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

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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
egional levels. Examples of independent quality initiatives include the HAIRC,which includes quality of life dimensions, as well as quality of care elements.Internationally, many countries have moved to put in place mechanisms toguarantee better monitoring and assessment of quality in long-stay care. TheUK and Australia have established independent agencies to regulate social andhealthcare services. The USA has developed an RAI and MDS in order to identifyand develop quality indicators for nursing home residents, which include somequality of life domains. However, quality of life is still in its infancy and remainsunderdeveloped in most countries. This is why the policy focus in Ireland inthe coming years must be on quality of life as much as on quality of care if realimprovements in the lives of older people in long-stay care are to be realised.226The emphasis on quality of care at the expense of quality of life in long-stay carehas been due to the fact that quality of care has proved easier to measure andassess due to its more tangible nature. Difficulties in measuring quality of life arisedue to its complex, multidimensional and subjective nature. Quality of life coversmany domains and the relevance and importance of these domains remaincontentious. Nevertheless, while quality of life will depend on people’s individualcircumstances, personality and life history, there are many things that an institutioncan do to enhance quality of life. For this reason, asking people directly about theirquality of life must be built into any new legislation and regulations dealing withquality in residential care. It is acknowledged that there are considerable challengesto measuring the quality of life of older people in long-stay care, particularly forresidents suffering from dementia. Cognitive and/or communication impairmentsmean that dementia sufferers may find it more difficult to report on their quality oflife. Yet, if dementia sufferers are not consulted about quality of life, this leaves outa considerable proportion of long-stay residents. Measuring quality of life in dementiapatients is not impossible and a number of researchers have successfully identifiedperson-centred quality of life domains for residents suffering from dementia.Any new legislation must acknowledge that residential care is the permanent homeof the majority of its residents. Therefore, long-stay facilities must be encouragedthrough regulation and sanctions to produce a more home-like environment andreduce the institutional feel of facilities. Residents must be able to continueliving as they did in their former homes, taking into account their limitations andcapabilities. Finding out what people like and dislike is the first step to givingresidents a more home-like environment. Giving people more choice will help todevelop residents’ independence and autonomy, thus contributing to their dignityand self-respect. For example, dignity can be ensured by giving the resident theImproving Quality of Life for Older People in Long-Stay Care Settings in Ireland
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ImprovingQuality of Lifefor Older P
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National Council on Ageing and Olde
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Authors’ AcknowledgementsThe rese
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ContentsCouncil Comments and Recomm
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6.7 Meaningful Occupation 1296.8 Ch
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CouncilComments andRecommendations
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Quality of Life DomainsThe research
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Meaningful ActivitiesThe research n
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the research revealed that, in gene
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The Council accepts that the cultur
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this regard. The Council believes t
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ExecutiveSummary
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MethodologyA mixed method research
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Long-Stay Facility Survey FindingsT
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Residents were most positive about
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Chapter OneIntroduction
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There is no single definition descr
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This chapter provides justification
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Chapter TwoQuality of Careand Quali
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2.2 Separating Quality of Care and
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2.3 Policy for Long-Stay Care in Ir
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2.4 Regulatory StructuresThere are
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Medical preparations - medication s
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inspections are mainly concerned wi
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often not designed to meet the spec
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Residents who did not want to be in
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Human resources management standard
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The Mid-West Standards for Resident
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process and outcomes of the service
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2.9 ConclusionQuality of life for o
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Chapter ThreeThe Interpretationand
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The difficulty of defining such an
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Implicit definitions use the broad
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Human needs may also provide part o
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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
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 216 and 217: attitude to their institutionalisat
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 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
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National Council on Ageingand Older
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