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

8.7 ConclusionThis chapter presented findings related to the care environment and ethos of care.The findings revealed that there were significant differences in resident experiencesacross care study sites and some public/private differences among the sites.The findings suggest that physical environment constrained resident choice and,therefore, impacted greatly on quality of life. The physical environment was poorin some facilities, more so in the public than the private sector. The ethos of carein many facilities did not facilitate resident inclusion in decision-making and routinecontinued to prevail in some facilities. This was also more evident in the publicsector than the private sector. That said, there was awareness among staff, evenin routine-based systems, that more flexibility was required to enhance the qualityof life of residents. The problem was that they could not see a way to effectchange from routine-based care to individualised care. The findings also revealedthat staffing levels and skill mix were major issues in the provision of quality ofcare. Concern was expressed about registered nurse staffing levels and skill mixwithin the private sector, particularly as there was a reliance on non-qualified carestaff in the provision of resident care. It was evident from the data that the careenvironment, staffing and ethos of care have a very significant impact on a resident’squality of life.165