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

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MethodologyA mixed method research design was selected for this study as the aim was toexplore the quality of life of older people living in long-stay care from a number ofperspectives. Three methods were employed within this study: focus groups withmanagers; quantitative survey of long-stay facilities; and qualitative interviews withresidents, relatives and staff.Focus group interviews and analysis were undertaken prior to other data collectionas they informed the development of the survey instruments and provided,alongside the literature review, contextual information on factors that influenceresidents’ quality of life and care provision in general. Focus groups enabled importantbackground information on quality issues in long-stay care to be gathered. Sevenfocus groups were held with managers/proprietors of long-stay facilities. A purposeful,stratified sampling strategy was employed to ensure that representatives from fivetypes of facilities (geriatric hospital/home, health board district hospital/communityhospital, health board welfare home, voluntary geriatric home/hospital, and privatenursing home), three sectors (public, voluntary and private) and a mix of facilities(large, small and geographical setting) were invited to participate. In all, 67 managersparticipated in focus groups held in Donegal, Dublin, Cork and Galway.27The survey of all long-stay facilities extends and develops previous work by thethen National Council for the Aged (now the NCAOP) on quality of life in private andvoluntary nursing homes in Ireland (O’Connor and Thompstone, 1986). All 556 longstayfacilities in Ireland were surveyed. The final response rate was 332 giving aresponse rate of 62 per cent. The response varied across facility type; the highestrate was achieved in welfare homes (95 per cent) and the lowest in private nursinghomes (56 per cent). The quantitative survey of long-stay facilities was designed toprovide an insight into the likely impact of physical, environmental and staffingissues on older people’s quality of life.The qualitative interview data provided information on resident and staff perceptionsof quality of life in long-stay care. 2 The focus was on environmentally-related qualityof life issues (both physical and social) rather than on the individual health andfunctional capacity of respondents, although some data was collected on the latter.2 Long-stay care is provided to those who reside permanently within a facility.
The interviews with residents, staff and relatives were gathered in 12 long-stay carestudy sites. This approach yielded a rich contextualised data set and was resourceefficient as it allowed a large number of residents and staff to be interviewed in thesame setting over a period of a few days.In all, 101 resident interviews were gathered with between eight and ten undertakenin each study site. The sample comprised of residents who were newly admitted,residents who had lived in the facility for longer than three months and residentswho had some cognitive impairment but were able to understand questions andrespond. Both male and female residents were included. Forty-eight interviewswere conducted with staff across facilities, four within each study site. Allcategories of staff were included: registered nurses, directors of nursing, healthcare assistants, care attendants, cooks, cleaning staff, physiotherapists andoccupational therapists. Interviews with relatives were conducted by phone;in all, 13 interviews were conducted with relatives who agreed to participate.28Focus Group FindingsThe findings from focus groups revealed that low staffing levels and inappropriateskill mix were considered to be major barriers to the provision of quality care.The relatively low ratios of registered nurses to care assistants in some privatenursing homes was also raised as an issue of concern. Participants also reportedthat it was increasingly difficult to recruit and retain staff. Participants consideredthe physical and social environment of the facility to be key determinants ofresidents’ quality of life. The major negative impacts on quality of life wereidentified as a lack of privacy and an institutionalised approach to care. A shift toindividualised and person-centred care was viewed as central to improving qualityof life and well-being of people in long-stay care. Focus group participants madea number of recommendations for change. Chief among these were the need forstronger regulation and legislation and an independent inspectorate for both publicand private facilities.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland
Page 1 and 2: ImprovingQuality of Lifefor Older P
Page 3: National Council on Ageing and Olde
Page 6 and 7: Authors’ AcknowledgementsThe rese
Page 8 and 9: ContentsCouncil Comments and Recomm
Page 10: 6.7 Meaningful Occupation 1296.8 Ch
Page 14 and 15: CouncilComments andRecommendations
Page 16 and 17: Quality of Life DomainsThe research
Page 18 and 19: Meaningful ActivitiesThe research n
Page 20 and 21: the research revealed that, in gene
Page 22 and 23: The Council accepts that the cultur
Page 24 and 25: this regard. The Council believes t
Page 26 and 27: ExecutiveSummary
Page 30 and 31: Long-Stay Facility Survey FindingsT
Page 32 and 33: Residents were most positive about
Page 34 and 35: Chapter OneIntroduction
Page 36 and 37: There is no single definition descr
Page 38 and 39: This chapter provides justification
Page 40 and 41: Chapter TwoQuality of Careand Quali
Page 42 and 43: 2.2 Separating Quality of Care and
Page 44 and 45: 2.3 Policy for Long-Stay Care in Ir
Page 46 and 47: 2.4 Regulatory StructuresThere are
Page 48 and 49: Medical preparations - medication s
Page 50 and 51: inspections are mainly concerned wi
Page 52 and 53: often not designed to meet the spec
Page 54 and 55: Residents who did not want to be in
Page 56 and 57: Human resources management standard
Page 58 and 59: The Mid-West Standards for Resident
Page 60 and 61: process and outcomes of the service
Page 62 and 63: 2.9 ConclusionQuality of life for o
Page 64 and 65: Chapter ThreeThe Interpretationand
Page 66 and 67: The difficulty of defining such an
Page 68 and 69: Implicit definitions use the broad
Page 70 and 71: Human needs may also provide part o
Page 72 and 73: successfully complete a self-report
Page 74 and 75: In relation to older people specifi
Page 76 and 77: The results of this particular stud
Page 78 and 79:
The design of a residential care se
Page 80 and 81:
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
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Table 9.5: Freedom and constraintsA
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9.5 PrivacyThe degree of privacy en
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9.6 Self-RespectAcknowledging resid
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9.7 ConclusionsThe findings suggest
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Chapter TenConnectedness,Social Rel
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10.2 Connectedness, Involvement and
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A concrete example of the priority
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Cultural differencesnot an issueI f
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esidents but reserved the title of
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Table 10.3: Relationships among res
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it feel more like visiting somebody
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Near home(I) was living up the road
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Chapter ElevenActivitiesand Therapi
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had a special activities/therapies
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11.3 Therapeutic ActivityThis categ
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A few facilities had incorporated o
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Some facilities organised special t
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For residents, what appeared to be
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Chapter TwelveConclusions andRecomm
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The prevalence of quality deficits
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attitude to their institutionalisat
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higher the proportion of care given
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was that they had a choice. In some
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The physical environment in some fa
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activities need to be dynamic and r
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Older people in residential care mu
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choice regarding the gender of a ca
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Residents and their families should
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References
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Birren, J.E. and Dieckmann, L., 199
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Collin, C., Wade, D.T., Davies, S.,
Page 238 and 239:
Hubbard, G., Downs, M.G. and Tester
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McCormack, B., 2003. ‘A conceptua
Page 242 and 243:
Redfern, S., Hannan, S., Norman, I.
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Appendices
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Profile of your long-stay facility1
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6a. Are there any reasons why you w
Page 250 and 251:
Staff resources10. How many whole-t
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Services and facilities17. Are any
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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
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45. Are any of the following provid
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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
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c) providing information and advice
Page 278:
National Council on Ageingand Older
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