RELATIVES SATISFACTION WITH CARE PROVIDED

1 Introduction

1.1 Background

The Registration and Inspection Unit, Eastern Health & Social Services Board (R&I Unit) is empowered under the Registered Homes (NI) Order 1992 Article 29 to inspect nursing homes and residential care homes. The aim of the R&I Unit is to measure the services being provided against current standards which together reflect the quality of life of the people living in the Home.

The Eastern Health and Social Services Council (EHSSC) is an independent organisation set up to represent the interests of the public in health and social services in the EHSSB area. In acting to protect the rights of users of health and social services, it seeks to make the delivery of services more responsive to user need.

The EHSSC identified a need for reliable and valid information in the area of the quality of care provided in nursing and residential homes. As the R&I Unit had previously undertaken work in this area it was agreed to undertake a joint project. The majority of concerns brought to the EHSSC about nursing and residential homes come from relatives. While relatives are encouraged to express their views about the care provided in homes at each annual announced inspection, undertaken by the R&I Unit, few avail of this.

It is recognised that the views of relatives may not be consistent with the views of residents in nursing and residential homes. However, relatives can often express the true feelings of residents without some of the censorship residents impose upon themselves .

1.2 Project Aims and Objectives

This project aimed to obtain the views of relatives of individuals receiving care in nursing or residential homes in the EHSSB area. The project had as its objectives:

• to describe relatives' perceptions of the quality of service received by individuals.
• to describe the experience and level of satisfaction of relatives in the different settings.

1.3 Context

As individuals become older they may require assistance and support with certain aspects of their lives. There is a continuum of support, ranging from occasional contact with the health centre, to dependence on family or friends, to requiring the continuous care provided in residential or nursing homes. One of the factors to be considered when deciding upon the type of home, is the level of care needed. Residential homes provide for those who require support, as they are 'no longer able to cope with the practicalities of living in their own homes even with the help of domilicilary services' . Nursing homes provide care for those who are unable to live independently, and 'provide nursing care for persons suffering from any illness, injury or infirmity'

Residential settings should provide quality care that is safe, manageable and comfortable, and encourage the individual residents to achieve maximum independence . Factors which contribute to this quality care, have been identified as relating to the following values: privacy, dignity, independence, choice, rights and fulfilment .

The decision to place an individual in residential care, due to increasing care demands, should not end the family's involvement in caregiving. Staff should involve relatives, where possible, in caregiving . It has been suggested that the relationship between residents, staff and relatives in Homes is triangular , and a number of factors are significant in defining the experience of each. These factors include roles and expectations, communication, residential care and practice, and complaints and advocacy.

Not only do relatives want good consistent care to be provided to residents; they also have a range of expectations:

• to be treated as intelligent adults;
• to encounter staff who understand feelings of loss when a family member moves to residential care;
• to be encouraged to continue the family caring/advocacy role and not be replaced by staff as 'family';
• to have the uniqueness of the family relationships respected;
• to be listened to and have complaints acted upon;
• to have accessible management and staff, and to know their names and roles;
• to know that staff give priority to the caring tasks and are around to communicate with residents;
• to be confident that there are enough trained staff to provide good quality care.

Relatives also need to be able to communicate with staff about residents' health and well being, any concerns and for information sharing. The absence of formal opportunities or structures for this communication allows the significance of relatives in the lives of residents to go unrecognised . One suggested method of consultation is the establishment of a residents/relatives committee .

The findings of this research will provide a baseline of relatives' satisfaction with care provided in nursing and residential homes, highlight areas that need to be improved upon, and provide direction to the Inspection process.