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

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4.3.3 Data AnalysisThe transcripts were coded initially using open codes; a coding guide of interpretivecodes was then developed and transcripts were recoded using this guide. Codeswere then compared, clustered and collapsed. Analysis revealed six themes:measuring dependency, issues in staffing, recruiting and retaining staff, educationand training, maintaining quality of life and policy issues.4.4 Survey of Long-Stay FacilitiesThe quantitative survey of long-stay facilities provided an insight into the likelyimpact of physical, environmental and staffing issues on older people’s quality oflife. This national survey of all long-stay facilities extends and develops previouswork by the then National Council for the Aged (now the NCAOP) on quality of lifein private and voluntary nursing homes in Ireland. The total population of 556 longstayfacilities in Ireland were included in the study. The thirty facilities included inthe pilot study were excluded leaving 526 long-stay facilities in the main survey.For the purpose of the study, the DoHC (2003) five categories of long-stay carewere used to define the categories of long-stay facilities. 5 These were:83health board geriatric homes/hospitalshealth board welfare homeshealth board district/community hospitalsvoluntary geriatric homes/hospitalsprivate nursing homes.Two sources of data were used to develop a comprehensive list of facilities undereach of these headings: the long-stay care statistics produced by the DOHC andhealth board lists of all public, private and voluntary long-stay facilities within eachregion. A comparison of these lists revealed a number of discrepancies. Not alllists distinguished between public geriatric hospitals, welfare homes and district/community nursing units. Voluntary facilities were categorised differently across lists.5 The DoHC has made some changes to the categorisation of long-stay facilities for 2004 but previouspractice in regard to categorisation was followed.
A small number of private nursing homes listed had closed. There were alsodifferences between how facilities were categorised on the lists received from thehealth boards and how the facilities categorised themselves. Most discrepanciesoccurred where a facility categorised as voluntary in the list from the health boardcategorised itself as private. Also, some facilities listed as welfare homes in thehealth board data categorised themselves as public geriatric homes. There were,therefore, considerable difficulties in categorising facilities. Pragmatic decisionswere made in light of these discrepancies; lists were modified to ensureconsistency and some facilities were recategorised. In addition, a web search fornew facilities was also undertaken and new facilities added, where appropriate.4.4.1 Questionnaire Design84The questionnaire used in the survey was developed from that used in theO’Connor and Walsh (1986) study as one of the aims of this study was to allowsome comparison between the two studies. The survey instrument, therefore, hadto be broadly comparable to the instrument used in 1986. This prior study, however,only focused on the private and voluntary long-stay sector. Following a review ofthe literature and examination of data from focus groups, a number of changes tothe survey instrument were made to reflect changes in the health and social caresystem in the interim and the need for the questionnaire to be equally applicable topublic and private facilities (Appendix One). Questionnaires were coded accordingto type of facility, health board region and number of facilities in that region.4.4.2 Pilot SurveyPrior to the main survey, a pilot questionnaire was sent to thirty long-stay facilitiesacross the country (Table 4.2). The pilot sample was stratified to mirror thecharacteristics of the population as a whole using the following criteria:representation from the five categories of long-stay facilitiesinclusion of at least one facility in each category from each health board area(where possible)appropriate urban/rural mixthe total number of facilities used as pilot sites reflected the percentageof total long-stay beds in each of the categories.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
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ContentsCouncil Comments and Recomm
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6.7 Meaningful Occupation 1296.8 Ch
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CouncilComments andRecommendations
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Quality of Life DomainsThe research
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Meaningful ActivitiesThe research n
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the research revealed that, in gene
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The Council accepts that the cultur
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this regard. The Council believes t
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ExecutiveSummary
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MethodologyA mixed method research
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Long-Stay Facility Survey FindingsT
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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 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 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
Page 110 and 111: Participants also discussed at leng
Page 112 and 113: Chapter SixQuality of Lifein Long-S
Page 114 and 115: Table 6.1: Type of facilityN %Priva
Page 116 and 117: Figure 6.2: Age profile of long-sta
Page 118 and 119: Figure 6.5 shows the percentages of
Page 120 and 121: Figure 6.7: Long-stay residents’
Page 122 and 123: In private and voluntary facilities
Page 124 and 125: Table 6.6: Ratio of RNs on the even
Page 126 and 127: Staff turnover investigates the num
Page 128 and 129: Table 6.10: Therapeutic and other s
Page 130 and 131: sector and 50 per cent in the volun
Page 132 and 133: 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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