Improving Quality of Life for Older People in Long-Stay Care ...

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Recruiting and retaining staff: comments from focus group participantsA lot of nurses see a nursing home as a stepping stone to get back into nursing …and then move on once they are back into the system. That is where I have beenburnt. (FGC)The nurse I would like to see is a nurse who has spent at least three or four yearsin the acute sector, who comes to you with total confidence in her abilities, and it isvery difficult for them to develop a lot of skills in the care of the elderly. … She needsto develop (these skills) in the wider setting, and maybe in the bigger hospital. (FG1D)In the private nursing home sector, I think there’s about 80-85 per cent of staff fromoverseas. … Older people sometimes have difficulty in trying to communicate, buttrying to communicate with somebody who doesn’t understand (is difficult). (FG2D)It’s hard. … It’s a physical job, they’re tired, they haven’t the same energy, some ofthem may have back problems or whatever, they don’t have the same interest ineducation either, you know, and they just want to come in, do a day’s work andgo home, and that’s it. (FG1G) (Referring to older nurses)It (flexible working options) means that the person who’s there all the time –a bigger burden falls on them, because they have to be the lynchpin … the burdenof responsibility seems to fall on them. (FGDO)5.5 Education and Training101Participants suggested that education and training of staff within older people’sservices was an essential prerequisite to staff motivation and organisationalchange. They were concerned, however, about staff access to educationalopportunities as releasing staff was a problem and suitable courses whichwere geographically convenient were not always available.Many participants reported that some care attendants in their facility were undertakingthe training programme for health care assistants and suggested that this coursehad made an enormous difference to both the skills of staff and their approachto practice. Care attendants who had either completed or were undertaking theprogramme were described as more questioning, assertive and better able tocontribute to individualised care. However, many participants across focus groupshighlighted the difficulties they had in implementing the evolving health careassistant role as there was a lack of clarity in relation to job description, nationalissues in negotiating new contracts, and issues related to pay and cover fordomestic tasks.
Education and training: comments from focus group participantsIt’s one of the most difficult things to initiate – is organisational change. At the end ofthe day, it’s the hardest job. … And I think the only way you will deal with it is througheducation and training. It’s the only tool that you will break it down with. (FG3D)I think sometimes on the fringes you do lose out (on educational opportunities) andit’s vital to keep in touch now. Everything is changing so rapidly … and I know practiceis important too, but in order to practise, you have to have the knowledge. (FG1G)I’ve seen a difference in their actions and their behaviours on the ward. … Muchmore careful and much more precise. … They’re asking more questions … takingmore individual attention to the patient. (FGC) (Referring to care assistants whoare undertaking the health care assistants training programme)5.6 Maintaining Quality of Life102Participants considered a focus on quality of life to be important. They perceivedthat residents’ quality of life is affected by the physical and social environmentsin which they live. Opportunity to keep in touch with their community was alsoidentified as a dimension of good quality of life.5.6.1 Physical EnvironmentParticipants believed that the physical environment of the facility significantlyimpacted on residents’ quality of life. Participants described the negative impactof the structure of older facilities on residents’ independence, privacy and dignity.Participants working in older facilities indicated that in these facilities, large openwards and cramped space was the norm. In some cases, the lack of day roomsmeant residents had little option but to remain by their bed for the duration ofthe day. Participants believed that poor building structure and lack of amenitiescould decrease older people’s independence and ability to self-care. There wasunanimous agreement across focus groups that communal living, particularlywhen coupled with an institutionalised approach, impacted negatively on residents’quality of life.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland
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ImprovingQuality of Lifefor Older P
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National Council on Ageing and Olde
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Authors’ AcknowledgementsThe rese
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ContentsCouncil Comments and Recomm
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6.7 Meaningful Occupation 1296.8 Ch
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CouncilComments andRecommendations
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Quality of Life DomainsThe research
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Meaningful ActivitiesThe research n
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the research revealed that, in gene
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The Council accepts that the cultur
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this regard. The Council believes t
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ExecutiveSummary
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MethodologyA mixed method research
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Long-Stay Facility Survey FindingsT
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Residents were most positive about
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Chapter OneIntroduction
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There is no single definition descr
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This chapter provides justification
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Chapter TwoQuality of Careand Quali
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2.2 Separating Quality of Care and
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2.3 Policy for Long-Stay Care in Ir
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2.4 Regulatory StructuresThere are
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Medical preparations - medication s
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inspections are mainly concerned wi
Page 52 and 53: often not designed to meet the spec
Page 54 and 55: Residents who did not want to be in
Page 56 and 57: Human resources management standard
Page 58 and 59: The Mid-West Standards for Resident
Page 60 and 61: process and outcomes of the service
Page 62 and 63: 2.9 ConclusionQuality of life for o
Page 64 and 65: Chapter ThreeThe Interpretationand
Page 66 and 67: The difficulty of defining such an
Page 68 and 69: Implicit definitions use the broad
Page 70 and 71: Human needs may also provide part o
Page 72 and 73: successfully complete a self-report
Page 74 and 75: In relation to older people specifi
Page 76 and 77: The results of this particular stud
Page 78 and 79: The design of a residential care se
Page 80 and 81: Chapter FourMethodology
Page 82 and 83: each method used at the same point
Page 84 and 85: 4.3.3 Data AnalysisThe transcripts
Page 86 and 87: Table 4.2: Distribution of question
Page 88 and 89: 4.4.4 Quantitative Data AnalysisThe
Page 90 and 91: Anonymity and confidentiality are i
Page 92 and 93: from stakeholders who attended the
Page 94 and 95: 4.7 Ethical ClearanceEthical cleara
Page 96 and 97: Chapter FiveQuality of Lifein Long-
Page 98 and 99: All participants reported that ther
Page 100 and 101: Staffing and skill mix: comments fr
Page 104 and 105: Impact of physical environment on r
Page 106 and 107: 5.6.2 Social EnvironmentParticipant
Page 108 and 109: They believed that this problem was
Page 110 and 111: Participants also discussed at leng
Page 112 and 113: Chapter SixQuality of Lifein Long-S
Page 114 and 115: Table 6.1: Type of facilityN %Priva
Page 116 and 117: Figure 6.2: Age profile of long-sta
Page 118 and 119: Figure 6.5 shows the percentages of
Page 120 and 121: Figure 6.7: Long-stay residents’
Page 122 and 123: In private and voluntary facilities
Page 124 and 125: Table 6.6: Ratio of RNs on the even
Page 126 and 127: Staff turnover investigates the num
Page 128 and 129: Table 6.10: Therapeutic and other s
Page 130 and 131: sector and 50 per cent in the volun
Page 132 and 133: Table 6.13: Number of facilities in
Page 134 and 135: stay units also allow ambulant, men
Page 136 and 137: The majority of private and volunta
Page 138 and 139: Table 6.17: Call bell facilities by
Page 140 and 141: Chapter SevenDescription ofStudy Si
Page 142 and 143: others were open and residents’ b
Page 144 and 145: 7.2.2 StaffingRegistered nurses and
Page 146 and 147: Some residents were able to leave t
Page 148 and 149: the day by their bed. In addition,
Page 150 and 151: equired full assistance with dressi
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Chapter EightCare Environmentand Et
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8.2 Promoting AutonomyThis category
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Table 8.1: Involvement of residents
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Table 8.2: Maintaining independence
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Focus group participants reported t
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Staff respondents also highlighted
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Therefore, the practice of rosterin
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8.7 ConclusionThis chapter presente
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Chapter NinePersonal Identity
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Table 9.1: Identity and personalise
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The real meI’m there in a photogr
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how important it was that residents
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Table 9.5: Freedom and constraintsA
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9.5 PrivacyThe degree of privacy en
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9.6 Self-RespectAcknowledging resid
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9.7 ConclusionsThe findings suggest
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Chapter TenConnectedness,Social Rel
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10.2 Connectedness, Involvement and
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A concrete example of the priority
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Cultural differencesnot an issueI f
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esidents but reserved the title of
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Table 10.3: Relationships among res
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it feel more like visiting somebody
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Near home(I) was living up the road
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Chapter ElevenActivitiesand Therapi
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had a special activities/therapies
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11.3 Therapeutic ActivityThis categ
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A few facilities had incorporated o
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Some facilities organised special t
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For residents, what appeared to be
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Chapter TwelveConclusions andRecomm
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The prevalence of quality deficits
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attitude to their institutionalisat
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higher the proportion of care given
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was that they had a choice. In some
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The physical environment in some fa
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activities need to be dynamic and r
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Older people in residential care mu
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choice regarding the gender of a ca
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Residents and their families should
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References
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Birren, J.E. and Dieckmann, L., 199
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Collin, C., Wade, D.T., Davies, S.,
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Hubbard, G., Downs, M.G. and Tester
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McCormack, B., 2003. ‘A conceptua
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Redfern, S., Hannan, S., Norman, I.
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Appendices
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Profile of your long-stay facility1
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6a. Are there any reasons why you w
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Staff resources10. How many whole-t
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Services and facilities17. Are any
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Care process24a. Can long-stay resi
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32b. If Yes, when can residents smo
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38a. Was this facility purpose-buil
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45. Are any of the following provid
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General atmosphereComment on the ge
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DomainFeeling caredfor/feelingsecur
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DomainFeeling caredfor/feelingsecur
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DomainGeneralCue question/promptsHa
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DomainCompanionship/relationshipCon
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DomainRelationship tofamily/friends
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Terms ofReference
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c) providing information and advice
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National Council on Ageingand Older
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