Background to the Research

• No research in relation to the quality of care for people aged 65+ living in nursing and residential care had been carried out in the Southern Board's area. This study sought to rectify this by exploring relatives' experiences and perceptions of the care provided for residents (over 65 years) of nursing and residential homes. It also compared and contrasted perceptions of the quality of care in the different types of homes and made recommendations.
  

Research Approach

• Six focus group discussions were held with a total of 63 relatives, then 932 postal questionnaires were issued to the relatives of people living in 46 residential and nursing homes within the SHSSB area, 626 questionnaires were returned.
  

Main Findings

Profile of the Sample

• Sixty-one per cent of respondents were female and 67% were aged between 41-65 years. The majority of residents were female (73%) and 84% were over 75 years of age.
• Over half (54%) of respondents were the children of residents, 17% were nieces/nephews, 15% were siblings and 7% spouses.
• Thirty-six per cent of residents were in nursing homes, 23% in residential homes and 41% in dual registered homes. In terms of care, 46% received residential care and 53% nursing care.
• The majority of respondents (89%) visited their relative at least once a week, 33% visited 2-3 times a week and 15% every day. Of respondents whose husband/wife was in the home, 39% visited them every day.
• Fifty-three per cent of residents had been in their nursing/residential home longer than 2 years, 23% for between 1-2 years, 12% for between 6 months and 1 year and 28% had been in a different home previously.

Staff

• Ninety-three per cent of respondents stated that they were 'always' or 'usually' made to feel welcome by staff and 92% stated that their relative was 'always' or 'usually' treated with respect and dignity by staff.
• Thirty-four per cent said their relatives 'sometimes' had to wait for long periods for assistance from staff and 4% said this was 'always' or 'usually' the case. Twenty-six per cent reported that staff were 'sometimes' too busy to talk to their relative and an additional 9% said this was 'always' or 'usually' the case.
• Over two thirds of those whose relative was in a voluntary or statutory sector residential home said their relative 'never' had to wait for long periods for assistance compared with 37% of those in a private nursing home or 40% of those in a private dual registered home. Eighty-one per cent of those whose relative was in a voluntary sector home reported that staff were 'never' too busy to talk to their relative compared to 50% of those in a private nursing home.
• Recommendation: Staff in nursing and residential homes should ensure that residents do not have to wait for long periods for assistance. All homes should ensure that adequate staff training is provided to young care assistants and agency staff.

Activities

• Seventy-two per cent of respondents reported that activities were organised within the home, this was more likely in statutory residential homes (86%) than in private residential homes (70%). Nearly half of activities occurred at least once a week, however, 24% of respondents reported that they occurred only once a month or less.
• One-in-ten respondents did not consider the activities suitable for their relative, a higher proportion of respondents whose relative was in a private nursing home (15%) or dual home (11%) did not consider activities suitable.
• Recommendation: Nursing and residential homes should provide a programme of activities suitable to each resident and ensure that they have the opportunity to take part in at least one activity per day.

Access to Services

• Twelve per cent of respondents reported that their relative 'never' had access to physiotherapy, occupational therapy (9%) and speech therapy (8%) when needed. Residents of private and voluntary homes had greater difficulty in accessing physiotherapy and occupational therapy services.
• Eighty-two per cent said their relative had access to religious services, but this varied from between 2/3 times a week to less than once a month.
• Recommendations: The Trusts should ensure that physiotherapy and occupational services are more accessible to older people in homes, particularly in the private and voluntary sector.
• Homes should take steps to engage the main Churches to increase provision of religious services, ensuring access for residents at least once a week .

Housekeeping and Food

• Overall, 80% of respondents rated the cleanliness in the home as 'good', the highest rating (96%) was received by the voluntary homes, with private nursing homes receiving the lowest (76%). Seventy-four per cent of all respondents rated the laundry arrangements as 'good', with the laundry service rated as 'good' in 90% of voluntary homes and 71% in private homes.
• Whilst the majority of respondents were satisfied with the size, choice and nutritional content of meals, satisfaction with the availability of fresh fruit was lower. Seventy-nine per cent stated that their relatives' special dietary requirements were fully met and 21% said they were partially met.
• Recommendation: All homes should ensure the availability of fresh fruit for residents, the Health Promotion department of SHSSB should form links with homes to implement a health promotion strategy for older residents.

Accident Prevention

• Forty-six per cent of respondents stated that their relative had experienced a fall or injury while in the home. Fifty-one per cent had been informed of this immediately, 22% after a couple of hours and 18% were not told until the next visit.
• Recommendations: Older people in homes should be targeted as part of the 'fall prevention' programmes already under development.
• Managers of homes should ensure that the wishes of relatives in relation to being informed about accidents are carried through.

Contact between Respondent and Home

• Ninety-three per cent of respondents thought it 'important'; or 'very important' for them to be consulted about decisions concerning their relative. Eleven per cent had not been consulted as much as they would have liked and less than four-in-ten were aware of an organised procedure in the home for consultation.
• Recommendation: Homes should introduce procedures to ensure that relatives are consulted about decisions and encouraged to be involved in the care of their relative. Mechanisms should be established to make this possible.

Complaints

• Forty-eight per cent of respondents stated that their relative had expressed satisfaction and 12% dissatisfaction with the home. Satisfaction rates were highest in statutory residential homes (65%) and lowest in private nursing homes (37%). Conversely, dissatisfaction was highest among those in private residential homes (19%) and lowest in statutory residential homes (1%).
• Fourteen per cent of respondents had at some stage felt worried about the standards of care or the way things were done in the home and 23% had made a complaint or raised an issue of concern. Nineteen per cent of respondents whose relative was in a private nursing home felt worried about standards of care or the way things were done compared with 4% in of those in voluntary or statutory homes. Thirty per cent of respondents with a relative in a private nursing home had made a complaint.
• Recommendation: All homes should regularly distribute information on their complaints procedures to residents and relatives.

Awareness of R&I Unit and SHSSC

• Seventy-three per cent of residents did not know about the R&I Unit and 86% did not know anything about the function of the Council. Only 24% knew they could access inspection reports and only 10% had accessed such a report.
• Recommendation: The R&I Unit should pilot the provision of a short summary report of the outcome of the inspection of the home to residents and relatives. The SHSSBC should take steps to raise awareness of its services in relation to nursing and residential homes.