Quality of Life and Well-Being for Residents in Long-Term Care Communities : Perspectives on Policies and Practices

Acknowledgement 9 Author ́s Note 10 Contents 11 About the Authors 14 List of Figures 16 List of Tables 23 List of Exhibits 24 Chapter 1: Quality of Life in Long-Term Care 27 1.1 Aging Demographics across the Globe 28 1.2 Defining ``Good ́ ́ Quality of Life 29 1.3 Long-Term Care Communities 30 1.4 The Decision to Move into a Long-Term Care Community 32 1.5 Influence of Quality of Life on Other Metrics 34 1.6 Enhancing Resident Quality of Life 34 1.7 Quality of Care Vs. Quality of Life 36 1.8 Balance between Safety and Autonomy 38 1.9 Resident-Defined Quality of Life 39 1.10 Quality of Life Domains 40 References 44 Chapter 2: Resident Autonomy, Dignity, and Respect 48 2.1 Respect 49 2.2 Autonomy 51 2.3 Dignity 54 2.4 Sense of Purpose 55 2.5 Promoting Respect, Autonomy, Purpose, and Dignity in Residential Care Communities 56 2.5.1 The Golden Rule 57 2.5.2 Autonomy, Choice, and Control 59 2.6 Essential Influencers 64 2.6.1 Nurses and Nurse Aides 64 2.6.2 Social Workers and Admissions Directors 65 2.6.3 Activities Directors and Aides 65 2.6.4 Dietary Directors and Aides 65 References 66 Chapter 3: Relationships with Other Residents, Staff, and Family Members 69 3.1 Peer Relationships 70 3.1.1 Care Recipients Are Unique 72 3.1.2 How Residents Develop Peer Relationships 73 3.1.3 Potential Barriers to Peer Relationships 74 3.1.4 Facilitating Positive Peer Relationships 74 3.2 Resident-Staff Relationships 77 3.2.1 How Resident-Staff Relationships Develop 78 3.2.2 Optimizing Resident-Staff Relationships 79 3.3 Resident-Family Relationships 84 3.3.1 Family Member Roles 85 3.3.2 Facilitating Resident-Family Relationships 86 3.4 Romantic Resident Relationships 92 3.4.1 Supporting Romantic Resident Relationships 93 3.5 Essential Influencers 95 3.5.1 Nursing and Direct Care Staff 95 3.5.2 Social Workers 96 3.5.3 Activities Director and Aides 96 3.5.4 Dining Staff 97 3.5.5 Volunteers 97 References 97 Chapter 4: Activities and Religious Practices 101 4.1 Psychosocial Benefits of Activities 102 4.2 Frequency and Variety of Activities 105 4.3 Adapting Activities for Residents with Impairments 113 4.4 Religious and Spiritual Activities 115 4.5 Essential Influencers 117 4.5.1 Activities Director 117 4.5.2 Activity Aides and Volunteers 118 4.5.3 Social Workers 118 4.5.4 Therapists 119 4.5.5 Clergy 119 References 120 Chapter 5: Environment and Surroundings 123 5.1 Use of Homelike Design Principles 124 5.1.1 Homelike and Hospitable Care 126 5.1.2 Resident Bedrooms 128 5.1.2.1 Privacy 128 5.1.2.2 Personal Belongings 130 5.1.2.3 Autonomy Over Personal Environment 133 5.1.2.4 Bathrooms 133 5.1.3 Design of Communal Spaces 135 5.1.3.1 Caregiver Workspace 136 5.1.3.2 Living, Lounging, and Activity Spaces 137 5.1.3.3 Kitchen and Dining 141 5.1.3.4 Shower and Tub Rooms or ``Spas ́ ́ 142 5.1.4 Environmental Comfortability 144 5.2 Creating Safe and Functional Access to the Outdoors 148 5.3 Environmental Considerations for Residents with Dementia 151 5.4 Essential Influencers 154 5.4.1 Social Workers 154 5.4.2 Maintenance Personnel 155 5.4.3 Nursing and Direct Care Staff 155 5.4.4 Activities Director 156 5.4.5 Dining Staff 156 References 156 Chapter 6: Food and Dining 159 6.1 Aging Changes that Affect Food Consumption 160 6.2 Quality of Food and Menu Options 163 6.3 Modified Diets and Changes to Food Preparation for Resident Health Conditions 166 6.4 Improving the Dining Experience 167 6.5 The Dining Environment 171 6.6 Essential Influencers 174 6.6.1 Dieticians and Dietary Managers 174 6.6.2 Medical Director and Therapists 174 6.6.3 Dietary Aides 175 6.6.4 Nurse Aides 175 References 176 Chapter 7: Quality of Care 179 7.1 Quality of Care 181 7.2 Intersection of Care and Quality of Life 183 7.3 Measuring and Assuring Quality 186 7.4 Providing Quality Resident Care and Therapy Services 188 7.5 Care Planning for Residents 191 7.6 Transfers between Care Settings 193 7.7 Essential Influencers 194 7.7.1 Medical Director and Director of Nursing 194 7.7.2 Nursing Staff and Nurse Aides 195 7.7.3 Therapists and Service Staff 195 References 195 Chapter 8: Summary, Policy Recommendations, and Conclusions 199 8.1 Care Recipients Should Direct their Care 200 8.2 Administrators as Champions and Chief Influencers 201 8.3 Organizational and Leadership Support 204 8.4 Opportunities for Government Licensure and Regulatory Agencies 205 8.5 The Imperative and Charge to Improve Resident Quality of Life 207 Appendix 209 This book explores key factors long-term care recipients have identified as impacting their quality of life and offers programmatic and policy recommendations to enhance well-being within long-term care communities. Leadership and staff who work in nursing homes and other residential care communities serve as gatekeepers to resident well-being, often without recognizing how residents’ quality of life is impacted by their decision-making. This book takes a life domain approach to build on research-based studies that document key drivers of care recipients’ quality of life, including relationships, autonomy and respect, activities and meals, environment, and care. Using a framework that enhances understanding of resident quality of life, it outlines practical, programmatic, and policy suggestions for long-term care stakeholders, such as administrators, managers, front-line staff, family members, and policy-makers, whose directives and actions impact the lived experience of long-term care residents. As such, this book serves as a roadmap for leaders and managers of long-term care communities, along with policymakers who regulate health and human services, to best structure care environments to maximize quality of life and well-being for long-term care recipients.