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

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Human resources management standards – these focus on issues such asselection and recruitment of personnel, enhancing personal performance andthe provision of a healthy work environment.Information management standards – these enable the organisation to assessand evaluate the planning, obtaining, management and security of data andinformation provisions.Leadership and partnership standards – these relate to an organisation’sgovernance, management and collaborative performance.Four quality dimensions (responsiveness, system competency, patient/client/community focus, and work environment) provide the basis for the structure of thestandards. The accreditation process provides a framework to enable organisationsto identify, prioritise and implement ways to continuously improve the quality oftheir services.The HAIRC is a joint programme by the NCAOP and the Irish National HealthPromoting Hospitals Network (INHPH) and was launched in January 2005. Thisinitiative enables older people in residential care facilities to become activelyinvolved in their own care and to have a say in how their quality of life may beimproved. The initiative is designed to encourage the involvement of residents indecision-making by establishing patient interest groups in residential care facilitiesin order to give residents a voice. The objective of the initiative is to achieve personcentredcare, a positive work environment for care workers and a family friendlyatmosphere in care facilities. A list of Ten Steps to Healthy Ageing have beendesigned in order to realise these objectives. The Ten Steps to Healthy Ageing are:551. Consultation – consult with residents to ensure that health promotion policyreflects their needs and preferences.2. Health promotion policy – develop and implement personalised practices thatsupport healthy ageing.3. Policy to practice – initiate structures that will enable and support best practicetowards healthy ageing.4. Choice – facilitate full resident involvement in decision-making and daily activitychoices.5. Information practices – establish effective communication and informationprocesses that best meet the needs of residents, carers, staff and community.6. Personal space and belongings – ensure the development of practices thatrecognise the individuality of all residents.
7. Independence – develop support systems that enable and protect theautonomy of all residents.8. Lifestyle – facilitate the development of procedures that promote healthylifestyle choices among residents.9. Healthy staff – establish practices and procedures that acknowledge and meetstaff development and training requirements.10. Family friendly – create an organisational environment that encourages thecontinued involvement and participation of the resident in family andcommunity activities.The Ten Steps provide a framework for care facilities to realise and act upon theirhealth promoting capacity and, thus, improve the quality of life of residents. Sincethe initiative has been launched, a wide range of innovative projects and activitieshave been undertaken in order to improve the quality of life of residents. Suchprojects include: arts in residential care settings; holiday schemes; music; dancingand physical exercise; and reminiscence therapy.56Essence of Care is a patient-focused quality initiative that is now used at localand regional levels as a way of improving quality of care for older people throughproviding a supportive environment for carers. It achieves this by benchmarkingbest practice in nine areas of care: privacy and dignity; food and nutrition;recordkeeping; continence; personal and oral hygiene; pressure ulcers; principlesof self-care; safety; and communication. Essence of Care is particularly appropriatefor residential care settings as it provides a more holistic, person-centred, socialand collaborative model of care.Essence of Care was first implemented in the North Western Health Board (NWHB).It has been successfully implemented by the HSE in the Southern Area. A sevenmembersteering group was established and 27 implementation sites dealing withthe care of older people were identified. These sites included community, voluntaryand acute hospitals, welfare homes and mental health areas. An implementationstrategy was developed based on an excellence model using an emancipatorypractice development approach. A facilitator training programme, road showsand roll-over sessions were put in place. The benchmarking cycle was thenimplemented at all 27 sites. Evaluation of the Essence of Care programme atall of these sites was carried out using semi-structured interviews, progressquestionnaires, focus groups and feedback from facilitators.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 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 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 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
Page 106 and 107:
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
Page 234 and 235:
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
Page 240 and 241:
McCormack, B., 2003. ‘A conceptua
Page 242 and 243:
Redfern, S., Hannan, S., Norman, I.
Page 244 and 245:
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
Page 260 and 261:
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
Page 270 and 271:
DomainCompanionship/relationshipCon
Page 272 and 273:
DomainRelationship tofamily/friends
Page 274 and 275:
Terms ofReference
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c) providing information and advice
Page 278:
National Council on Ageingand Older
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