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

meet and work on a joint project or introducing resident/staff committees to workon an agreed project. The introduction of biographical interviewing would enablestaff to get to know the resident, his/her past experience and interests.224The provision of physiotherapy, occupational therapy and speech and languagetherapy was identified by this study as a key concern. In the public sector, whilephysiotherapy services were available free of charge in most facilities, theresources were often spread very thinly and resulted in many residents notreceiving adequate attention. Occupational therapy was generally less availablein public facilities and where it was available it was also likely to be thinly spread.Speech therapists, psychologists and social workers were even less available.If the focus of long-stay care is on maintaining and promoting a resident’sindependence, these services are crucial to quality of life. While the survey datarevealed that these services could be accessed at market rates in most privatefacilities, the ability to pay may be an issue for residents, especially for those inreceipt of public subventions. This gives rise to the anomaly that older people inpublic long-stay facilities tend to have greater access to public therapeutic facilitiesthan publicly supported residents living in private nursing homes, even allowingfor issues of availability in the public sector. A key finding of this research is theneed to see all long-stay facilities in dynamic rather than static terms, as placesof rehabilitation and recovery for the people who live there rather than placesof dependency and decline.12.7 Policy and Practice IssuesAt the heart of any reform with respect to policy and practice is the need toembrace a new philosophy that places older people at the centre of decisionmakingin long-stay care. The central principles that should underpin any newlegislation include: personhood, autonomy, empowerment and capabilities.Personhood offers an opportunity to personalise care that will enhance the dignityand self-respect of residents. Self-respect incorporates both self-worth and selfconfidenceand individuals require these attributes in order to believe that theiractions in everyday life are worthwhile and are appreciated by others. The moveto residential care can lead to an erosion of people’s independence, autonomy andsense of self. Therefore, it is particularly important that the ethos of the residentialcare facility is one of encouraging autonomy and empowerment and that there arestructures in place to encourage and promote the self-determination of residents.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland