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

More documents

Recommendations

Info

attitude to their institutionalisation to be important to their own interpretationof quality of life. This may explain why it is so difficult to compare facilities;subjective experiences within institutions can vary so much. In addition, qualityof life is enhanced or constrained by the wider environment, including the physicalenvironment of the care setting and wider community and social factors. Figure12.1 represents quality of life in Ireland in respect of the four key determinants ofthis study as expressed by residents, and the mediating and constraining factorsthat influence and inform these determinants.Figure 12.1: Model of factors determining residents’ quality of lifein long-term careFACILITATING/CONSTRAINING FACTORSPhysical environmentMEDIATINGPersonality andFACTORSlife experiencesCORE FACTORSQUALITY OF LIFESense of self andidentityExpectationsCareenvironmentand ethosof careConnectedness,socialrelationshipsand networksAdaptiveresponses215Activities andtherapiesHealth status/dependency levelSocial environmentCareenvironmentand ethosof care
12.3 Key Findings216Analysis of the key findings will focus on understanding the dynamic aspects of therelationship between care provision and environment in residential settings, andresidents’ quality of life. There are differences in resident quality of life both withinsectors and across sectors, some of which relate to the care environment, othersof which relate to the dependency and personality of the resident themselves.What is clear from the data is that management and organisational structures withinlong-stay care facilities matter for quality of life and can compensate for poorphysical environment in certain circumstances. The issue is less whether care isdelivered publicly or privately, more whether care is resident-centred and qualitydriven. The focus of the final chapter is to explore what can be done to bring aboutan improvement in quality of life for residents on the basis of the findings of theresearch. Notwithstanding the complexity associated with the meaning andmeasurement of quality of life, there are underlying issues that need to be resolvedto effect an improvement in the lives of older people in residential care. Anexamination of the four key quality of life determinants revealed threeinterconnected issues that had a significant impact on all determinants: staffing andskill mix; physical environment and ethos of care; and the provision of meaningfulactivities and therapies.12.4 Staffing Levels and Skill MixA survey of 19 OECD countries, including Ireland, found that staff shortages andstaff qualifications are the primary concerns of long-stay care policy-makers in thesecountries (OECD, 2005). This finding was confirmed by survey and interview data inthe present study. It was evident from the study sites that there were significantdifferences in staffing levels and staff mix across facility types. Within the privatesector, the ratio of registered nurses to care assistants was significantly lower thanthat in the public sector. In addition, the survey found that the ratio of registerednurses to residents was significantly lower in the private sector than in the publicsector. While dependency levels in public geriatric hospitals were highest, thisalone could not account for the variance in staffing levels. Three issues are apparent:the ratio of registered nurses to care assistants impacts directly on the capacityof registered nurses to supervise the work of care assistants; care assistants whoare providing a very high percentage of residents’ care in the private sector must befully trained for this role in order to provide an acceptable standard of care; and theImproving Quality of Life for Older People in Long-Stay Care Settings in Ireland
Page 1 and 2:
ImprovingQuality of Lifefor Older P
Page 3:
National Council on Ageing and Olde
Page 6 and 7:
Authors’ AcknowledgementsThe rese
Page 8 and 9:
ContentsCouncil Comments and Recomm
Page 10:
6.7 Meaningful Occupation 1296.8 Ch
Page 14 and 15:
CouncilComments andRecommendations
Page 16 and 17:
Quality of Life DomainsThe research
Page 18 and 19:
Meaningful ActivitiesThe research n
Page 20 and 21:
the research revealed that, in gene
Page 22 and 23:
The Council accepts that the cultur
Page 24 and 25:
this regard. The Council believes t
Page 26 and 27:
ExecutiveSummary
Page 28 and 29:
MethodologyA mixed method research
Page 30 and 31:
Long-Stay Facility Survey FindingsT
Page 32 and 33:
Residents were most positive about
Page 34 and 35:
Chapter OneIntroduction
Page 36 and 37:
There is no single definition descr
Page 38 and 39:
This chapter provides justification
Page 40 and 41:
Chapter TwoQuality of Careand Quali
Page 42 and 43:
2.2 Separating Quality of Care and
Page 44 and 45:
2.3 Policy for Long-Stay Care in Ir
Page 46 and 47:
2.4 Regulatory StructuresThere are
Page 48 and 49:
Medical preparations - medication s
Page 50 and 51:
inspections are mainly concerned wi
Page 52 and 53:
often not designed to meet the spec
Page 54 and 55:
Residents who did not want to be in
Page 56 and 57:
Human resources management standard
Page 58 and 59:
The Mid-West Standards for Resident
Page 60 and 61:
process and outcomes of the service
Page 62 and 63:
2.9 ConclusionQuality of life for o
Page 64 and 65:
Chapter ThreeThe Interpretationand
Page 66 and 67:
The difficulty of defining such an
Page 68 and 69:
Implicit definitions use the broad
Page 70 and 71:
Human needs may also provide part o
Page 72 and 73:
successfully complete a self-report
Page 74 and 75:
In relation to older people specifi
Page 76 and 77:
The results of this particular stud
Page 78 and 79:
The design of a residential care se
Page 80 and 81:
Chapter FourMethodology
Page 82 and 83:
each method used at the same point
Page 84 and 85:
4.3.3 Data AnalysisThe transcripts
Page 86 and 87:
Table 4.2: Distribution of question
Page 88 and 89:
4.4.4 Quantitative Data AnalysisThe
Page 90 and 91:
Anonymity and confidentiality are i
Page 92 and 93:
from stakeholders who attended the
Page 94 and 95:
4.7 Ethical ClearanceEthical cleara
Page 96 and 97:
Chapter FiveQuality of Lifein Long-
Page 98 and 99:
All participants reported that ther
Page 100 and 101:
Staffing and skill mix: comments fr
Page 102 and 103:
Recruiting and retaining staff: com
Page 104 and 105:
Impact of physical environment on r
Page 106 and 107:
5.6.2 Social EnvironmentParticipant
Page 108 and 109:
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 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 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
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 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
Page 226 and 227: Older people in residential care mu
Page 228 and 229: choice regarding the gender of a ca
Page 230 and 231: Residents and their families should
Page 232 and 233: References
Page 234 and 235: Birren, J.E. and Dieckmann, L., 199
Page 236 and 237: Collin, C., Wade, D.T., Davies, S.,
Page 238 and 239: Hubbard, G., Downs, M.G. and Tester
Page 240 and 241: McCormack, B., 2003. ‘A conceptua
Page 242 and 243: Redfern, S., Hannan, S., Norman, I.
Page 244 and 245: Appendices
Page 246 and 247: Profile of your long-stay facility1
Page 248 and 249: 6a. Are there any reasons why you w
Page 250 and 251: Staff resources10. How many whole-t
Page 252 and 253: Services and facilities17. Are any
Page 254 and 255: Care process24a. Can long-stay resi
Page 256 and 257: 32b. If Yes, when can residents smo
Page 258 and 259: 38a. Was this facility purpose-buil
Page 260 and 261: 45. Are any of the following provid
Page 262 and 263: General atmosphereComment on the ge
Page 264 and 265: DomainFeeling caredfor/feelingsecur
Page 266 and 267:
DomainFeeling caredfor/feelingsecur
Page 268 and 269:
DomainGeneralCue question/promptsHa
Page 270 and 271:
DomainCompanionship/relationshipCon
Page 272 and 273:
DomainRelationship tofamily/friends
Page 274 and 275:
Terms ofReference
Page 276 and 277:
c) providing information and advice
Page 278:
National Council on Ageingand Older
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?