Long term care recipients want to be addressed in a polite, friendly and appropriate manner and treated with respect for their personal privacy, hygiene and appearance, choice of clothes and furnishings and access to appropriate care and assistance with eating, drinking, washing, toilet and other daily activities.
Older people wish to retain independent control over their lives for as long as possible, regardless of whether they are in their own home or an institution. And they deserve to be treated as equals and given choice over how they live and die.
A study from a UK teaching hospital (Sheffield Hallam) developed a Senses Framework1 for long term care that takes into account the needs of both care recipients and caregivers, based upon six key senses (see below).
To embrace these values in a care environment, elderly people – unless they are severely cognitively compromised – should play an active role in determining the type and extent of care they receive. This includes the right to ask others to assume responsibility or help to coordinate complex care packages. Direct payments are one option that allow individuals discretion over how their care budget is spent, while care plans can be agreed that reflect each individual’s goals.
Yeoh Lam Keong, Senior Adjunct Fellow & Vice President, Institute of Policy Studies & Economics Society of Singapore
Care providers should also acknowledge that ’quality of life’ is not the same as ‘quality of care’. Overly structured and complex care programs could actually impair quality by restricting people’s ability to make choices and pursue their own ambitions. Such a philosophy represents a significant change in mindset for the professionals caring for the elderly. Giving individuals a greater say in their care can also save money, as they may well choose to avoid what they regard as unnecessary or unwanted procedures and medications – including the prolonging of life when in great pain or discomfort. As care recipients gain more autonomy over their care, the burden of risk should accordingly shift, to some extent, away from the health professional and more towards the decision-maker; i.e. the elderly person and his or her family members. If the chosen care is considered less medically ‘safe’ than more orthodox approaches, then the care recipient, family and caregiver need to jointly agree on a contract acknowledging the risks within the care program. For such change to occur, all parties should accept that a relatively ‘risk free’ environment can stifle freedom and independence
Dr. Stephen Judd, Chief Executive Officer, HammondCare, Australia
Improve the experience in care homes
Moving into a long term care institution is a major life step that can be highly unsettling. However, the quality of care in a residential facility can be compromised by a negative culture, over-emphasis on policies and procedures, lack of staff training, poor recruitment and screening of staff, inadequate standards and subsequent regulatory monitoring.
It is therefore vital that the home creates a sense of community, with meaningful relationships between staff, residents, family, friends and nearby inhabitants. UK studies suggest that approximately 3 percent of residents’ time is spent on constructive activities2 , so there should be a stronger emphasis on meaningful activities, enabling residents to contribute to day-to-day life and pursue their own interests.
End-of-life care is a further priority, as multiple, often chronic health problems can make it difficult to define when someone is dying, with the accompanying uncertainty leading to impersonal, reactive and inappropriate care3. Staff also need the right level of support and training, so leadership should ensure that workers’ personal and emotional needs are also met.
Paul Gregersen, Managing Director, BUPA Care Services, Australia
1The Senses Framework: improving care for older people through a relationship-centred approach. Getting Research into Practice (GRiP) Report No 2. (PDF 1.4 MB), Nolan, M. R., Brown, J., Davies, s., Nolan, J. and Keady, J. Sheffield Hallam University Research Archive, 2006
Accessed 17 November 2012.
2Care and Support Briefing (PDF 133 KB), Age UK
Accessed 25 January 2013.
3Quality of Death Index – Ranking end of life care across the world, Economist Intelligence Unit
Accessed 9 January 2013.