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

themselves experience it. The approach was not to homogenise quality of life butto represent its complex and varied nature. For that reason, what gave meaningto the lives of older people within residential care was of greater interest than theirhealth and functional capacity.The methodology employed in this study, therefore, took a more holistic approach,including social, psychological, philosophical, emotional, spiritual and environmentaldimensions. To establish domains of quality of life for older people in long-stay care,the following steps were taken:214review of the literature on quality of life for older people, especially for peoplein residential carereview of existing summary measures of psychosocial quality of lifefor older people in residential carediscussion with stakeholders through focus groups in the early stagesof the research processorganisation of a one-day seminar with stakeholder groups on qualityof life issuesanalysis of the interview data taken from residents, staff and relativesin the 12 study sites.Four core themes emerged as important for older people in long-stay residential carein Ireland: care environment and ethos of care; personal identity; connectednessto family and community; and activities and therapies. These factors were foundto be the ‘constants’ which determined residents’ overall quality of life. Withinthe theme of care environment and ethos of care, four categories emerged:autonomy; independence; staff and physical resources; and care philosophy.Identity incorporated four categories: self-expression; individuality; privacy andself-respect. Connectedness included relationships with fellow residents, staff,family and communities. The activities domain covered purposeful activity, therapeuticactivity, activities outside the long-stay facility and making activities work.To claim that all dimensions of quality of life of older people in residential care arecaptured in this typology would do an injustice to the vast array of literature onquality of life and the exhaustive search for overarching domains that continues tobe pursued in the literature (as evident from Chapter Three). Residents’ experienceof these domains is mediated by factors individual to him or her, for example theirhealth status, personality, past experiences or expectations of care and their ownadaptive response. This explains why individual residents’ quality of life may differwithin the same facility. The results of this study show residents’ morale andImproving Quality of Life for Older People in Long-Stay Care Settings in Ireland