But does it work? The role of regulation in improving the quality of residential care for older people in Europe

2015 ◽  
Vol 16 (2) ◽  
pp. 118-128 ◽  
Author(s):  
Ciara O'Dwyer
Keyword(s):  
Older People ◽  
Residential Care ◽  
Command And Control ◽  
European Countries ◽  
Comparative Approach ◽  
Content Type ◽  
Financial Investment ◽  
And Control ◽  
Care For Older People

Purpose – Regulation is the tool preferred by policy-makers to manage the quality of residential care for older people. However, it remains unclear which form of regulation is most effective. The residential care sector for older people in Europe offers a unique opportunity to explore this issue as countries vary in how they control quality in the sector. The paper aims to discuss this issue. Design/methodology/approach – The study used a comparative approach, collating secondary data from various sources and conducting qualitative comparative analysis on the data. Findings – Three regulatory approaches were in operation – many Northern European countries operate on a self-regulatory basis, and are associated with the highest quality. Many continental countries, the UK and Ireland operate a command-and-control regulatory approach, with a moderate standard of care. Mediterranean and Eastern European countries have limited regulation, with care of a lower standard. However, the type of regulation appears to be a product of the prevailing culture and philosophy of care within each country. Thus, quality outcomes are a measure of financial investment in care. Social implications – Consistent calls for command-and-control style regulation may be misguided; high-quality care requires high-public investment and a professional workforce with the freedom to focus on quality improvement mechanisms. Originality/value – The paper provides a framework for analysing outcomes associated with different types of regulation. While a self-regulatory model is linked with the best outcomes, financial investment and the philosophy of care may be more important factors influencing the quality of care.

Experiences of nursing in older care facilities in New Zealand

2010 ◽  
Vol 34 (1) ◽  
pp. 11 ◽  
Author(s):  
Jenny Carryer ◽  
Chiquita O. Hansen ◽  
Judy A. Blakey
Keyword(s):  
New Zealand ◽  
Older People ◽  
Registered Nurses ◽  
Residential Care ◽  
Nurse Practitioners ◽  
Clinical Care ◽  
Nursing Services ◽  
The Impact ◽  
Care For Older People

To examine issues related to the working life of registered nurses in residential care for older people in New Zealand, 48 registered nurses completed surveys (n = 28) or participated in discussions (n = 26) regarding their work roles, continuing education and interactions with specialist nurse services when providing care for older people living with chronic illnesses. This nursing workforce is characterised by ageing, relative isolation, reduced confidence and few opportunities for induction of new graduates. Registered nurses reported their struggle to deliver the appropriate quality of care to residents as acuity increases, general practitioner availability decreases and the opportunities for increasing their knowledge and competence remain limited. The provision of nursing services in residential care for older people is an area of growing concern to many Western countries. Nurse practitioners offer opportunities to improve the quality of residential care. What is known about the topic?The lack of registered nurses generally and the more critical shortage in residential care is well known. What does this paper add?This paper explains the impact on the current and future viability and the quality of registered nurse services in an area of service where acuity continues to rise and the demand for nursing services is increasing. What are the implications for practitioners?Nurses in older care settings often express a sense of isolation and note limited career development despite their passion for serving the frail older person. The establishment of nurse practitioner (gerontology) roles offers the potential for improved quality of clinical care for residents and clinical champions for development of nursing services.

scholarly journals Should dehydration in older people be a marker of lack of quality in long term care provision?

2014 ◽  
Vol 15 (4) ◽  
pp. 232-236 ◽  
Author(s):  
Lee Hooper ◽  
Diane K Bunn
Keyword(s):  
Older People ◽  
Residential Care ◽  
Design Methodology ◽  
Long Term Care ◽  
Care Provision ◽  
Good Care ◽  
Term Care ◽  
Content Type

Purpose – The purpose of this paper is to consider whether dehydration in older people should be used as a marker of lack of quality in long-term care provision. Design/methodology/approach – The piece examines the assumed relationship between dehydration and the quality of care, and then considers the factors that can lead to dehydration in older people. Findings – Even with the best care, older people, in the absence of a sense of thirst, and for fear of urinary accidents, difficulties getting to the toilet or choking, may choose to drink less than would be ideal for their health. While good care supports older people to minimise these problems, it also respects older people making their own decisions around when, what and how much to drink. It appears that dehydration may sometimes be a sign of good care, as well as arising from poor care. Social implications – Residential care homes should not be stigmatised on the basis of their residents being dehydrated, but rather helped to explore whether they are achieving an appropriate balance between care and quality of life for their residents. Originality/value – This discussion may be of use to those living in, working in, managing or assessing residential care.

scholarly journals Media reports of abuse in adult residential care: implications for staff and practice

2019 ◽  
Vol 23 (3) ◽  
pp. 177-184
Author(s):  
Yvonne Pedley ◽  
Paul McDonald
Keyword(s):  
Older People ◽  
Residential Care ◽  
Media Coverage ◽  
Single Case ◽  
Care Home ◽  
Health And Safety ◽  
Public Perceptions ◽  
Care Staff ◽  
Content Type ◽  
Care For Older People

Purpose There is often a focus on the negative aspects of residential care for older people. In the UK, there has been increasing media attention on abuse in these and other care settings and this has impacted upon public perceptions and subsequent government policy. Consequently, care staff are “tarred with the same brush”, yet narratives of their views have rarely been investigated. The paper aims to discuss these issues. Design/methodology/approach This undergraduate, qualitative, single-case study aimed to investigate the views of staff and explore the implications for them and their practice. The views of 15 participants in a residential care home were obtained through interviews and a focus group. Findings Although the findings reveal sensitivities to the negative portrayal of care roles, they also reveal positive responses through a willingness to change practice, a strengthening of care values and a reduction in risks. Originality/value This study will be of interest to those multi-disciplinary residential teams who care for older people as it uncovers a striking sense of guardianship amongst residential care staff, and a willingness to reflect on, and change, practice. The study endorses the value of small practitioner-led research as an illustration of how a residential care team consisting of managers and staff can strengthen its resolve against adverse media coverage and negative public perceptions. This study suggests that this will have positive implications for the health and safety of older people living in residential settings.

scholarly journals Primary palliative care for older people in three European countries: a mortality follow-back quality study

2019 ◽  
Vol 10 (4) ◽  
pp. 462-468 ◽  
Author(s):  
Kim de Nooijer ◽  
Lara Pivodic ◽  
Luc Deliens ◽  
Guido Miccinesi ◽  
Tomas Vega Alonso ◽  
...  
Keyword(s):  
Palliative Care ◽  
Older People ◽  
Patient Communication ◽  
European Countries ◽  
Epidemiological Surveillance ◽  
Palliative Care Services ◽  
Complex Health Problems ◽  
Almost All ◽  
Care For Older People

BackgroundMany older people with serious chronic illnesses experience complex health problems for which palliative care is indicated. We aimed to examine the quality of primary palliative care for people aged 65–84 years and those 85 years and older who died non-suddenly in three European countries.MethodsThis is a nationwide representative mortality follow-back study. General practitioners (GPs) belonging to epidemiological surveillance networks in Belgium (BE), Italy (IT) and Spain (ES) (2013–2015) registered weekly all deaths in their practices. We included deaths of people aged 65 and excluded sudden deaths judged by GPs. We applied a validated set of quality indicators.ResultsGPs registered 3496 deaths, of which 2329 were non-sudden (1126 aged 65–84, 1203 aged 85+). GPs in BE (reference category) reported higher scores than IT across almost all indicators. Differences with ES were not consistent. The score in BE particularly differed from IT on GP–patient communication (aged 65–84: 61% in BE vs 20% in IT (OR=0.12, 95% CI 0.07 to 0.20) aged 85+: 47% in BE vs 9% in IT (OR=0.09, 95% CI 0.05 to 0.16)). Between BE and ES, we identified a large difference in involvement of palliative care services (aged 65–84: 62% in BE vs 89% in ES (OR=4.81, 95% CI 2.41 to 9.61) aged 85+: 61% in BE vs 77% in ES (OR=3.1, 95% CI 1.71 to 5.53)).ConclusionsConsiderable country differences were identified in the quality of primary palliative care for older people. The data suggest room for improvement across all countries, particularly regarding pain measurement, GP–patient communication and multidisciplinary meetings.

scholarly journals “I live with other people and not alone”: a survey of the views and experiences of older people using Shared Lives (adult placement)

2016 ◽  
Vol 20 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Nadia Brookes ◽  
Sinead Palmer ◽  
Lisa Callaghan
Keyword(s):  
Older People ◽  
Well Being ◽  
Community Based ◽  
Negative Experiences ◽  
Content Type ◽  
Form Part ◽  
Family Based ◽  
And Control ◽  
Practical Implications

Purpose The purpose of this paper is to report on the views and experiences of older people using Shared Lives (adult placement) in 2012/2013. Design/methodology/approach As part of a survey collecting information about outcomes for older users of Shared Lives issues of whether it had made a difference to quality of life, and positive and negative experiences of support were explored. Findings Questionnaires were returned by 150 older people using Shared Lives services. Findings suggest that this model of community-based support has a number of advantages for some older people, such as reducing social isolation and loneliness, promoting independence, choice and control, providing emotional support and increased well-being. Research limitations/implications The questionnaire was self-completed and so responses were not followed up to provide deeper insights. Practical implications Shared Lives is not appropriate for everyone but it is suggested that this option should form part of local commissioning strategies, be part of a range of options for social care practitioners to consider in their work with older people and helps to meet various current policy imperatives. Originality/value The potential of Shared Lives for older people is under-researched and this paper contributes to the literature in exploring the views of older people about family-based support in the community.

Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people

2016 ◽  
Vol 16 (2) ◽  
pp. 190-206 ◽  
Author(s):  
Eva Ericson-Lidman ◽  
Gunilla Strandberg
Keyword(s):  
Quality Of Care ◽  
Action Research ◽  
Older People ◽  
Participatory Action Research ◽  
Residential Care ◽  
Research Process ◽  
Care Providers ◽  
Participatory Action ◽  
Care For Older People

Stress of conscience seriously influence the quality of care and the wellbeing of the care providers in care for older people. It is therefore of great importance to take measures to address, and relieve but preferably prevent stress related to troubled conscience. In our participatory action research studies, we have used troubled conscience as a driving force to relieve care providers’ burden and to increase quality of care. The aim with this paper is to present our experiences of using a further developed participatory action research process in practice to deal with care providers' troubled conscience in residential care for older people. The contribution to participatory action research practice in our studies is a support to the participatory action research process through using a modified model of problem processing, an approach which we found fruitful. In the paper, we describe our experiences and discuss them in relation to relevant literature and theory. Our experiences are that in participatory action research it is crucial to build a trusting relationship and striving to create a fruitful dialogue between the researchers and the participants. In our studies, we found that participatory action research is an easy approach to adapt as a problem-solving process in clinical practice and in nursing research.

scholarly journals The importance of addressing ageism in Swedish healthcare

2020 ◽  
Vol 40 (3) ◽  
pp. 113-115
Author(s):  
Katarina Sjögren Forss
Keyword(s):  
Older People ◽  
Health Inequalities ◽  
European Countries ◽  
Or Groups ◽  
Significant Class ◽  
Care For Older People

Ageism is discrimination against individuals or groups based on their age. In the Swedish healthcare context, the term is uncommon, despite the fact that older people are a significant class of users. One of every five individuals in Sweden is 65 years of age or older, and the proportion of older people in the population is rising. Therefore, ageism in healthcare warrants more awareness and focus. In three recent articles that we have published relating to nutritional, depression and continence care for older people, we found indications of ageism even though we did not aim to study it. There is a need to identify the manifestations of ageism and label them, and to become alert to both the visible and invisible expressions of ageism. This will help in the development of interventions and policies to eliminate ageism in healthcare. With health inequalities growing and seemingly becoming the norm rather than the exception in Sweden and other European countries, it has become imperative to address and eliminate health inequalities through a range of initiatives and mechanisms. Fighting ageism in different settings must be a part of this larger goal.

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