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

8.2.2 Exercising ChoiceResident and staff respondents emphasised the importance of having choice withinthe day. Choices about the time residents were woken, had breakfast, went backto bed, had meals and what they did during the day were identified by respondentsas important. It was also evident from respondent accounts that choice could onlybe facilitated when there was flexibility in care giving routines. Care was demonstrablymore routine in some sites than others, and this had an important affect on residents’ability to make choices. In the more flexible regimes, residents had more choiceand this contributed significantly to their overall quality of life.154The quotes in Table 8.1 from residents, staff and relatives demonstrate the extentto which choice is allowed in their care setting. For many resident respondents,choice over their day was possible, they were able to request changes to their dailypattern if they so wished, and they had been fully involved in the decision aboutthe time they got up or went back to bed. Other respondents, however, felt theyhad little control over their day and for them choice was very constrained. Someresident respondents described being woken at around 6 a.m. to have breakfastand stated that they would not wake so early if the choice were theirs. It appearedfrom the accounts of these residents that breakfast was traditionally given by thenight staff and the early start was to ensure that this task was completed prior tothe day staff arriving on duty. Going back to bed in the early afternoon was alsoan experience of some residents. While this was described as a choice by someresidents because they were tired, for others it was part of the routine and justsomething that happened. Some staff respondents suggested that choice aboutwhen to go back to bed was only possible when staffing levels in the eveningallowed it or if residents could return to bed without staff help.Relatives were divided in the extent to which they perceived that the residents hadchoice. While the majority suggested that residents did, four stated that they didnot. However, two of these respondents perceived that the lack of choice wasbecause of the resident’s disability rather than practices within the care environment.Meal-times for most were set at fixed times and often the day was shaped aroundthese. In some facilities, however, meal-times were staggered to give residentssome choice of eating time and this was highlighted by resident respondents assomething they greatly appreciated and contributed positively to their quality of life.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland