QUALITY OF LONG-TERM CARE FOR OLDER PEOPLE IN RESIDENTIAL SETTINGS – PERCEPTIONS OF QUALITY OF LIFE AND CARE SATISFACTION FROM RESIDENTS AND THEIR FAMILY MEMBERS

Abstract

IntroductionPopulation ageing is a worldwide phenomenon. The very old (80 years+) is considered to be the fastest growing population group (Lafortune & Balestat, 2007; United Nations, 2009). In New Zealand (NZ), the ageing population (65+) is projected to grow to 1.28-1.37 million in 2041 (Statistics New Zealand, 2014), which means it is anticipated that the need for aged residential care will also increase. The New Zealand Health of Older People Strategy (Ministry of Health, 2002) has been emphasising the importance of planning for this growing service need. Debates about the best ways of ensuring highquality care provision for vulnerable older people are increasingly important. As the demand for residential care grows, the need to ensure standards of care and quality of life (QoL) in these settings becomes critical. Research has indicated that the perceptions of different stakeholder groups on quality of care can offer important information for care-provider organisations in identifying potential areas for improvement (Duffy, Duffy, & Kilbourne, 2001; Morrow-Howell, Proctor, & Rozario, 2001; Ryan & McKenna, 2015). The movement away from an institutional model of aged care to one that accepts resident-directed care as the guiding or defining standard of practice is part of a culture change that is positively impacting the provision of aged care services in New Zealand, Australia and around the world (Bowers et al., 2009; Brownie, Neeleman, & Noakes-Meyer, 2011; Cheek, 2011; Hamann, 2014; Miller, Booth & Mor, 2008; Petriwskyj, Parker, Brown Wilson, & Gibson, 2016). In a resident-centred approach, residents and their family members are seen as the key players in decisions about care (Hamann, 2014; Harlton, Keating, & Fast, 1998). Knowing the person, and understanding their values and beliefs, is important in the development of positive relationships which are essential in practice (Laird, McCance, McCormack, & Gribben, 2015). This study investigated older residents' perspectives on their QoL living in long-term care in New Zealand and their family members' perceptions on satisfaction with care provided.BackgroundResidential aged care services are an integral component of the accommodation and support system available for frail or disabled older people who are unable to live independently at home. These services aim to foster a sense of security and companionship, and enhance quality of life (Brownie & Horstmanshof, 2012; Oosterveld-Vlug et al., 2014). According to Sletteb0 (2008), nursing homes should provide an environment where residents' integrity and autonomy are protected and where residents can thrive (p. 22). For many older people, the transition from home to residential care may be a sudden, involuntary and disempowering experience due to their increasing dependence on facility staff for all aspects of their care (Lee, Simpson, & Froggatt, 2012; Rodgers & Neville, 2007; Tu, Wang, & Yeh, 2006; Williams, Straker, & Appelbaum, 2014). Research has long reported that daily life in an aged care facility tends to be associated with boredom and loneliness, loss of autonomy and control, lack of privacy and few opportunities for residents to construct meaningful lives (Choi, Ransom, & Wylie, 2008; Murphy, O'Shea, & Cooney, 2007; Nay, 1998; Ryan & McKenna, 2015; Timonen & O'Dwyer, 2009; Tuckett, 2007; Wilson, 1997).Many care homes try to create an atmosphere of homeliness, but this has been difficult, even in the smallest of homes (Peace & Holland, 2001; Williams et al., 2014). This may be due to facilities historically focussing primarily on clinical outcomes relating to medical and physical care, and institutional rationales such as low levels of staffing and financial constraints, which result in residents' loss of autonomy and control (Beringeer & Crawford, 2003; Davis, Byers, & Walsh, 2008; Jilek, 2000; Oostervekd-Vlug et al. …