LEARNING DISABILITY PRACTICE April 2009 | Volume 12 | Number 3
Feature
31
A senior nurse manager in a number of community
learning disability support teams was contacted
about gaining access to older people with learning
disabilities and their family/carers. A nurse
representative of the team who was known to the
individual and their family/carers then approached
the family or carers with information provided by
the researcher. once they had agreed to meet with
the researcher a direct approach was made and full
consent sought.
Stage three: Senior nurse managers who
represented learning disability and mental health
nurses, practice and district nurses were contacted
with the aim of gaining support and access to
these groups of nurses. They in turn contacted
nurses in their area of responsibility highlighting
the study and providing information regarding the
aims and contact details. There was little difficulty
in recruiting learning disability nurses and two
focus groups were conducted. only one district
nurse got in contact and a single interview was
thus undertaken. Two focus groups were recruited
from a convenience sample of practice nurses
and mental health nurses who were undertaking
post-registration studies at university. They were
provided with information and given two weeks
to consider the request to take part in the study.
Focus groups were held with nurses specialising
in the care of people with a learning disability
(two groups of community learning disability
nurses, n=4 and n=6) and with nurses who might
be involved in supporting older people with a
learning disability and their families but who did
not specialise solely in this area of work (mental
health nurses (n=3), practice nurses (n=4); in
addition, a single interview was conducted with
a district nurse). Interviews and focus group data
from stages 2 and 3 were tape-recorded, transcribed
and analysed systematically using interpretative
phenomenological analysis (Smith and osborn 2003)
and NVivo 7 software. Transcripts were read a
number of times and, with each reading, comments
were made and themes highlighted. Connections
between case studies (stage 2) and focus groups
(stage 3) were made until a set of superordinate
themes were finally established for each stage.
Nurses' views on the strengths and weaknesses of
current patterns of service provision for older people
with learning disabilities were obtained in stage
three of the study. These views, which focus on three
models of service provision and parent/carer needs,
will give readers a flavour of the issues professionals
such as nurses face in providing services to support
older people with learning disabilities.
Ethical considerations ethical approval was
sought and granted by the local research
ethics committee. To ensure informed consent,
each potential participant was sent a letter of
invitation and an information sheet before they
consented to participate. They were given two
weeks to consider the request and reflect on
the information provided. A consent form was
issued to participants at the start of the interview
and focus group, giving the participant a further
opportunity to withdraw if they so wished. To
ensure confidentiality, participants were assured
that no personal identifiable information would be
passed on to other parties and once the study had
been completed all data would be destroyed. The
data collection was undertaken in 2007/08.
Findings
In the past, many people with learning disabilities
were housed in long-stay institutions (learning
disability hospitals) which catered for all their needs.
For example, most hospital sites had their own
schools, places of worship, laundry, work, farms,
clothing stores and hairdressers, and were staffed
mainly by nurses under the direction of medical
staff. These self-contained institutions were often
situated in the country in isolation from the general
population and, at one time, were referred to as
`colonies' (Atherton 2007). It was not unknown for
people with learning disabilities to spend most, if
not all, their lives in such places and, after death, be
buried in the hospital grounds. A series of hospital
scandals brought this type of service provision to
an end and now most learning disability hospitals
are closed or due to be closed. Most residents
from these old institutions have been resettled in
community houses, family placement schemes or
other forms of housing support.
There is no clear policy for providing services
for older people with learning disabilities, and
three competing service models appear to operate
for this group (Grant 2001, see Box 1). There is
no national service framework for people with
learning disabilities, although there is one for older
people (DH 2001b). The policy document most
relevant to the needs of older people with learning
disabilities is the white paper Valuing People (DH
2001a), which makes some reference to the issue.
It acknowledges that the ageing process may start
`Services for older people with learning
disabilities may be provided without any
clear direction, philosophy or evidence base'

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