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

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Medical preparations – medication should be stored safely and properlyadministered and recorded.Treatment – where medical treatment is required and agreed to by the residentit must be carried out. A person’s right to refuse treatment must be respected.If physiotherapy, occupational therapy or chiropody is required it must be madeavailable by the nursing home proprietor or by arrangement with the health board.Services – a nursing home proprietor may make arrangements with the healthboard for the provision of services by that health board.Registration certificate – the current registration certificate must be displayedin a prominent place in the nursing home at all times.Insurance – residents must be adequately insured against injury.These regulations were supplemented in 1995 by the voluntary Code of Practicefor Nursing Homes agreed by experts including the health boards, owners ofnursing homes, the NCAOP, carers and other people experienced in the care ofolder people (Mangan, 1998). The Code of Practice is designed to complement the1993 regulations and guides nursing homes in the operation of best standards ofcare beyond the minimum standards outlined in the regulations. In particular, the‘aim of the Code of Practice is to promote a good quality of life for residents innursing homes’ (DoHC, 1995).47The Code of Practice proposes that nursing homes should create an environmentthat imitates home life as closely as possible. In particular, it proposes that thelifestyle of residents should be as non-institutionalised as possible. The coderecommends that:residents must be involved in decision-making regarding the routines of thehome to the extent that this is feasiblerigid routines should not be imposed on residents, who should be able toexercise a degree of choice regarding daily activities such as bedtimes andmealtimes, and selecting food and clothingthe facility should seek to develop the full potential of the individual andpromote his or her independenceresidents should be able to avail of introductory visits to the nursing homeresidents should be able to access their personal recordsresidents should be given a choice regarding the gender of the care giver
estraint should only be used in cases where residents pose a threat of injuryto themselves or other residentsa complete nursing review of each resident should be undertaken at least everysix monthsa wide range of normal activities should be made available to residents andcompetent residents should be free to judge the risk to them posed by certainactivitiesvisiting arrangements by families and friends of residents to the nursing homeshould be flexiblevisits from volunteers and members of the local community should befacilitatedthere should be a mechanism within nursing homes to deal with in-housecomplaints.48The Code of Practice was an interesting and welcome quality initiative intended tobroaden the scope of existing regulatory structures for nursing homes in Ireland.It focused on quality of care and quality of life of residents. It recognised theimportance of choice and autonomy for older people, their empowerment throughconsultation, their connectedness to the outside world and their involvement inmeaningful activities. The main difficulty with the code was, and is, that it remainsvoluntary and the actions recommended are not subject to monitoring or evaluation.Moreover, like the regulations, the code is confined to private and voluntary nursinghomes and does not cover public long-stay institutions.2.5 Problems with Current Regulatory StructuresThe problems of the current regulatory structures for long-stay care in Ireland arewell known and have been articulated in many reports and commentaries (O’Shea,1991; Ruddle et al., 1997; NCAOP, 2000; Women’s Health Council, 2001; Mangan,2003). Some of the main concerns in this area are that:there are no national standards of careexisting regulations are confined to nursing homes and voluntary homesthe lack of tangible outcome measures means that standards of care are largelydependent on the personal interpretation of different inspectorsImproving 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 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 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
Page 86 and 87: Table 4.2: Distribution of question
Page 88 and 89: 4.4.4 Quantitative Data AnalysisThe
Page 90 and 91: Anonymity and confidentiality are i
Page 92 and 93: from stakeholders who attended the
Page 94 and 95: 4.7 Ethical ClearanceEthical cleara
Page 96 and 97: Chapter FiveQuality of Lifein Long-
Page 98 and 99:
All participants reported that ther
Page 100 and 101:
Staffing and skill mix: comments fr
Page 102 and 103:
Recruiting and retaining staff: com
Page 104 and 105:
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
Page 160 and 161:
Focus group participants reported t
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Staff respondents also highlighted
Page 164 and 165:
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
Page 176 and 177:
Table 9.5: Freedom and constraintsA
Page 178 and 179:
9.5 PrivacyThe degree of privacy en
Page 180 and 181:
9.6 Self-RespectAcknowledging resid
Page 182 and 183:
9.7 ConclusionsThe findings suggest
Page 184 and 185:
Chapter TenConnectedness,Social Rel
Page 186 and 187:
10.2 Connectedness, Involvement and
Page 188 and 189:
A concrete example of the priority
Page 190 and 191:
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
Page 234 and 235:
Birren, J.E. and Dieckmann, L., 199
Page 236 and 237:
Collin, C., Wade, D.T., Davies, S.,
Page 238 and 239:
Hubbard, G., Downs, M.G. and Tester
Page 240 and 241:
McCormack, B., 2003. ‘A conceptua
Page 242 and 243:
Redfern, S., Hannan, S., Norman, I.
Page 244 and 245:
Appendices
Page 246 and 247:
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
Page 252 and 253:
Services and facilities17. Are any
Page 254 and 255:
Care process24a. Can long-stay resi
Page 256 and 257:
32b. If Yes, when can residents smo
Page 258 and 259:
38a. Was this facility purpose-buil
Page 260 and 261:
45. Are any of the following provid
Page 262 and 263:
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
Page 276 and 277:
c) providing information and advice
Page 278:
National Council on Ageingand Older
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