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

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Table 9.5: Freedom and constraintsA feeling of freedomMealtimes are fixed, butotherwise I’m a free agentand that appeals to me like. …There’s a sense of freedom orsomething. There’s no rules, likeyou get your meals and that sortof stuff, but I can go out for awalk. I mean you can come andgo. (YW3 Resident 10, Private)It is just right, I couldn’t fault,unless I told a lie, I couldn’t findfault with, if I want somethingdone, I find them perfect really.Because if I want somethingdone they’ll get it done for me,and there’s an atmosphere ofhome about it. That you don’tfeel you’re in a strange place atall. (YW3 Resident 11, Private)Feeling constrainedAh sure, you’d have to get out, you couldn’tbe stuck in here the whole time.Int: Why?Oh God, you wouldn’t, never stick it. You mightas well be in Mountjoy.Int: And why is it like Mountjoy?Well, I mean to say, you’re confined. … That’swhy I call it, I mean, you’re confined here andyou’re not one of the people or anything, you’renot mixing with people or anything like that. Youonly see the patients here, and the nurses andwhatever men is here. (GN2 Resident 09, Public)It’s just that it’s like a school. It’s very, how shall Isay, regimented, you know. You do a thing now ifit’s handy for the hospital to do but if you want acup of tea you couldn’t get it. … In a democracyyou have to do the best for everyone you know.(GN1 Resident 01, Public)Knowing the individual the priorityThey understand a lot about me. … And then aswe grew, as (the Director) and I grew togethershe understood me. … There are things thatyou don’t do, naturally, and there are things thatyou can; she’s very broadminded. So it took awhile to settle in but it was a matter of gettingused to. … It was a matter of getting used toknow, them to know me. (YW3 Resident 03,Private)Knowing the individualnot a priorityInt: Do you feel that they knowyou, your likes and your dislikes,the staff here. Would they knowyou well?I don’t know about well butthey know your dislikes andyour individual, they might, I meanthey generally know that so andso doesn’t like too much cream.They know generally but you’dhave to remind them.(LCI Resident 10, Private)Some choices are not allowed ifthey (can) avoid it. … They avoidchanging the routine. (Relative)175
176Ways of copingThere are days I decide I’m not getting up.She comes around and asks me ‘are yougetting up today?’. No. A simple answerlike that. No.Int: So when you say no is that a problem?No, it’s not a problem with me.Int: You just stay there and that’s it?I just stay put and that’s it. And, and to be,to be honest about it … I defy anyone to moveme when I make up my mind.Int: And do you know the staff? Do you knowtheir names?I don’t know the staff. One thing I don’t do,I don’t inquire about the staff’s names oranything like that because I don’t like to getinvolved where any of the staff are concerned.Int: Why is that?Well, I have a twofold purpose you know; youbecome immune to anything they might sayagainst you, that would be the same forsomething they might say for you at the sametime. … It makes you immune to any criticism.Int: Not getting to know them.Not getting to know them. (GN2 Resident 10,Public)Int: Each day being the same,is that boring?Oh yes, that’s the word, boring,that’s the word … but I don’t likesaying anything because, you’re,if you say anything you’re in thebad books altogether.Int: Would you?I’d say that I wouldn’t.Int: What would happen if youwere in the bad books?Oh, I don’t know, they, they ignoreyou and everything else, isolateyou and everything.Int: Do they?Ah they would, they would,so I say nothing.Int: So that’s your policy,say nothing?That’s it now. I seen it a coupleof occasions with others, and it’s,I don’t like it. I’ve nothing to sayabout the nurses and that, costhey’re alright, but it’s em, it’s nota nice place to be in, and that’sto tell you the truth. (GN2 Resident09, Public)The difference between facilities centred on whether residents felt empoweredor powerless in the system. Some facilities empowered resident respondentsby making them feel ‘in charge’, while others made resident respondents feelpowerless and vulnerable. The ability to make respondents feel empowered relatedto how well staff knew residents as individuals and showed interest in them aspeople. Some respondents reported that staff spent time getting to know them andwere willing to meet their individual needs. This was more evident in the smallerfacilities than the larger, older facilities. Staff attitude to residents was also a factor;for example, viewing residents as patients may result in a focus on physical ratherthan emotional care. This may be the legacy of the experience of some staffworking in a general hospital. Focus group participants considered a move awayfrom this orientation to be key to good quality of life for residents.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
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Participants also discussed at leng
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Chapter SixQuality of Lifein Long-S
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Table 6.1: Type of facilityN %Priva
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Figure 6.2: Age profile of long-sta
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Figure 6.5 shows the percentages of
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Figure 6.7: Long-stay residents’
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In private and voluntary facilities
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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 160 and 161: Focus group participants reported t
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 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
Page 210 and 211: For residents, what appeared to be
Page 212 and 213: Chapter TwelveConclusions andRecomm
Page 214 and 215: The prevalence of quality deficits
Page 216 and 217: attitude to their institutionalisat
Page 218 and 219: higher the proportion of care given
Page 220 and 221: was that they had a choice. In some
Page 222 and 223: The physical environment in some fa
Page 224 and 225: 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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