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

While residents may have a range of physical and mental limitations, they cannot beviewed merely as patients. They are also members of a community and have needsand wants that go beyond health and physical functioning. Some commentatorshave proposed that the limited abilities and freedom of residents along with theinstitutional nature of long-stay care settings means these facilities impact on everyaspect of a resident’s life (Kane et al., 2004). It is important that managers and staffin long-stay care settings provide a service that is mindful of its full impact.42There have been more attempts to conceptualise and measure quality of carethan quality of life in long-stay care (Noelker and Harel, 2001). The concentrationon quality of care by policy-makers and regulators has occurred mainly becauselong-stay care settings are seen primarily as healthcare institutions and alsobecause measuring quality of care has proved to be a less difficult task thanmeasuring quality of life. Measurement of quality of care has been guided by aframework put forward by Donabedian which emphasises the components ofstructure, process and outcomes. Structure is concerned mainly with the physicalenvironment and staffing; process refers to ‘what is done (appropriateness ofcare), when it is done (its timeliness), and how well it is done (technical efficiency)’(Donabedian, 1980). Examples of process include mechanisms to protect residents’rights, well-functioning transfer and discharge management, procedures of residentassessments used for care planning, availability of services needed to attain andmaintain residents’ highest practicable level of functioning, and availability ofsufficiently qualified staff around the clock, seven days a week (OECD, 2005).Care outcomes have received the most attention for monitoring the quality oflong-stay care, mainly because they are the easiest to measure and are regardedas being central to quality assurance and regulation (Noelker and Harel, 2001).Some examples of quality outcomes include the prevalence of pressure sores,the prevalence of malnutrition and adequacy of tube feeding, use of restraints,number of falls, infections, and poorly managed pain (OECD, 2005).However, interpretations and developments arising from Donabedian’s frameworkfor quality of care do not recognise or incorporate the full range of factors influencingthe quality of life of residents. The focus on the physical structure of the residentialcare setting, the facilities and care provided, and the health and safety of residentsmeans that important aspects of a resident’s quality of life such as privacy, socialinteraction, activities, independence and autonomy are ignored and neglected.Therefore, the prominence given to quality of care is inadequate and the onus isnow on policy-makers to address the important issue of quality of life in long-staycare services. The next section examines how quality issues in long-stay care havebeen handled in respect of public policy for long-stay care in Ireland.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland