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Chapter 1: Introduction and Background
summarises the 32 national standards that must now be met by all residential care
facilities for older people in Ireland. Other national developments include the
establishment of a new Office for Older People on 30 th January 2008, and proposals
to develop a “National Strategy on Positive Ageing”, which will focus on setting the
strategic direction for future policies, programmes and services for older people.
Reiterating the United Nations (UN) Madrid International Plan of Action on Ageing
(MIPAA, 2002 and 2008), which recognises that there is global acknowledgement of
the need to include older adults in autonomous decision-making processes, these
developments may be viewed positively as a means to actively engage with older
people so that future healthcare policies can to be meaningful for older people.
However, while research has suggested that autonomy is important for older people
in residential care, and while policies state that autonomy should be promoted, there
is no consensus in the literature about what autonomy for older people in residential
care actually means. Hewitt-Taylor (2003) states that autonomy is high on the
current healthcare agenda but that a universally accepted definition has yet to be
adopted or tested in practice. Rodgers and Neville (2007) state that autonomy has
significance for everyone and that formulating a precise definition is problematic due
to the wide ranging meanings attached to autonomy. This indicates that research
needs to be conducted that will firstly analyse the meaning of the concept of
autonomy for older people in residential care, and secondly explore the concept of
autonomy in the real world of practice.
The growing ageing population will demand not only sufficient healthcare services
but high quality healthcare services, and trends show that there will be an increase in
the demand for residential care facilities that facilitate an acceptable quality of life.
The importance of autonomy for quality of life has been recognised, and therefore
autonomy for older people in residential care should not be underestimated.
Autonomy is an important concept because it brings dignity to people’s lives,
regardless of physical circumstances. However, many older people living in
residential care find that their autonomy is curtailed. This is largely because
autonomy for older people is poorly understood and hence nurses working with older
people need to become clear about what autonomy is and how it can be facilitated.