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

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Staff turnover investigates the number of staff who have left or joined the facilityin the six months prior to the survey. Over 1,000 people joined the staff of allfacilities in the past six months, with 715 people leaving in the same period.Overall, more people joined the staff in the past six months than left. The meanturnover does not vary by facility type, when corrected for size, but the range ofturnover varies greatly with one long-stay unit in the private sector having 24 staffleave over the six months prior to the study. However, there is no evidence ofdifferences between the public and private sectors in their ability to recruit orkeep new staff. Details of turnover are shown in Table 6.9.Table 6.9: Staff turnover of nursing and non-nursing staffin the previous six months by facility typeJoined in the last 6 monthsN Sum Min. Max. Mean Std.dev.Left in the last 6 monthsSum Min. Max. Mean Std.dev.AllfacilitiesPrivatenursinghomesPublichomes/hospitalsVoluntaryhomes/hospitalsDistrict/communityhospitalsWelfarehomes303 1,043 0 20 3.4 3.9 715 0 24 2.4 2.8189 620 0 20 3.3 3.9 434 0 24 2.3 2.837 179 0 16 4.8 4.2 103 0 8 2.8 2.333 145 0 20 4.4 4.8 106 0 16 3.2 3.532 88 0 10 2.8 2.4 56 0 8 1.8 2.112 11 0 3 0.9 1.1 16 0 8 1.3 2.2125
6.5 Provision of Therapy and Other Services126Table 6.10 provides details of the availability of various therapeutic services freeof charge in the five facility types. Physiotherapy is available free of charge inover three quarters of public geriatric hospitals, in 88 per cent of district/communityhospitals and in 71 per cent of welfare homes. Forty-seven per cent of voluntaryhomes and 23 per cent of private nursing homes provide physiotherapy free ofcharge, although it is not known if the cost of physiotherapy is built into feeschedules in the latter. Occupational therapy provision is generally poorer thanphysiotherapy provision across all facility types. Occupational therapy is availablefree of charge in 66 per cent of public geriatric hospitals, 50 per cent of district/community hospitals and 43 per cent of welfare homes. Provision of speech andlanguage is the least available of all therapies, at 20 per cent overall. Provision ofspeech therapy is lowest in the voluntary and private sectors. Each of the abovetherapies are, at least in theory, available privately in the majority of private nursinghomes (and from some voluntary homes), but not from public geriatric hospitals,district hospitals or welfare homes. However, the data supports the commonly heldperception that public residents in public facilities have a much higher probabilityof accessing therapeutic services than publicly subvented residents in private andvoluntary facilities. A limitation of the data is the absence of information on thenumber of therapists relative to the number of residents. The data, therefore,does not provide a full picture of the adequacy of provision, even where it exists.Publicly provided social work provision was uniformly low across all facilities and,in contrast to therapy provision, was also less likely to be available for a fee ineither private or voluntary facilities. Provision of public psychology services waslow and again was rarely available in any facility for a fee. In addition, wherepsychology services are provided, there is no indication as to the type of service(e.g. counselling, clinical psychology and neuropsychology) available to residents.This may be important as the type of service available may mean that provisionis restricted to a subgroup of residents in the facility. The provision of publiclyprovided chiropody services is uniformly good across most facilities with themajority of public facilities providing chiropody free of charge, and voluntary andprivate facilities providing a mixture of free of charge and fee-based services.Hairdressing services are not generally available free of charge even in publicfacilities, which is interesting given the weight that most people, old and young,place on personal appearance as an indicator of their own general well-being.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
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Human needs may also provide part o
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successfully complete a self-report
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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 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 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
Page 170 and 171: Table 9.1: Identity and personalise
Page 172 and 173: The real meI’m there in a photogr
Page 174 and 175: 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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