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

This chapter provides justification for both the quantitative and qualitativeapproaches used in the study, as well as for the quality of life frameworks used toorganise the collection of data from the survey and interviews. Chapter Five reportson policy and practice issues with regard to quality issues in long-stay care fromthe viewpoint of nurse managers. The focus groups of nurse managers provided avaluable insight into current thinking on quality of life among staff in residential caresettings and helped to inform subsequent data collection in these settings. Thefindings from the survey questionnaire are presented in Chapter Six. A number ofdifferent dimensions are covered including: beds, residents, dependency, staffing,services, facilities, activities, care environment and physical environment. Whereverpossible, a comparison is made with previous work by O’Connor et al. (1986) on thequality of life in private and voluntary nursing homes.Chapter Seven provides detailed descriptions of the study sites used to collectqualitative information from residents and staff on their perceptions of factors thatcontribute to older people’s quality of life in long-stay care. This is followed in ChapterEight by the first of four chapters on qualitative aspects of quality of life in long-staycare. This chapter examines the care environment and the ethos of care, both ofwhich have a huge influence on the ability of residents to live life to the full withinan institutional setting. A number of interrelated issues are explored including:autonomy and freedom, choice, and the opportunity to shape the pattern of dailyliving. Chapter Nine examines the extent to which personal identity can be maintainedin long-stay care. Identity emerges as a leading issue in respect of quality of lifein long-stay care in Ireland; particularly whether the resident’s own sense of selfremains intact following admission and prolonged stay in a long-stay facility. Identityis, of course, multifaceted and incorporates many dimensions, the most importantof which will be considered in this chapter including: a sense of well-being, attitudeand outlook, self-expression, spirituality, appearance and privacy.37Connectedness issues are explored in Chapter Ten; relationships are importantin determining quality of life in long-stay settings and moving into a long-stay facilitymay enhance or diminish the potential set of connections and relationships withother people, including family and friends. The chapter explores internal residentinteractions, companionship, family relationships, intergenerational contacts, andgeneral links between the community and the residential facility. Meaningful andpurposeful activities are also important for quality of life in long-stay settings andthese are examined in Chapter Eleven. People’s preferences are unlikely to alteronce they enter long-stay care, given that they have been formed and shapedover a lifetime. It is important, therefore, that residents are given the opportunityto pursue interests and activities that they have enjoyed all of their life, as well asthe opportunity to participate (voluntarily) in new activities offered by the facility.