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

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inspections are mainly concerned with physical conditions and health andsafety. There is little reference to quality of life or social gain issuesthe regulations do not provide a framework to monitor residents’ care plans.There are no mechanisms to identify how much long-stay care is required,how it is to be provided and whether the individual needs of residents havebeen metit is difficult to prosecute nursing homes that violate existing regulationsand it is rare that a nursing home will be closed down even if a breach ofthe regulation is proventhere is no published analysis of the inspection reports of private facilitiesthe recommendation of The Years Ahead report and the 2001 healthstrategy, Quality and Fairness: A Health System for You, that an independentinspectorate be established has still not been implemented. It is plannedthat the Bill establishing the Social Services Inspectorate on a statutory basiscovering both public and private long-stay facilities will be published in the nearfuture. The forthcoming Bill will also include a specific provision to allow easyaccess by the public to inspectors’ reports on nursing homes (DoHC pressrelease, 2005).there is no common, standardised approach to nursing home inspectionswhich leads to an inconsistent application of standards throughout the country.The training of inspectors is neither comprehensive nor uniformthere is no statutory independent complaints and appeals system within thehealth service. Nor is there an organised advocacy service for vulnerable olderpeople in residential carethe Code of Practice for Nursing Homes is not legally enforceable and there isno means of assuring the standards outlined in it are respected and adhered toby nursing homesthe remit of the Ombudsman only extends to public long-stay care facilitiesand not to private or voluntary nursing homes, although public policy for privatehomes is coveredthe system of linking the amount of subvention paid to the dependency levelof residents in private nursing homes has encouraged ‘dependency creep’,with some older people being placed in the highest dependency categoryin order to qualify for the maximum subvention payment49
public patients in private nursing homes do not get the same access toassessment and rehabilitation that they would receive in public facilities.More services are available in public residential care, for example occupationaltherapy and physiotherapy, and the ratio of nursing staff to care staff is likelyto be higher in public facilities.2.6 Evidence of Quality Deficits in Residential Care50Quality deficits in long-stay care have been reported throughout OECD countries,though most of the evidence relates to poor care outcomes rather than poorquality of life of residents. The most commonly reported problems for older peoplein long-stay care include: pressure sores, malnutrition, inappropriate use of physicaland pharmaceutical restraints, unsatisfactory pain management, neglect and abuse(OECD, 2005). In 2002, for example, 9 per cent of nursing home residents in theUSA were found to have pressure sores, while in Australia 28 per cent of residentshad insufficient pain relief. Other shortfalls reported by the OECD include theinsufficient use of anti-psychotic drugs and unsatisfactory practices concerningthe tube feeding of residents.Research has found that many of the reported quality problems appear to beinterrelated and the presence of one problem may lead to, or signal, the presenceof one or more quality deficits; for example, the risk of a resident developingpressure sores is increased by malnutrition and dehydration, incontinence and theuse of physical restraint. The prevalence of pressure sores can, in turn, highlightneglect or mistreatment of residents. Problems with the structure and processof care delivery are most likely to contribute to the quality deficits outlined above.For example, poor infrastructure and design, and inadequate numbers of trainedand experienced staff are the most common impediments to good quality care(OECD, 2005; Noelker and Harel, 2001).Research on the quality of care delivery and the quality of life of residents inIrish long-stay care settings is limited. In 1986, the National Council for the Agedpublished two studies, one quantitative the other qualitative, on quality of lifein private and voluntary nursing homes in the Republic of Ireland (O’Connor andWalsh, 1986; O’Connor and Thompstone, 1986). The quantitative study revealedthat most of the facilities were in a good physical condition. Most of them,however, were not purpose built as nursing homes, therefore facilities wereImproving 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 48 and 49: Medical preparations - medication s
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
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Staffing and skill mix: comments fr
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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
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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
Page 268 and 269:
DomainGeneralCue question/promptsHa
Page 270 and 271:
DomainCompanionship/relationshipCon
Page 272 and 273:
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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