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Frangipanis, Friendship and Football: Understanding Quality of Life in Residential Aged Care
1. Frangipanis, friendship and football:
understanding quality of life in
residential aged care
A research collaboration between BallyCara & Queensland University of Technology
Ms Geraldine Donoghue / Assoc Prof Evonne
Miller
School of Design, Creative Industries Faculty
Queensland University of Technology
Brisbane, Australia
geraldine.donoghue@qut.edu.au
2. • Critical demographic transition – ageing population
– by 2050, one in four Australians will be older than 65 years – which is an
increase from 13% to 22% of the population (ABS, 2005)
– the number requiring high-level residential aged care is expected to
increase 63%, up from 520,000 in 1998 to 1.4 million in 2031 (ABS, 2005)
Project background / context
3. Active Ageing Framework for Understanding “Happiness” and QoL in
Aged Care
Figure 1: The three pillars of active ageing (WHO, 2002)
Participation: “provide education and learning
opportunities; recognise and enable
participation in formal and informal work;
encourage full participation in community life”
(WHO, 2002, p51-52)
Health: “encompasses all aspects of physical,
mental and social wellbeing, as expressed in the
WHO definition of health” (WHO,2002, p47-51)
Security: “ensure the protection, safety and
dignity of older people by addressing the social,
financial and physical security rights and needs
of people as they age” (WHO,2002,p52)
The World Health Organisation has advocated ‘active
ageing’, identifying health, participation and security as
the three key factors that enhance quality of life for
people as they age. The well known 'active ageing' dictum
is that 'years have been added to life, we must add life
to these years' (WHO, 2002)
4. Current research
Figure 1: The three pillars of active ageing (WHO, 2002)
Existing research has tended to focus on:
• reason for relocation into RACF (e.g., Krout et al., 2002; Timonen & O’Dwyer, 2009)
• the relationship between positive attitudes and successful early adjustment to
living in RACF (Bergland & Kirkevold, 2006; Edwards et al., 2003; Hjaltadottir &
Gustafsdottir, 2007)
• examining resident-centred care and specific initiatives that facilitate physical and
emotional health, including nutrition, exercise, falls prevention, and inter-
generational activities (e.g., Shura et al, 2011)
• the association between the activity levels of residents in aged care and health
related QoL (Jenkins, Pienta & Horgas, 2002; Voelkl, Fries & Galecki, 1995),
• the relationship between place attachment and health (Heisler, Evans & Moen,
2004)
• the impact of changing social interaction on health outcomes (Ball et al., 2000;
Bergland and Kirkevold, 2006; Tsai and Tsia, 2008)
5. There is surprisingly little research on defining and
understanding what is important to older people
living in care– in part because our focus is on
operational day-to-day priorities (compliance,
staff, nutrition, health etc).
There is an extensive body of research on resident-
centred care (and specific initiatives to facilitate
physical and emotional health), yet the reality is:
“insights into daily living in residential care settings
are rare... there is limited research outlining what
is important to older people who live in residential
care settings” (Timonen & O’Dwyer, 2009, p.597)
This research addresses this knowledge gap.
Knowledge Gap – “Happiness” and Daily Life in RACF
Reference: Timonen, V. & O'Dwyer, C. (2009). Living in institutional care: Residents' experiences and coping strategies.
Social Work in Health Care, 48(6), 597-613
6. over-arching aim is to explore, understand and identify the key
facilitators to QoL and active ageing in aged care from perspective of
residents*
2012-13 pilot study tracked the expectations and experiences of 15 new
(LOW CARE) aged care residents over a period of a year:
– in-depth interviews
– monthly brief surveys (tracking QoL)
– PhotoVoice (a participatory photographic task; residents take
photographs that capture their daily lives – “lowlights and
highlights” - in aged care). Exhibition Outcome
Facilitating quality of life for aged care residents
* In July 2013 - awarded an Australian Research Council Linkage grant to expand project (over 3
years ), investigating and longitudinally tracking the lived experiences of older Australians
utilising the continuum of services from RACF (community care, independent living units, low-
care), as well as the perspectives of key current and future stakeholders (including family, formal
service providers and baby boomers - the future generation of older people)
7. • Lets talk a little about what it is like to live here – and what things assist (or not) your
overall quality of life and happiness
• Tell me a bit about life here - how long you’ve lived here and tell me about what you do in
your daily lives/activities?
• What kinds of things do you do each day – and would like to do? (i.e., physical,
psychological, social & spiritual well-being)
• Tell me about any the things you like and dislike most about living here (Jot down issues
and allow respondent to nominate as many as they like without interrupting, then go back
and use the following 3 questions to explore each respondent category for more detail):
ISSUES TO COVER
– Social activities / interactions (other residents etc)
– Staff
– Daily life – e.g., food etc
– Activities / Excursions
– Health and Physical activity
– Technology
– Physical Environment – room, complex/village (RACF), local community
– Other... what other things do you like and dislike?
Example Interview Items
8. 1. Moving to Residential Aged Care
GeneralEvaluation
a. Thinking back to you when you first entered this
aged care residence, how did you feel about being
admitted?
Very
Reluctant
Reluctant Neutral Enthusiastic Very Enthusiastic
Thinking back, what were your main feelings and concerns about moving to residential aged care...?
What words of advice would you give staff, future residents and their family members?
a. Now, overall, how do you feel about living here?
Very
Reluctant
Reluctant Neutral Enthusiastic Very Enthusiastic
Tell me a little more about your daily experience living here..?
What do you like and dislike most?
Example Survey Items
9. Satisfactionwith
Room
Thinking about your room, how would
you rate the following:
a. The size of your room?
a. The amount of storage space?
a. The bathroom?
a. How would you rate your room overall?
What, if anything, would you change your room to make it better?
What is the ONE thing you like most and ONE thing you dislike most about your room?
Satisfactionwith
StaffCare
Thinking about staff, how would you
rate the following:
Very
Dissatisfied
Not
Satisfied
Neutral Satisfied
Very
Satisfie
d
a. Their attitude towards you? 1 2 3 4 5
a. Their respect for your privacy? 1 2 3 4 5
a. The promptness with which they
respond to your calls for help?
1 2 3 4 5
What, if anything, would you change to improve interactions with staff?
Example Survey Items
10. Initial Findings – four key themes, centred on “mental attitude”
Joining a “family” -
forming positive peer
& staff relationships
Activities - creating
a “structure for
living”
Maintaining
independence -
self-determination,
autonomy & freedom
“Living within
these walls”
- safety, comfort
& physical
environment
Residents’
mental
attitude to
living in aged
care
11. Most residents described how
they were leading much more
socially active lives now than
when they had been living
independently.
Residents reported feeling more
social connectedness and
involvement with others –
forming important social
relationships with
both peers and staff
Theme - “Joining a Family” (social connections/interactions)
Making the Christmas wreaths was such fun.
What a festive mood! June’s photovoice
12. Theme - “Joining a Family” - Positive STAFF Relationships
Ah we have fun with Ros! We have
close friendships with the staff.
June’s photovoice
Overwhelmingly, residents described
the staff as being kind, respectful of
their privacy and highly agreeable. Staff
were generally very attentive to their
individual needs.
Even F1, who was desperately unhappy
with many aspects of RACF life,
explained how she was grateful for the
kindness of staff who “genuinely care..
you can’t buy kindness and care”.
“like my own home, only I don’t have to do
any work”
“you’re taken care of. Yeah, yeah, well,
that’s what I believe”
13. Staff Attitudes Not satisfied Neutral Satisfied
Thinking about staff, how would you rate
their attitude towards you?
0 0 100%
Thinking about staff, how would you rate
their respect for your privacy?
0 9% 92%
Thinking about staff, how would you rate
the promptness with which they respond
to your calls for help?
18% 9% 73%
Interview responses reinforced the critical role carers play in
facilitating resident’s quality of life, specifically the value of taking
a few extra minutes during their daily routines to just talk. What
resonated strongly throughout all interviews was the ‘culture of
caring’ that all residents reported experiencing at Ballycara.
14. Friendship. We have found great mates.
Beryl’s photovoice
Theme - “Joining a Family” - Positive PEER Relationships
Developing co-resident peer friendships
helped foster feelings of belonging and a
strong sense of being important to others
(example - family noticed positive change)
“when you come in here, you feel like a family” (F6)
“the friendliness of everybody…we are all here for a
reason. We all get along together” (F4)
EXCEPTION: Not all residents viewed RACF as a
“family”. Two found living in RACF very
difficult, navigating a wide array of different
personalities, personal life histories and
behaviours – and hating ill health reminders
15. Theme - Activities, ”Structure for Living”
We love crafts!
June’s photovoice
Life in RACF provided a structure to daily lives
that most residents reported greatly enjoying.
Valued the multiple activities on offer-
including exercise classes, religious
services/classes, bingo, craft, concerts and
outings, which provided a reason to “get up in
the morning and get dressed”“
When I was home I couldn’t care, I used to open my
eyes in the morning and think ‘Oh, I’m still here
another day.’ But since I’ve been here I’ve got, you
know, ‘Oh, I’ve got crafts to do tomorrow’, sort of
thing”. I’m into craft work now, which I’ve never
been since I came in here” (F6)
16. “You should treat people like they are
adults, not jolly them up. I look forward
to activities, but I don’t think SONA has
helped me to feel part of the
community. I can't cope with people
who are always noisy and happy, trying
to be bright”
not all appreciated activities in aged care
EXCEPTION: Not all residents enjoyed the social activities, interactions and structure of life in
RACF, resenting the limited degree of privacy and ‘forced, holiday camp’ vibe.
As F3 explained, many of the activities did not interest her and the challenge was to find a
“compatible group for cards... I don’t like Bingo, don’t need trips, don’t like listening to concerts...
I would rather be in the concert”. When asked what could be changed to improve her quality of
life and happiness in RACF, her answer was simple: “that is not possible”.
17. Women’s club coffee outing.
Women’s club coffee outing
Theme – Maintaining Independence
Maintaining independence can be difficult
for some residents of RACF, however, we
found most residents reported feeling a
critical sense of freedom in making their
own choices in terms of day-to-day
activities. Residents also felt staff
encouraged their independence
“I think they want us to be independent
and free as long as we can…” (F4)
"Independently, I go down to the water
each day…the mobility is good” (M1
18. “If I go out of the room, I either go up for meals or I go out for a walk. Or I go out. I
mean I was out yesterday with my daughters and you do what you want…you can go
out everyday, if you want to” (F7)
Outing to local football match
Maintaining independence - self-determination, autonomy & freedom
19.
20. Initial Findings – four key themes, centred on “mental attitude”
Joining a “family” -
forming positive peer
& staff relationships
Activities - creating
a “structure for
living”
Maintaining
independence -
self-determination,
autonomy & freedom
“Living within
these walls”
- safety, comfort
& physical
environment
Residents’
mental
attitude to
living in aged
care
Ms Geraldine Donoghue
Research Fellow
School of Design, Creative Industries
Faculty
Queensland University of Technology
Brisbane, Australia
geraldine.donoghue@qut.edu.au
Associate Professor Evonne Miller
Research Leader
School of Design, Creative Industries
Faculty
Queensland University of Technology
Brisbane, Australia
e.miller@qut.edu.au
Notes de l'éditeur
The results are presented in key themes - these themes illuminate the central importance of resident’s mental attitude towards living in RACF, which subsequently shaped their views on all other aspects.
mental attitude towards living in RACF
joining a “family” – forming positive peer and staff relationships
activities - creating a “structure for living”
maintaining independence
“living within these walls” –safety, comfort and the physical environment
As illness and declining health frequently precipitated the move into the RACF, resident’s narratives about staff often highlighted their relief of being in an environment where their daily life and healthcare needs were being met.
For many, the time and energy associated with managing their day-to-day life (demands of cleaning, cooking, paying bills etc) in their previous residence had become extremely challenging, especially when combined with constant worries and concern about their declining health (managing medications, travelling to/from appointments, falling at home etc).
Residents felt that they now had much more emotional and practical support in terms of managing and living with their health conditions; as one explained, “you’re taken care of. Yeah, yeah, well, that’s what I believe” (F2). Overwhelmingly, residents reported feeling a deep sense of comfort and safety, which was driven by the sense that trained staff cared about and for them.
Although relationships with staff were highly valued by the residents, how the care was administered presented some room for improvements. One resident explained how adjusting to rules and norms of RACF living was challenging; she explained how staff would knock and then, without waiting for a response, immediately enter her bedroom. She disliked this and the proposed solution from staff, that she put a ‘do not disturb’ sign on her door. She went on to explain that she would always resent being reliant on others for help as her health deteriorated, noting how you “had to accept what you can’t change... but don’t have to like it though” (F3). Staff discontinuity and wait times for assistance were of particular concern to some residents, with a sense that at times the RACF was “understaffed” (M2).
In our study, interview responses reinforced the critical role carers play in facilitating resident’s quality of life, specifically the value of taking a few extra minutes during their daily routines to just talk. The process and complexities of providing care can at times make taking this time for social interactions challenging, but it was highly valued by residents. Fortunately, the RACF management ethos (which prioritises the happiness of residents) gives carers the impetus to take the time for these social interactions and discussions. Indeed, what resonated strongly throughout all interviews was the ‘culture of caring’ that all residents reported experiencing at Ballycara.
Residents described how the peer friendships they had developed helped foster feelings of belonging and a strong sense of being important to others, with one resident describing how “when you come in here, you feel like a family” (F6).
This same resident went on to note how her family had noticed and commented on a positive change in her since moving into the RACF, which she attributed to having company that she never did when she lived in more isolated circumstances on her own, in her own home in the community. Another resident, F4, clearly relishes her connectedness with other residents, and explains how comforting it is to be surrounded by people who care about each other. In response to the question “what do you like most about living here?”, F4 quickly responded with “the friendliness of everybody…we are all here for a reason. We all get along together”.
Of course, not all residents viewed RACF as a “family”.
In particular, they found seeing the negative impact of hearing and memory loss experienced by other residents confronting, serving as a daily reminder of the inevitable reality of ageing and subsequent health challenges that likely lay ahead for them. As one resident (F1) explained, she did not like: “living in an institution... which is the opposite to what I would chose. Today, there is nobody close to me, no companionship. I dislike having everyone in your face, we are all different personalities and some have dementia and it’s a trial. You see people you don’t like and you have to put up with them everyday. It’s an effort... I prefer to be on my own and please myself”.
Many residents described taking a more active stance in daily living after entering RACF, with the variety of activities helping to keep busy and encourage a positive mindset.
“I used to imagine that you’d sort of sit in a corner with a book, and watch a bit of TV. But there is activities going on here everyday….and that keeps us occupied. You don’t get time to think or worry or anything like that” (F4)
Unfortunately, a few residents explained that although they would like to join in on more activities, they felt unable to do so due to a lack of staffing, uncommunicated changes, or a lack of friends that were able to enjoy the same activity.
Maintaining independence - self-determination, autonomy & freedom
Maintaining independence can be difficult for some residents of RACF, however, this study found that on the whole residents reported feeling a critical sense of freedom in making their own choices in terms of day-to-day activities. Importantly, the residents also reported feeling as though staff encouraged their independence and how they valued maintaining independent activity: “I think they want us to be independent and free as long as we can…” (F4) and "Independently, I go down to the water each day…the mobility is good” (M1). The fact residents’ family and friends could come and visit whenever they liked, was warmly discussed by nearly all the residents, looked forwarded to and helped to greatly contribute to their sense of self-determination and autonomy. As residents explained:
“If I go out of the room, I either go up for meals or I go out for a walk.
Or I go out. I mean I was out yesterday with my daughters and you do what you want…you can go out everyday, if you want to” (F7)
“Yeah, it’s good, I’ve got a good family and they take me to places.
You know, we can go and have a meal together at the RSL and up at the leagues club, you know, things like that. And I go to, if they’ve got a party on for somebody’s birthday, I’m always invited” (F2)
