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

Residents and their families should be asked directly about their experiences ofquality of care and quality of life in residential care as part of the inspection andregulatory process and procedures carried out by a newly established SocialServices Inspectorate for long-stay care. Information should be published regularlyon the results of inspections, including specific information on care environmentand ethos of care, sense of self and identity among residents, social connectednessand meaningful activities and therapies. As part of the new emphasis on quality oflife, all long-stay facilities should be mandated to develop appropriate consultationstructures designed to give older people a voice in how the facility is run, includingwhat services are provided to residents.New investment is also required in respect of public long-stay facilities to replacean ageing capital stock that, for the most part, was not designed to cater for theneeds of dependent older people. Unfortunately, regulations on the design of carebuildings have accumulated over time with little knowledge of their impact on thequality of life of building users. This must change and any new investment mustbe small-scale and facilitate the independence of residents. Building features thatmaximise choice and control, privacy, social connectedness, physical support,cognitive support, comfort and personalisation will enhance the quality of lifeof residents. The physical care environment and overall design of the buildingsare particularly important for people with dementia. Finally, good quality facilitiesshould be rewarded with extra resources and residents, while poor qualityproviders, whatever their origins, should be named, shamed and prosecuted.229In conclusion, it is evident that much work remains to be done in ensuring agood quality of life for older people resident in long-stay care. To date, not enoughattention has been paid by policy-makers and regulators to quality of life and theyhave instead chosen to focus their attention on ensuring a good quality of care ismade available in long-stay residential care. While this can be justified by the centralrole played by these facilities as providers of care and the more tangible nature ofquality of care indicators, the prominence given to quality of care, while necessary,is not sufficient and it is imperative that quality of life in long-stay care is giventhe due recognition it deserves. Older people in long-stay care are more than justpatients; they are individuals who deserve to live the remainder of their days withdignity and respect in an environment that is empowering and enabling, notbelittling. It is not only policy-makers that have to change; management and staffalso need to change and see their roles in terms of developing quality of life asmuch as quality of care. Long-stay care settings are not places to die; they areplaces to live and live well. The impetus is now on regulators, policy-makers andpractitioners to ensure that residents of long-stay care are guaranteed the bestquality of life possible in these settings as well as the best possible care.