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

The physical environment in some facilities was less suitable for residents withdementia than others. Lack of space to wander and constrained physical space ingeneral exacerbated resident agitation. In addition, many staff reported that theyfelt they did not have the skills to manage residents with dementia. It is importantthat residents with dementia are cared for in appropriate facilities and managed bystaff that are skilled in the care of people with dementia. There also needs to bea mechanism to transfer residents whose challenging behaviour is problematicto facilities that are structured to support their particular needs.Privacy is an important issue for residents in long-stay care. Many residents livingin public facilities are accommodated in communal units. While many of theseunits have been adapted from large open wards to smaller units, residents in thesefacilities have little opportunities for privacy or personalising their environment.Sharing a room with others may be a choice that a resident would make, but manypublic facilities could not offer such a choice to residents because they have a verylimited number of single rooms. Residents who expressed greatest satisfactionwith their environment generally had a room of their own. A room of their owngave residents control over their environment, greater choice in how they spenttheir time and more privacy. Residents who lived in large open-plan wards wereleast satisfied. They described their struggle to live a private life in a public spaceand many expressed a desire for a room of their own. A single room was thenorm across private facilities (apart from residents who choose to share) but theexception in public facilities. The authors recommend that single occupancy roomswith en suite facilities should be the norm in all future buildings. This standardshould apply across both public and private facilities. Clearly, the time has cometo modernise public long-stay facilities and invest in new, appropriately designed,buildings for the care of older dependent people.221It was evident from the interview data that the perspectives of residents andstaff differed in what they considered important for privacy. Staff equated privacyto physical privacy. Residents, in contrast, perceived privacy to include socialand psychological privacy in addition to physical privacy. Many residents living incommunal spaces wanted a private visiting area and a quiet place away from thegeneral noise of the ward. The survey demonstrated, however, that you were lesslikely to have access to a private visiting space if you were living in a public facility.Another issue raised by residents was staff failing to knock prior to entering theirrooms. It is important that residents’ rooms are considered to be their privatespaces and sensitivity should be demonstrated.