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

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There is no single definition describing this concept, which makes it more difficultto think about domains of quality of life. It is important, however, to provide aframework for the exploration and measurement of quality of life for residents inlong-stay residential care settings. While an objective assessment of quality of lifeis important, the subjective experiences of residents also matter; these must becommunicated if we are to move towards an understanding of the ‘good life’ withinresidential care. It is only then that policy-makers will be able to develop quality oflife indicators and implement meaningful regulatory structures to improve qualityof life in long-stay care.Despite the complex and subjective nature of quality of life and the variousmeasurement difficulties it poses, quality of life is being increasingly recognisedas a key outcome of the care of older people. Sander and Walden (1985) describethe ideal nursing home as a place where people live their lives with as little physicalor psychosocial discomfort as possible, ‘with dignity and a good quality of life’. Thelife of the nursing home resident, they suggest, should be as similar as possible tothe life he or she would choose to live at home. The Royal College of Physicians(1992) insists that good quality of life should be the goal of long-stay care. RecentIrish health policy espouses similar goals, although plans are weak on definitions,measurement instruments and implementation strategies (Department of Healthand Children [DoHC], 2001; Department of Health, 1994; Department of Health,1988). There is an evolving literature on quality of life for people in long-stay care,which has identified a number of important key domains including: identity,autonomy, physical environment, social environment, connectedness, andmeaningful activity (Age & Opportunity, 2003; Standing Nursing and MidwiferyAdvisory Committee, 2001; Nolan et al., 2001; National Council on Ageing andOlder People (NCAOP), 2000; Davies et al., 1999; Royal College of Nursing, 1991).Notwithstanding an increased emphasis on quality of life, we must now developregulatory frameworks to bring about genuine improvements in quality of life forolder people in residential care settings. This is particularly so in Ireland, wherewe have been much better at providing beds and financial support for older people,albeit sometimes controversially, than considering the many and varied issues thataffect quality of life.35
Traditionally, the quality focus in residential care settings in Ireland has been onquality of care rather than quality of life. The Health (Nursing Homes) Act, 1990,provides a regulatory framework that emphasises structural and process dimensionsof quality of care. The main areas covered by the regulations include the care andwelfare of residents, staffing, accommodation, facilities, hygiene, inspectionsand complaints – all of which contribute to quality of life, but none of which,even in combination, determine quality of life. Several quality initiatives havebeen developed and implemented in recent years in an effort to improve thequality of long-stay care for older people, but the dominant concern in most ofthese has been on enhancing standards of care rather than quality of life. Theseinitiatives include the establishment of the interim Health Information and QualityAuthority (iHIQA), the Irish Health Services Accreditation Board (IHSAB), theHealthy Ageing Initiative for Residential Care (HAIRC) (which directly covers qualityof life dimensions) and various Health Services Executive (HSE) programmes,based mainly on Essence of Care frameworks for older people in long-stay care.36Long-stay care units are more than just providers of healthcare; they are also thepermanent dwelling place of residents – home for the people that live there. Theyhave the potential, therefore, to influence and affect many aspects of residents’daily lives beyond health and functional ability. It is important, therefore, thatpolicy-makers and other interested parties recognise and understand the importantelements that constitute a good quality of life in long-stay care in order to put inplace mechanisms that will ensure that this objective is achieved.The origin of this research report lies in the concern of the NCAOP about the qualityand effectiveness of long-stay care services in Ireland and its desire to developquality assurance mechanisms for long-stay care that emphasise quality of life asmuch as quality of care. The purpose of the report is to explore quality of life issuesas perceived by residents and staff in long-stay care settings in Ireland.The report begins with an examination of quality of care and quality of life issuesfor older people in Ireland. Existing measurement instruments and regulatoryframeworks for quality of care and quality of life are described. A cross-countrycomparative review of public policy relating to quality of life in long-stay care isalso provided. Chapter Two examines various approaches to understanding qualityof life before going on to explore quality of life for older people. A number of qualityof life frameworks for older people in long-stay care are examined with a viewto ascertaining their usefulness in exploring quality of life in an Irish context inChapter Three. The methodology used in the study is outlined in Chapter Four.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 32 and 33: Residents were most positive about
Page 34 and 35: Chapter OneIntroduction
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
Page 84 and 85: 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
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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
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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
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DomainGeneralCue question/promptsHa
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DomainCompanionship/relationshipCon
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DomainRelationship tofamily/friends
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Terms ofReference
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c) providing information and advice
Page 278:
National Council on Ageingand Older
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