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

Chapter OneIntroduction34Quality of life has become an increasingly popular term and is now spoken of in adiversity of contexts. Its usage has become widespread covering almost all facetsof daily living, although the concept remains complex and mostly ill-defined. Qualityof life is especially relevant for residents in long-stay care facilities, who may beconsidered as one of the most vulnerable groups in society given their increasingage and levels of dependency. For this group, a poor quality of care provisionwill have a significant impact on their quality of life. Furthermore, older peoplein residential settings may be unable or unwilling to complain about substandardcare or conditions due to cognitive and/or communication impairments, or becauseof low expectations about quality of life in long-stay care. Older people living inresidential care cannot always exercise their usual consumer sovereignty andthe power relationship between the providers of long-stay care and residentsis an unequal one. Residents in long-stay care may be afraid to criticise theservices provided to them due to a concern that such action might have negativerepercussions. In addition, many residents may have little or no support outsidethe residential care setting and, therefore, have no alternative but to acceptthe treatment given to them. While regulations have been put in place in mostcountries, including Ireland, to ensure that minimum acceptable standards areadhered to in residential care and that the rights and entitlements of residentsare recognised and respected, this has not always been enough to ensure goodquality of life. There is evidence, for instance, that the quality of long-stay careservices for older people is variable in many countries and does not always meetthe expectations of the public, the users of services or their families (OECD, 2005).Quality of life for people with dementia may be a particular problem in residentialcare settings (Moise et al., 2004).While quality of life is a useful and widely used expression, its apparent simplicitymasks the complexity and ambiguity surrounding the concept. There is muchdebate and confusion over what elements should be included in quality of life, howthese various elements should be measured and who should do the measuring.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland