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

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The Mid-West Standards for Residential Hospitals and Nursing Units originatedin Essence of Care but developed specifically for the Mid-West; they operated innine public community hospitals/nursing units across Clare, Limerick and NorthTipperary. The standards were developed following a process of consultationinvolving staff, patients, informal carers, consumer panels, a regional advisorycommittee on older people’s services and the public. The following principlesguided the development of the standards: respect; privacy; dignity; health andwell-being; social and emotional well-being; security and safety; participation;and culture and belief. Once a standard is agreed upon (there are 55 in total),comparison groups are established and a baseline audit of practice against thestandard is performed. This initial audit provides information on best practicein order to change the implementation plan if necessary. Another audit is thencarried out and the results are disseminated to other care units and a new standardcan be recommenced.Finally, a large group of private nursing homes in counties Meath, Kildare, Dublinand Wicklow have developed evidence-based standards of care for clinical nursingpractice which could have universal application to residential care facilities for olderpeople. It is proposed that these standards will have in-built audit tools to allowindividual facilities to continually monitor their own compliance with the standardsand identify areas for improvement. The specific objectives of this project are:57to identify areas of clinical nursing practice in older person care that couldbe standardised based on best practice information, e.g. falls prevention,continence promotion etc.to develop standards of care for these areasto ensure that standards identified are realistic and achievable within thecontext of the facilities involvedto identify audit criteria for each standard to allow continuous monitoringof standard complianceto supplement individual standards with nursing policies, procedures andprotocols where appropriate. (For example, where a standard of care isdeveloped for pressure sore prevention, this standard would be supplementedwith a protocol that nurses could use to make decisions about mattressesand other pressure relieving devices for patients; or a standard for medicationmanagement would include a procedure for administration of medications.)to write the standards in a format that will allow them to be used forstandardised care plans/care pathways for older people
to identify and liaise with other relevant stakeholders, including the IHSAB,representatives from the HSE inspectorate, residents and carers, nursingand midwifery planning and development units etc. when developing thesestandards so that standards reflect overall health policy and strategies.While all of these initiatives are to be welcomed, particularly the HAIRC initiativewith its focus on quality of life, it is essential that there is greater integration ofthese separate initiatives in order to avoid overlap and duplication. Coordination ofthe setting and measurement of quality standards is necessary at a national level inorder to ensure consistency and a comprehensive uniform approach to quality inlong-stay care. The overall goal must be the development of national care standardsthat cover quality of life as well as quality of care, for application in all care settings.It is imperative that any national initiative recognises the importance of quality of lifeof older people in long-stay care and develops policies accordingly.2.8 International Developments58The increased awareness by governments of the need to monitor and improvethe quality of long-stay care is reflected in the numerous policy initiatives developedand implemented in many OECD countries. Three broad approaches have beenused to monitor and guarantee better quality in long-stay care. Firstly, there hasbeen increased monitoring by regulators and purchasers; secondly, the commitmentto quality improvement on the part of providers of care has been enhanced; andthirdly, market competition and consumer information have been strengthened(OECD, 2005).It has been accepted in most OECD countries that providers of long-stay careshould be more accountable and should conform to a set of external standards.These standards are often a precondition for the licensing of institutions and thefailure to adhere to such standards and regulations may lead to a nursing homelicence being revoked. Traditionally, standards have focused on care rather than onquality of life, but this has begun to change in recent years, albeit slowly. Examplesof various government initiatives to improve the quality of long-term care includethe Care Standards Act 2000 in the UK, the Nursing Home Reform Act of 1987 inthe USA, the Aged Care Act 1997 in Australia and the Health and Disability Services(Safety) Act 2001 in New Zealand. The care standards outlined in these Acts arequite complex as they tend to cover a wide range of criteria in respect of structure,Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland
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ImprovingQuality of Lifefor Older P
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National Council on Ageing and Olde
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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 56 and 57: Human resources management standard
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
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Birren, J.E. and Dieckmann, L., 199
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Collin, C., Wade, D.T., Davies, S.,
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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
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DomainFeeling caredfor/feelingsecur
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DomainFeeling caredfor/feelingsecur
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DomainGeneralCue question/promptsHa
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DomainCompanionship/relationshipCon
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DomainRelationship tofamily/friends
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Terms ofReference
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c) providing information and advice
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National Council on Ageingand Older
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