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

Impact of physical environment on residents’ quality of life:comments from focus group participantsNew buildings should (have) single rooms, like … the criteria that are used to buildnursing homes … that should be exactly the same for the public. There should beno difference. (FGDO)Patients get up in the morning and they’re sitting on their chair which is beside theirbed, and the next bed is literally a couple of inches from them. Now the person onthe other side of the curtain could be using a commode while this person is actuallyeating, because we don’t have day rooms, so therefore everything is done in the onespace. (FG1G)I would hate to think that when I’m eighty years of age that my future life would bein a six-bedded ward with the toilet beside the bed, having to watch what the otherfive want and having to eat what’s put in front of me, request something, havingto get up when I’m told to and go back when I’m told to. When you put it like that,what you would want for yourself? (FGDO)One patient if he wants to go to the bathroom has to walk one hundred steps tothe nearest bathroom. The chances are that he will become dependent on nursingintervention much more easily than say, if he had an en suite facility that he hasto walk four steps to get to the toilet. … The environment (should enhance) theirmovement and maintenance of function. (FG1D)Participants saw the opposite to institutionalised care as individualised care. Theybelieved a resident should be treated as an individual and a person, not a patient.However, participants suggested that individualised did not necessarily mean noroutine. They believed that some degree of routine was important and necessarybut the goal should be to have as ‘few rules as possible’.103Participants believed creating a home-like environment was an importantdeterminant of residents’ quality of life. They equated ‘homely’ with givingresidents control and choice over their day-to-day activities. All groups agreedthat the goal of care should be that the life of residents is as similar as possibleto the life that they would choose to live at home. They believed residents shouldbe given choices about their day, including the time they got up, when they wentto bed and what they did during their day. They argued residents should not beexpected to fit into the routine, rather the routine should be sufficiently flexibleto allow residents choice. Participants believed that greater choice was possiblebut that staff attitudes inhibited residents’ choice as much as staffing levels.They suggested staff were sometimes too immersed in the routine to see beyondit and reported that choice was not a reality in some care settings because routinecontinued to dominate care organisation.