Irish nursing home residents’ lives explored in ‘first of its kind’ research

 

Ageism & stigma compounding concept of nursing home care

 

Stronger cooperation between health and support workers, families and wider society required to improve the transition experience

 

A major research study analysing, for the first time, the lived experiences of Irish nursing home residents is published today, Wednesday 13th September.  

 

The two-year study by Ulster University will be launched by Minister of State with Responsibility for Older People Jim Daly TD at 10.30am at Palmerstown House, Co Kildare.

 

The research, commissioned by Nursing Homes Ireland, considers the context and meaning of what constitutes ‘home’ from the perspective of a nursing home resident. It evaluates and critiques the role of nursing home staff and wider healthcare providers in enabling and maximising a ‘homely’ experience for nursing home residents. 

 

Report authors Dr Kevin Moore and Professor Assumpta Ryan, Ulster University, will publish their research findings at a launch with nursing home residents, staff and Minister Daly. Professor Des O’Neill, consultant physician in geriatric and stroke medicine and Professor in Medical Gerontology, will provide a response to the report. 

 

The research, The Lived Experience of Nursing Home Residents in the Context of the Nursing Home as their Home, was undertaken following recommendation that the perspectives and narratives of nursing home residents be explored to support the effectiveness of care delivery within the nursing home sector.

 

Such research has never been undertaken previously in Ireland and there is a dearth of such research internationally. Its findings have been presented at a Royal College of Nursing International Research Conference in the UK and will be presented at the International Ageing and Society Research Network Conference 2017 in the United States.

 

Minister of State for Older People Jim Daly said: “I welcome this important research study and its focus upon documenting the views, likes, dislikes, and wishes of persons living in our nursing homes. It is fundamentally important that residents’ rights and dignity are respected and valued and that their voice is loudly heard, listened to and acted upon. It is also significant that the voices of staff, entrusted with meeting residents’ care needs on a daily basis, have also been recorded. The frontline experience documented within the report demonstrates that nursing homes are indeed viewed as ‘home’ for many of the residents interviewed. I commend University Ulster and Nursing Homes Ireland for undertaking this unique and very valuable research.”  

 

Ulster University’s Professor Assumpta Ryan, report co-author, said: “The findings emanating from this unique study send out an important message to Irish society and particularly to older people no longer able to live at home that nursing homes can present a very positive life choice for many older people. This can lead to a better quality of life for older people themselves and their families. The challenge is not to try and replace a person’s interpretation of home, but to focus upon ensuring the nursing home is perceived as their new home. There is a need for strong cooperation and effective communication between family, health services and support workers, and wider society to create greater awareness and assurance surrounding older peoples transitions to nursing home care.

 

“The concept of providing homely care within the nursing home sector is compounded by the unfair ageism and stigma that prevails around nursing home care. These are exacerbated by the belief that admission to a nursing home is viewed as the end phase of an older person’s life trajectory. Such rigid views negate the essence and meaning of the lived experiences of nursing home residents within this study. There is requirement for greater understanding surrounding the effectiveness and quality of life experienced by residents in nursing home care. This is critically important, particularly at a time when such care is perhaps undervalued or subjected to unfair criticism within the media

 

“The report found residents wanted to be involved in decisions about their long-term care arrangements and particularly valued the safety and security of the nursing home environment where they had regular contact with other people. This fulfilled a need that many felt had not been previously met when they lived alone in their own homes.  Others took a more philosophical perspective of their current life trajectory, demonstrating a capacity for adaptation and change.  The residents portrayed a picture that emphasised that they were making the most of their later life, embracing their new relationships both with staff and residents, and feeling a sense of belonging in their new nursing home community.”

 

Findings and recommendations emanating from the research follow. An Executive Summary or Full Copy of the Report is available under embargo. Media queries will be facilitated by Michael McGlynn, NHI Communications & Research Executive, by contacting 01 4699806 or 087 9082970.

 

Read

The Lived Experience of Nursing Home Residents in the Context of the Nursing Home as their 'Home', Executive Summary, University Ulster / NHI, September 2017

The Lived Experience of Nursing Home Residents in the Context of the Nursing Home as their 'Home', Full Report, University Ulster / NHI, September 2017

 

Watch

Report co-authors Professor Assumpta Ryan and Dr Kevin Moore discuss their report findings with contributions also from Professor Des O'Neill and Minister for Older People Jim Daly

 

Nursing home residents speak at the launch of the research report The Lived Experience of Nursing Home Residents in the Context of the Nursing Home as their 'Home'

 

Notes for the Editor

A total of 8 staff groups and 8 resident groups participated in 16 focus groups which were conducted in both urban and rural nursing homes from the private and voluntary sectors.

 

92 persons - 48 residents and 44 staff members - participated in the qualitative research study that was informed through semi-structured interviews with all participants. 

The objectives of this study were:

    • To identify the context and meaning of ‘home’ from the perspective of residents and staff in the nursing home sector.
    • To identify, compare and contrast the residents’ context and meaning of ‘home’ prior to admission to the nursing home.
    • To examine current levels of nursing home practice that determines a ‘typical day’, thus enabling identification of the factors that may maximise or minimise the lived experience of ‘home’.
    • To explore the factors that influence current practice and service provision that promotes or inhibits a ‘homely’ experience.
    • To make recommendations to NHI that will inform policy, practice, education and research.

 

Key findings emanating from the research include:

  • The concept of dignity, respect and promotion of independence was identified by nursing home residents as central to the provision of effective care within the nursing home. Maintaining a level of independence appeared to be a core component of individuality as was the importance of involvement and choice in decision making.
  • Time and again residents spoke about how the promotion of their dignity related to effective communications within the nursing home and a sense of feeling listened to and valued, particularly if they had raised issues of concern within residents’ meetings, that were subsequently addressed.
  • Residents valued the safety and security of the nursing home environment where they had regular contact with other people. This fulfilled a need that they felt had not been previously met when they lived alone in their own homes.  Others took a more philosophical perspective of their current life trajectory. Many demonstrated a capacity for adaptation and change and in essence portrayed a picture that emphasised that they were making the most of their later life; embracing and enjoying their new relationships, both with staff and residents that they had formed since moving into the nursing home. 
  • A genuine understanding and knowing of the person is central to the concept of homely care. This was clearly evident within all homes that had participated within the study.
  • In some cases, particularly in urban areas, the move to the nursing home was directly from hospital and it appeared that the resident did not always get a choice in the decision-making process.
  • Respecting residents’ choices was linked to how well the staff knew the residents and for many residents, truly knowing them as a person meant respecting their choices, affording them respect within all communications and promoting their independence
  • Staff identified the importance of the regulations and standards but nonetheless felt that there was too much focus on clinical and medical matters which they felt detracted from a homely experience. 
  • The concept of providing homely care within the nursing home sector is compounded by the ageism and stigma, albeit largely unsubstantiated, that continues to prevail around long-term care settings and which are exacerbated by the belief that admission to a nursing home is viewed as the end phase of an older person’s life trajectory.  Such rigid views negate the essence and meaning of the lived experiences of nursing home residents who participated to inform the research.  It further negates the evidence within the study regarding the importance of relationships, community and a sense of contentment and belonging.

Recommendations include:

  • The challenge is not to try and replace residents’ interpretation of ‘home’ (as experienced before the admission to the nursing home) but rather to focus on creating a new home.  If one subscribes to the belief that ‘home is not a place but a feeling’, perhaps the question is not whether the nursing home is perceived as the resident’s home but rather whether it is perceived by them as their home now.     
  • As the transition from an acute hospital was particularly stressful for the residents in this study, there is an immediate need to put effective systems in place to ensure greater communication and cooperation between HSE staff and nursing homes.
  • Fair Deal Placement Officers should ensure that residents are central to the decision-making process about their choice of nursing home.  It is also recommended that these officers should provide nursing homes with all the information they require in order to meet the resident’s needs and in doing so to facilitate a positive transition
  • There is requirement for greater collaboration between the HSE and individual nursing homes. As residents’ transition from a hospital environment or from their own home to a nursing home setting, there is a need for strong cooperation and effective communication amongst all stakeholders in this process.
  • Health and social care professionals are ideally placed to initiate discussions with the older person without fear of reprisal.  Such discussion should not be deferred until the older person becomes ill but rather comprise part of the regular contact with GPs or public health nurses in a pro-active manner.
  • The creation of a ‘homely environment’ depends on staff ‘knowing the person’.  However, turnover rates can result in a loss of intrinsic and intuitive knowing of the resident and nursing homes should consider additional and more creative ways of retaining staff to promote greater continuity of care.  
  • If nursing homes are to become and remain ‘homes’ for their residents, then residents should be more actively involved in the inspection process and have their voice heard and acted upon.  This needs to go beyond the existing models in operation and be truly used to fully triangulate inspection findings for the benefit of residents.
  • Many staff expressed frustration around regulatory and inspection processes and procedure. There is an urgent need for HIQA and the nursing home sector to work in partnership to address these issues. While both parties have a remit for the maintenance of standards, it appears that much more can be done to ensure that the inspection process does not have adverse consequences for residents and staff. 
  • Recognising the power of language, there is a need to challenge the public perception and use of ageist terms such as ‘elderly’ and ‘institutions’ as these perpetuate stereotypes that mitigate against quality care provision for older people.       
  • The role of gerontological nursing at both under-graduate and post-graduate or specialist level requires greater recognition and attention within the educational, clinical practice and academic arena.
  • The development of pre- and post-registration nursing programmes should be informed by the views of older people and their carers with input from experienced nurses across all settings providing care to older people including nursing home staff. 

Background

  • Circa 28,000 people reside within nursing homes in Ireland
  • The average age of a nursing home resident is 82.9 years of age* and over half of nursing home residents are aged 85+**
  • The CSO projects the population aged 85+ will grow by 49.6% over the period 2016 to 2026

*Health in Ireland Key Trends 2016

*Nursing Homes Annual Survey 2014 / 2015

 

 

 

 

 

 

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