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

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process and outcomes of the services provided. 3 For example, the UK’s CareStandards Act 2000 outlines 38 standards grouped under seven main headings:choice of home; health and personal care; daily life and social activities; complaintsand protection; environment; staffing and management; and administration. Similarly,the Australian Aged Care Act of 1997 compels an accreditation assessmentby providers against 44 criteria covering: management systems, staffing andorganisational development; health and personal care; resident lifestyle; andphysical environment and safe systems.The Nursing Home Reform Act of 1987 in the USA outlines standards relating tofive major elements: residents’ rights; quality of life and quality of care; staffingservices and resident assessment; federal survey procedures; and enforcementprocedures. In addition to government standards, a number of self-regulatoryapproaches involving voluntary standards have been put in place by professionalsocieties, trade associations and other organisations in various countries (OECD,2005). For example, in the Netherlands, the major care service association requiresall its member organisations to act in accordance with a formal system of internalquality management. An independent agency ensures compliance and uponapproval an organisation is certified.59In order to ensure compliance with standards, many countries have establishedindependent agencies to monitor long-stay care institutions (OECD, 2005). In theUK, the Care Standards Act 2000 created the National Care Standards Commission(NCSC), which is an independent non-governmental public body responsible forregulating social and healthcare services. The national minimum care standardsprovide the basis for decisions made by the NCSC regarding whether or not a carefacility should be registered or have its registration cancelled, or whether to takeaction for breach of regulations. A similar agency, the Aged Care Standards andAccreditation Agency (ACSAA), has been established in Australia. In the USA,the Centers for Medicare and Medicaid Services rely on the ‘mandatory use of astandardised, comprehensive system, known as the Resident Assessment Instrument(RAI), to assist in assessment and care planning (Hawes et al., 1997). The RAIprovides a means of assessing each resident in order to develop a care planspecifically designed to meet the individual’s needs. Residents are assessed uponentering a nursing home and at regular intervals thereafter (Mozley et al. 2004).3 See OECD (2005) for an overview of efforts to monitor and improve quality long-stay carein OECD countries.
The introduction of the RAI entailed a shift in focus away from physical facilitiesand features of care towards aspects of quality of life. The RAI is required to includeobservation and communication with residents as well as communication withstaff. The main functional assessment instrument in the RAI is the Minimum DataSet for Nursing Home Resident Assessment and Care Screening (MDS) (Hawes,1997). The MDS forms the basis for the development of quality indicators for thefollowing domains: accidents; behaviour/emotional patterns; clinical management;cognitive patterns; continence nutrition; physical functioning; psychotropic druguse; skin care and quality of life. These domains can help to identify facilitiesperforming below the minimum standards and are also used to compare andrank institutions according to their performance (Mor, 2001).60Reform has also sought to ensure conformity with minimum standards by theimposition of sanctions in cases of non-compliance. For example, the NursingHome Reform Act of 1987 in the USA permits ‘the imposition of civil moneypenalties, denial of payment for new admissions, temporary management,immediate termination, and other remedies or sanctions’ (OECD, 2005). Australia’sAged Care Act of 1997 outlines several sanctions that may be enforced includingrestricting, revoking or suspending an institution’s approval as a provider of careservices for older people, revoking or suspending all or some of the places alreadyallocated to the care provider or prohibiting the further allocation of places, andthe repayment of some or any grants paid to the care provider. Legislation hasalso provided mechanisms for the increased empowerment of nursing homeresidents. For example, the Aged Care Complaints Resolution Scheme (ACCRS)was established in Australia in 1997 to deal with complaints about care servicesfunded by the government. Funds are also provided for independent support andinformation to recipients of care services or other interested parties. In the USA theNursing Home Quality Initiative (NHQI) was established in 2002 to allow publicationof information about the quality of care in nursing homes in all fifty states.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland
Page 1 and 2:
ImprovingQuality of Lifefor Older P
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National Council on Ageing and Olde
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Authors’ AcknowledgementsThe rese
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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 58 and 59: The Mid-West Standards for Resident
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
Page 108 and 109: 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
Page 278:
National Council on Ageingand Older
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