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

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Residents were most positive about staff who chatted and showed an interest inthem. Overall, interaction amongst residents was good, although people wantedmore choice in relation to how these relationships were negotiated and mediated.There were widespread differences in the provision of activities across study sites.Some sites had an extensive range of activities while others provided little in theway of activities. Some residents, therefore, had good opportunities to pursuemeaningful activities while others did not. It was evident that some residents’days were long and boring; consequently, these residents were often frustratedand disengaged. Residents were most likely to participate in activities whichwere designed to take into account their own particular interests. The absenceof occupational therapy and physiotherapy were highlighted as particular concernsby residents and staff in both public and private facilities.ConclusionIt was evident that much work remains to be done in ensuring a good quality oflife for older people in long-stay care. Any new legislation will have to acknowledgethat residential care is the permanent home of the majority of its residents. Longstayfacilities must, therefore, be encouraged, through regulation and sanctions,to produce a more home-like environment and reduce the institutional feel of thesefacilities. Residents must be able to continue living as they did in their former homestaking into account their limitations and capabilities. Finding out what people likeand dislike is the first step to giving residents a more home-like environment. Givingpeople more choice will help to develop residents’ independence and autonomy,thus contributing to their dignity and self-respect. Dignity can also be upheld byrespecting residents’ need for privacy, through, for example, the provision of anadequate number of single rooms.31To date, not enough attention has been paid by policy-makers and regulators toquality of life, who have instead focused their attention on ensuring a good qualityof care. While this can be justified by the central role played by these facilities asproviders of care and the more tangible nature of quality of care indicators, theprominence given to quality of care, while necessary, is not sufficient and it isimperative that quality of life in long-stay care is also given the due recognitionit deserves. Older people in long-stay care are more than just patients, theyare individuals who deserve to live the remainder of their days with dignity and
espect in an environment that is empowering and enabling, not belittling. It is notonly policy-makers that have to change; management and staff also need to changeand see their roles in terms of developing and enhancing quality of life as much asquality of care. Long-stay care settings are not places to die, they are places to liveand live well. The impetus is now on regulators, policy-makers and practitionersto ensure that residents of long-stay care are guaranteed the best quality of lifepossible in these settings as well as the best possible quality of care.Authors’ Recommendations321. Develop a person-centred ethos of care within residential settings througheducation and training of management and staff.2. Ensure that registered nurse to resident staffing ratios are high enough to allowthe direct participation of nurses in the planning, delivery and supervision of care.3. Develop uniform national care standards for all types of residential care settingsin Ireland.4. Establish an independent social services inspectorate for the regulation,inspection and monitoring of quality of care and quality of life in residential care.5. Ask residents and their families directly about their experiences of long-staycare as part of the regulatory and inspection process.6. Publish regular information on the results of inspection which includesreference to, and monitoring of, quality of life in the following domains: careenvironment and ethos of care, sense of self and identity, connectedness, andmeaningful activities and therapies.7. Develop appropriate consultation structures within long-stay settings to giveolder people a greater voice in how services are structured and delivered.8. Review the appropriateness of current care environments and the overallmanagement of residents with dementia, with particular reference to the careof people with challenging behaviours.9. Replace existing, inappropriately designed public long-stay facilities with newbuildings designed to provide accommodation that recognises the individuality of allresidents and allows them to choose their desired mix of private and public space.10. Develop an appropriate reward structure for residential care settings that delivergood quality care and good quality of life for residents and penalties for thosethat provide poor quality of care and diminished quality of life for residents.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 28 and 29: MethodologyA mixed method research
Page 30 and 31: Long-Stay Facility Survey FindingsT
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
Page 82 and 83:
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
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32b. If Yes, when can residents smo
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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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