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

Focus group participants reported that there was great variation in staffing levelsacross long-term care facilities in Ireland. They suggested that staffing levels in thepublic sector were ‘historical’ and suggested that current levels did not meet theneeds of their service. Some focus group participants reported that staffing levelswere also an issue within some private nursing facilities. They suggested that theissue was related more to the ratio of registered nurses to care assistants ratherthan numbers per se and that some facilities did not have an appropriate numberof registered nurses. They suggested that the lack of registered nurses could leadto inadequate supervision of care staff and lower standards of care. The inspectorswho attended focus groups highlighted the need for review of the Health (NursingHomes) Act, 1990, which requires that only one registered nurse be on duty at anytime. This legislation, which governs care in private homes, was, in their view,outdated. They described how the dependency and numbers of residents in manyfacilities had increased as the trend was to build larger nursing homes or extendexisting ones. They suggested that the increasing numbers of residents were notalways matched by a commensurate increase in the number of registered nurses.They had, therefore, found the level of registered nurse cover totally inadequatein some nursing homes.Focus group participants also stressed the need for an appropriate skill mixamongst staff. They indicated that there was a need to review the role of registerednurses and health care assistants providing care for older people. They argued thatthere was a need to ensure that registered nurses’ expertise was maximised andsuggested that this could only be done if nurses were supported by appropriatelytrained health care assistants and care attendants, and if nurses themselvesembraced change. Some participants reported that they did not have an appropriatemix of staff in their facility. For some, the problem was a lack of registered nurses,and for others, not enough care assistants.159