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

Older people in residential care must be recognised as individuals in their ownright, not just patients. Residents of long-stay care have the same needs and rightsas all other people and, in fact, their needs are greater because of the prevalenceof physical and mental frailty. Capabilities refer to the ability of an individual tomaximise performance and achievement in terms of doing and being in life. Thecapability of a person is dependent on the resources available to them as well astheir personal characteristics. Thus, the residential care environment, both physicaland social, plays an important role in influencing the capabilities of its residents.The current legislation and regulations governing residential care have manylimitations, not least of which is their focus on quality of care rather than qualityof life. In addition, the regulations outlined under the Health (Nursing Homes) Act,1990, apply only to the private sector and are not relevant to public facilities. Thelegislation is weak on sanctions for facilities providing inferior quality of care. Thereis no independent inspectorate of nursing homes which means that it is left up tothe HSE to inspect private nursing homes while those facilities run by the HSE arenot subject to any inspection at all. Inspections are rarely carried out at night andunannounced inspections are uncommon. While inspection reports are availableunder the Freedom of Information Act, 1997, this is a cumbersome and timeconsumingprocess, making exposure of poor facilities less likely. Information isthe key to a transparent and quality-driven service and to competition within thesector. Residents are poorly served at the moment with respect to informationon quality of care and quality of life.225There is no statutory or independent complaints or appeals mechanism. It is rarethat private nursing homes are closed down following complaints or inspection.While the HSE can move to shut down a private or voluntary nursing home or put inplace its own management team if it believes the proprietors fail to meet minimumstandards, it can only do this with the compliance of the proprietors; otherwise,it must go to the District Court in order to carry out these actions. In the casewhere a nursing home is closed down, alternative accommodation must befound for the residents, which can be traumatic for residents and their families.Many countries, including Ireland, are becoming increasingly aware of theimportance of quality in long-stay care institutions. This has resulted in thedevelopment and implementation of quality mechanisms both nationally andinternationally, mainly in relation to physical environment and care process. InIreland, the Government has realised the need to foster and promote high-qualityhealth and care services and have established the HIQA and the IHSAB to achievethis goal. In addition, quality of care initiatives have been developed at local and