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

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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 This legislation, which governs care in private homes, was, in their view,outdated.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
Table 8.3: Staffing resources and physical environment160Staffing resourcesIt’s in their (proprietors) interests tokeep staffing levels low and if youare in a public nursing home it isprobably higher. … I would not thinkthey work half as hard as we do.(YW1 Nurse 01, Private)Because of our staffing levels,things are done according to routine.(PK1, Nurse 02, Public)When you get your breakfast and youmight want to go to the toilet and youcall the nurse and she would not come,… then you wait and wait and then youcall the nurse again, that nurse will say‘wait a minute’. Well, that minute couldbe an hour. (GN1 Resident 06, Public)This morning a lady turned on mebecause I wet the floor while I waswaiting for her to come along andshe was slow in coming and shethinks I should not have wet the floor.(GN2 Resident 08, Public)We are blessed here because theyhave great programmes going on ineducation. We have to pay and that’sanother issue. The staff have everyopportunity to up-skill their competence.(YW3 Nurse 01, Private)Physical environment(Space) it is very limited. You bring themto the day room when everyone is inthis little space with the table in frontof them. Then you have to move threetables before you get to the patientyou want. (PK1 Nurse 02, Public)The television goes on at six andit goes on until midnight; it is noisy.(PK2 Resident 07, Public)Sharing is not as good as a privateroom. I’d prefer a private room.(GN2 resident 08, Public)They could be more considerate. As avisitor you pass the other rooms and veryoften the doors are open. (Relative)There is no call system and the nursesare very far away. … I think it’s terrible.You would be wanting to go to thetoilet and you can’t get a nurse.(GN 01 Resident 06, Public)There’s a lot of Alzheimer’s patientshere and some of them, they’re lostreally. It’s the wrong place for them, youknow. There’s no facilities at all for them,you know. … They wander up and downthe corridor, that’s it. There’s nothing forthem to do or to get them interested,you know. Can’t sit and chat.(PK3 Health Care Assistant 01, Public)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
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The results of this particular stud
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The design of a residential care se
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Chapter FourMethodology
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each method used at the same point
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4.3.3 Data AnalysisThe transcripts
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Table 4.2: Distribution of question
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4.4.4 Quantitative Data AnalysisThe
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Anonymity and confidentiality are i
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from stakeholders who attended the
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4.7 Ethical ClearanceEthical cleara
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Chapter FiveQuality of Lifein Long-
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All participants reported that ther
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Staffing and skill mix: comments fr
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Recruiting and retaining staff: com
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Impact of physical environment on r
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5.6.2 Social EnvironmentParticipant
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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 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 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
Page 176 and 177: Table 9.5: Freedom and constraintsA
Page 178 and 179: 9.5 PrivacyThe degree of privacy en
Page 180 and 181: 9.6 Self-RespectAcknowledging resid
Page 182 and 183: 9.7 ConclusionsThe findings suggest
Page 184 and 185: Chapter TenConnectedness,Social Rel
Page 186 and 187: 10.2 Connectedness, Involvement and
Page 188 and 189: A concrete example of the priority
Page 190 and 191: Cultural differencesnot an issueI f
Page 192 and 193: esidents but reserved the title of
Page 194 and 195: Table 10.3: Relationships among res
Page 196 and 197: it feel more like visiting somebody
Page 198 and 199: Near home(I) was living up the road
Page 200 and 201: Chapter ElevenActivitiesand Therapi
Page 202 and 203: had a special activities/therapies
Page 204 and 205: 11.3 Therapeutic ActivityThis categ
Page 206 and 207: A few facilities had incorporated o
Page 208 and 209: 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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