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

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The Council accepts that the cultural shift necessary to translate these values intoaction is, by no means, insignificant and it recognises that such a shift requires thesustained provision of dedicated assistance, guidance, encouragement and supportto long-stay care staff.Education and Training for Age FriendlyLong-Stay Care ServicesParticipants in the nurse manager focus groups concluded that a programme ofeducation and training is required to facilitate the development of an ethos of carethat focuses on quality of life and addresses the attitudinal and organisational changesrequired in this regard. They also highlighted that training opportunities are limitedfor those working in the sector and noted that the traditional focus of training forlong-stay care staff has been on the process of nursing care delivery only.The Council has previously asserted its concern to promote education andtraining for an age friendly society, leading to a better understanding ofageing and older people in all walks of life and particularly where decisionsaffecting older people are being taken (Delaney et al., 2005). The Council will,therefore, endeavour to support the development of education and trainingfor age friendly long-stay care services in partnership with other agenciesand recommends that together with a focus on the quality of life domainsoutlined previously, a number of further strands be incorporated including:21age awareness trainingquality assurance trainingtraining for consultation.The Council recommends that standards for training and development plansthat have a specific quality of life focus be drawn up for all staff working inlong-stay care facilities, and advocates that staff should be provided withopportunities to avail of such education and training.
Age Awareness TrainingMany stereotypical assumptions about old age as being a time of disease, declineand passivity are fuelled by an absence of information about our older population.Through its programme of research, over a number of years, the Council has drawntogether a large volume of information about older people in Ireland. This informationhighlights the heterogeneity of the older population, in addition to dispelling someof the myths of ageing. The Council recommends that its research findings, andin particular, the findings detailed in this report be incorporated into any ageawareness training programme that is developed for long-stay care staff.Quality Assurance Training22Quality assurance is a process through which service providers and recipients canassess services to ascertain whether acceptable practices are being adopted, anddevise adjustments and improvements where deficiencies are identified. As such,quality assurance mechanisms are viewed as a way of continuous improvement. Inthis regard, the Council notes the Code of Practice for Nursing Homes (Departmentof Health, 1995), which was developed as a quality assurance guidance documentto encourage long-stay care service providers to promote quality of life for residents.Another form of quality assurance is accreditation. In this regard, the Council notesthe recent development of draft Residential Care Accreditation Standards (RCAS)by the Irish Health Services Accreditation Board (IHSAB). The Council reiteratesits recommendation for the development of quality assurance mechanisms forthe long-stay care sector. Specifically, it reiterates its recommendation that alllong-stay facilities be required to produce a quality assurance policy statementand a quality assurance service plan (NCAOP, 2000). In order to foster andenhance quality of life in particular, the Council advises that all qualityassurance mechanisms should take account of the findings of this research.An example of good practice with regard to quality assurance is the Healthy AgeingInitiative for Residential Care (HAIRC), which has been developed jointly by theNCAOP and the Irish National Health Promoting Hospitals Network (INHPHN). Theinitiative proposes ten steps to promote person-centred care and quality of life, thecreation of a positive working environment for those involved in care provision, andthe development of family friendly environments. Launched in 2005, the initiative isbeing evaluated with a view to its further development as a tool to promote qualityof life in the facilities that opt to implement the programme. It is critical to note thatexperience from the facilities to date highlights the need for support and training inImproving 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 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
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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
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Staff turnover investigates the num
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Table 6.10: Therapeutic and other s
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sector and 50 per cent in the volun
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Table 6.13: Number of facilities in
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stay units also allow ambulant, men
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The majority of private and volunta
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Table 6.17: Call bell facilities by
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Chapter SevenDescription ofStudy Si
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others were open and residents’ b
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7.2.2 StaffingRegistered nurses and
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Some residents were able to leave t
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the day by their bed. In addition,
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equired full assistance with dressi
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Chapter EightCare Environmentand Et
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8.2 Promoting AutonomyThis category
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Table 8.1: Involvement of residents
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Table 8.2: Maintaining independence
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Focus group participants reported t
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Staff respondents also highlighted
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Therefore, the practice of rosterin
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8.7 ConclusionThis chapter presente
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Chapter NinePersonal Identity
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Table 9.1: Identity and personalise
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The real meI’m there in a photogr
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how important it was that residents
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Table 9.5: Freedom and constraintsA
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9.5 PrivacyThe degree of privacy en
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9.6 Self-RespectAcknowledging resid
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9.7 ConclusionsThe findings suggest
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Chapter TenConnectedness,Social Rel
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10.2 Connectedness, Involvement and
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A concrete example of the priority
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Cultural differencesnot an issueI f
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esidents but reserved the title of
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Table 10.3: Relationships among res
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it feel more like visiting somebody
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Near home(I) was living up the road
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Chapter ElevenActivitiesand Therapi
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had a special activities/therapies
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11.3 Therapeutic ActivityThis categ
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A few facilities had incorporated o
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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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