about these institutions, their goals and objectives, evolving towards a model of accommodation that constitutes a clear alternative to the typical institutions. Within this framework, the aim of this chapter is to systematize a series of practices with a positive orientation. This term refers to those interventions aimed at promoting the development of skills, abilities and available resources for people staying in these long-term care homes. They were sorted out according to the different moments/stages a person may go through in nursing homes, with the main objective being to find greater autonomy for the elderly and a possible identity beyond the condition of institutionalization.(AU)

No campo da gerontologia, existe um consenso que pode ser expresso sinteticamente sob a premissa "evitar ou atrasar a institucionalização.” Esta premissa é a base de muitos esforços e intervenções que possam surgir, e devem continuar a surgir, com tal finalidade. No entanto, quando isso não é possível, e a pessoa idosa é incapaz de continuar a viver em casa, pretende-se que a atenção a ela se dê em centros de atendimento que, além de lhe proporcionar o cuidado necessário, permita-lhe o desenvolvimento pessoal. Para isso, a tendência atual, nacional e internacionalmente, é modificar a noção que se tem sobre tais instituições, suas metas e objetivos, evoluindo-se para um modelo de acolhimento que constitua uma clara alternativa para a residência institucional. Nesse contexto, o objetivo deste artigo é sistematizar uma série de práticas que, tributariamente a sua orientação, podem ser caracterizadas como positivas. Com este termo se faz alusão a intervenções que tendem a promover capacitação, habilidades e recursos disponíveis às pessoas acolhidas nessas residências. Elas foram classificadas de acordo com os diferentes momentos com que se move uma pessoa idosa no interior da residência, sendo o principal objetivo que se possa atingir é aquele que lhe dá identidade e a maior autonomia possível, para além da condição de institucionalização.(AU)

O trabalho do profissional de saúde mental em um processo de desinstitucionalização / The work of the mental health professional in a deinstitutionalization process

O artigo apresenta um recorte da pesquisa realizada em 2006 sobre o trabalho dos profissionais de saúde mental responsáveis pelo acompanhamento a moradores dos serviços residenciais terapêuticos do município de Carmo, no Estado do Rio de Janeiro. Estas moradias constituem uma etapa do processo de desinstitucionalização de um hospital psiquiátrico estadual do tipo colônia agrícola, fundado na década de 1940, onde estavam internados cerca de 280 pacientes. A partir de 2003, com a extinção do hospital, coordenada pelo gestor estadual, e a municipalização dos recursos, uma pequena parcela dos internos retornou ao seio familiar, mas a maioria (153) foi alocada em moradias assistidas, espalhadas pelas áreas urbana e rural do município. Tomando a tarefa de reinserção social como parte do viés político da Reforma Psiquiátrica brasileira, o trabalho cotidiano da equipe multiprofissional é focalizado. Neste plano relacional do trabalho, utilizamos a abordagem ergológica como arcabouço conceitual para a análise dos processos de trabalho. Iremos nos deter na discussão do trabalho junto à sociedade civil, em que o investimento dos técnicos visa a mudança do estatuto social do louco. No cotidiano, a experiência dos técnicos envolvidos mais diretamente com os moradores, como os cuidadores, produz uma "técnica" de escuta e mobilização, que não admite cartilhas nem regras preestabelecidas ou imutáveis.

The article presents part of a research work carried out in 2006 on the work of mental health professionals who assist dwellers of residential care homes in the city of Carmo, State of Rio de Janeiro. These residences integrate the process of deinstitutionalization of a state Psychiatry Hospital, an agricultural colony, established in the 1940's, with about 280 inpatients. From 2003 on, when the hospital was closed by the state manager, and resources were municipalized, a small part of inpatients returned to their families, but the majority (153) were placed in care homes, scattered over country or urban district areas. Taking the task of social inclusiveness as the political bias of Brazilian Psychiatric Reform, the daily work of the multi-professional team is focused. In this relational work level, we chose the ergologic approach as a conceptual framework to analyze the work processes. It is a step in a process, still half way between state and municipal administration, where the proposal is sustained by the administrators' political will, and, in becoming hegemonic, must be discussed among professionals and the civil society. The landscape is not homogeneous, and the dynamics reveal the various understandings and interests. This article discusses how professionals work with civil society, being their goal the change of the mentally ill social status. The daily experience of the professionals who work closer to the residents, as the caretakers, produces a "technique" of listening and stimulation, which by no means admits unchangeable or pre-established rules.