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

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Figure 6.7: Long-stay residents’ level of mobility by facility typeWelfare homes(n = 14)District/Community hospitals(n = 27)Voluntary homes/hospitals(n = 32)Public homes/hospitals(n = 37)Private nursing homes(n = 199)All facilities(n = 309)0% 20% 40% 60% 80% 100%Fully mobileMobile with the useof a walking aidMobile with the helpof another personImmobile6.4 StaffingThe majority of long-stay units (93 per cent) provide access to local GPs forresidents, ranging from 76 per cent of district/community hospitals to 97 per centof private nursing homes. Access to consultant geriatrician services is availablein 22 per cent of units responding to the survey, with access more likely in publicgeriatric homes/hospitals than in private nursing homes. The vast majority of carefor older people in long-stay units is, however, provided by nurses and other carestaff. Nurse staffing levels are influenced by numbers of residents and by dependency.Consequently, data relating to the mix and level of staff is presented by size offacility, specifically for facilities with forty residents or less, and for facilities withmore than forty residents. Staffing ratios are also correlated with dependencylevels. Care staff are characterised in terms of whole time equivalents (WTE) 11employed by the different facilities.119Differences in staffing with regard to ratios of qualified staff (i.e. registered nursingstaff) to non-nursing care staff (i.e. health care assistants or care attendants) betweenfacilities of different sizes are evident across facilities (Table 6.3). The average ratioof registered nursing staff to non-nursing staff across all facilities with fewer thanor equal to forty beds is 1:1.6, ranging from 1:0.7 in district/community hospitalsto 1:2.0 in private nursing homes. The average ratio of registered nursing staff tonon-nursing staff across all facilities with more than forty beds is 1:1.2, rangingfrom 1:0.7 in district/community hospitals to 1:2.7 in private nursing homes.11 Each whole time equivalent (WTE) equals one full-time staff member.
The differences between public geriatric hospitals/homes, welfare homes anddistrict hospitals, for both large and small facilities, were not significant whentested using category by size interaction effects. However, significant differencesemerged in respect of nursing/non-nursing staffing ratios between public facilitiesand voluntary and private nursing homes. Public facilities tend to have higher ratiosof registered nurses to non-nursing care staff, with the pattern reversed in voluntaryand private homes.Table 6.3: Ratio of registered nurses (RNs) to non-nursing care staffand (all) residents by facility type and size40 residents>40 residentsN RNs NonnursingcarestaffResidentsN RNs NonnursingcarestaffResidentsAll facilities 196 1 1.6 3.9 108 1 1.2 3.4120PrivatenursinghomesPublichomes/hospitalsVoluntaryhomes/hospitalsDistrict/communityhospitalsWelfarehomes142 1 2.0 4.7 53 1 2.7 6.513 1 0.8 2.0 24 1 0.8 2.514 1 1.9 3.7 15 1 1.8 4.515 1 0.7 2.1 14 1 0.7 2.212 1 1.3 4.4 2 1 1.0 2.8With regard to staffing ratios of registered nurses to residents, there is significantvariation at the 5 per cent level across the various facility types in both small andlarge institutions (Table 6.3). Overall, staffing ratios are 1:3.9 in facilities with fortybeds or less and 1:3.4 in facilities with more than forty beds. In public geriatrichospitals/homes, the average ratio of registered nurses to residents lies between1:2.0 and 1:2.5 depending on size. A similar ratio exists in district/community hospitalswith the range between 1:2.1 and 1:2.2. In welfare homes, where the trend is forthe resident population to be less dependent, the ratio is 1:4.4 for homes with fortyresidents or less and 1:2.8 for homes with more than forty residents.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
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often not designed to meet the spec
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Residents who did not want to be in
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Human resources management standard
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The Mid-West Standards for Resident
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process and outcomes of the service
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2.9 ConclusionQuality of life for o
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Chapter ThreeThe Interpretationand
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The difficulty of defining such an
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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 102 and 103: Recruiting and retaining staff: com
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 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
Page 152 and 153: Chapter EightCare Environmentand Et
Page 154 and 155: 8.2 Promoting AutonomyThis category
Page 156 and 157: Table 8.1: Involvement of residents
Page 158 and 159: Table 8.2: Maintaining independence
Page 160 and 161: Focus group participants reported t
Page 162 and 163: Staff respondents also highlighted
Page 164 and 165: Therefore, the practice of rosterin
Page 166 and 167: 8.7 ConclusionThis chapter presente
Page 168 and 169: 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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