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

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ContentsCouncil Comments and Recommendations 13Executive Summary 25Chapter One: Introduction 33Chapter Two: Quality of Care and Quality of Life for Older People 392.1 Introduction 402.2 Separating Quality of Care and Quality of Life 412.3 Policy for Long-Stay Care in Ireland 432.4 Regulatory Structures 452.5 Problems with Current Regulatory Structures 482.6 Evidence of Quality Deficits in Residential Care 502.7 Current Initiatives on Quality of Care and Quality of Life in Ireland 532.8 International Developments 582.9 Conclusion 61Chapter Three: The Interpretation andExploration of Quality of Life for Older People 633.1 Introduction 643.2 Origins of Quality of Life 653.3 Frameworks for Understanding Quality of Life 663.4 Assessing Quality of Life for People with Dementia 693.5 Quality of Life Domains for Older People 713.6 Influences on the Quality of Life of Older People 763.7 Conclusion 78Chapter Four: Methodology 794.1 Introduction 804.2 Research Design 804.3 Focus Groups with Managers/Proprietors 814.3.1 Development of Focus Group Interview Schedule 824.3.2 Conduct of Focus Groups 824.3.3 Data Analysis 834.4 Survey of Long-Stay Facilities 834.4.1 Questionnaire Design 844.4.2 Pilot Survey 844.4.3 Main Survey 864.4.4 Quantitative Data Analysis 87
4.5 Resident, Staff and Relative Interviews 874.5.1 Study Sites 874.5.2 Number of Study Sites 884.5.3 Gaining Consent for Interview 894.5.4 Profile of Study Sites 904.5.5 Research Instruments 904.5.6 Interview Schedules 904.5.7 Sampling Strategy 914.6 Interviews 924.6.1 Residents 924.6.2 Staff 924.6.3 Relatives 924.6.4 Qualitative Data Analysis 924.7 Ethical Clearance 934.8 Conclusion 93Chapter Five: Quality of Life in Long-Stay Care Facilities: Focus Group Findings 955.1 Introduction 965.2 Measuring Dependency 965.3 Staffing Levels and Skill Mix 975.4 Recruiting and Retaining Staff 995.5 Education and Training 1015.6 Maintaining Quality of Life 1025.6.1 Physical Environment 1025.6.2 Social Environment 1055.6.3 Keeping in Touch with Their Community 1055.7 Policy Issues 1065.7.1 Shaping Future Care Provision 1065.7.2 Increasing the Visibility of Older People 1085.7.3 Resources 1085.7.4 Changing the Approach to Inspection 1095.8 Conclusions 110Chapter Six: Quality of Life in Long-Stay Care Settings: Survey Findings 1116.1 Introduction 1126.1.2 Beds 1136.2 Residents 1146.3 Dependency 1166.4 Staffing 1196.5 Provision of Therapy and Other Services 1266.6 Activities and Communal Facilities 127Improving 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 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
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process and outcomes of the service
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2.9 ConclusionQuality of life for o
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Chapter ThreeThe Interpretationand
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The difficulty of defining such an
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Implicit definitions use the broad
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Human needs may also provide part o
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successfully complete a self-report
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In relation to older people specifi
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The results of this particular stud
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The design of a residential care se
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Chapter FourMethodology
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each method used at the same point
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4.3.3 Data AnalysisThe transcripts
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Table 4.2: Distribution of question
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4.4.4 Quantitative Data AnalysisThe
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Anonymity and confidentiality are i
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from stakeholders who attended the
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4.7 Ethical ClearanceEthical cleara
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Chapter FiveQuality of Lifein Long-
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All participants reported that ther
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Staffing and skill mix: comments fr
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Recruiting and retaining staff: com
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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.,
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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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