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

8.2 Promoting AutonomyThis category brought together the elements of the care environment whichdetermined the extent to which residents could exercise choice and autonomyin their daily life. Aspects of autonomy were discussed in the previous chapter,particularly in relation to getting up in the morning and going to bed at night.Within the study site data, this was explored through focusing on two keyaspects of autonomy: involvement in decision-making and exercising choice.8.2.1 Involvement in Decision-MakingStaff respondents identified the inclusion of residents in decision-making as animportant aspect of quality care for older people and some described ways in whichresidents were included. They suggested that residents’ opinions about care weresought and their care was based on these. Resident respondents also describedsituations when their opinion had been sought. Most relatives were not sure if theirrelative was consulted about their care or not. Some suggested that the illness oftheir relative made consultation difficult.In many sites resident inclusion in decision-making appeared to be ad hoc ratherthan part of the ethos. Some staff respondents, because they had worked in thefacility for some time, felt that they knew a resident’s likes and dislikes and could,therefore, make appropriate choices for them. In some facilities, residents felt theneed to fit in and do what they were told; some of them suggested that theremight be consequences for them if they did not.153A few facilities had formal resident committees and sought residents’ views inrelation to many aspects of day-to-day life within the facility. Others had suggestionboxes for residents to use. One public facility had set up an activities committee whichwas chaired by a resident and was charged with organising and planning outings.Some resident respondents differentiated between residents who had beenincluded in the decision to enter into long-term care and those who had not. Theyhad noticed that residents, whose families had made the decision for them to enterlong-term care, were less likely to feel settled, did not really participate in life withinthe facility and generally appeared more unhappy.