Long-Term Care and a Good Quality of Life

Abstract

Long-term care policies and programs in the United States suffer from a major flaw: They are balanced toward a model of nursing home care that, regardless of its technical quality, tends to be associated with a poor quality of life for consumers. This article proposes quality-of-life domains-namely, security, comfort, meaningful activity, relationships, enjoyment, dignity, autonomy, privacy, individuality, spiritual well-being, and functional competence. It argues that these kinds of quality-of-life outcomes are minimized in current quality assessment and given credence only after health and safety outcomes are considered. Five trends are reviewed that might lead to a more consumer-centered emphasis on quality of life: the disability rights movement, the emphasis on consumer direction, the growth of assisted living, increasing attention to physical environments, and efforts to bring about culture change in nursing homes. Building on these trends, the article concludes with strategies to move beyond current stalemates and polarized arguments toward forms of long-term care that are more compatible with a good quality of life.

Relationship between Familiarity, Attitudes and Preferences: Assisted Living Facilities as Compared to Nursing Homes

“…In line with the related literature, respondents were found to be more favorable toward assisted living, which they conceived of as more homelike and less institutional than a nursing home (e.g., Imamog˘lu and Imamog˘lu, 1992;French and Mosher-Ashley, 2000;Kane, 2001). Most respondents not only had favorable impressions of assisted living, but they were also more favorable about living in this place type in the future as compared to a nursing home.…”

“…On the other hand, just the opposite association was predicted for nursing homes, which generally are seen as unpleasant (e.g., FAMILIARITY, ATTITUDES AND PREFERENCES Imamog˘lu and Imamog˘lu, 1992;French and Mosher-Ashley, 2000;Kane, 2001;Imamog˘lu, 2002, unpublished). This prediction was based on the limitation of the mere exposure effect to stimuli that are initially perceived as pleasant or at least neutral.…”

“…This need to develop alternative care facilities first directed state bureaucracies toward the available medical model, which led to the design of nursing homes (Schwarz, 1999). However, nursing homes in general were not considered conducive to meeting the multidimensional needs of older adults in different countries (Johnson and Grant, 1985;Imamog˘lu and Imamog˘lu, 1992;Imamog˘lu and Kılıc¸, 1999;Schwarz, 1999;French and Mosher-Ashley, 2000;Kane, 2001). Still, factors such as the quality of the services provided (Carp, 1966;Lawton and Cohen, 1974;Imamog˘lu and Kılıc¸, 1999), voluntary relocation (Schooler, 1976;Rowland, 1977), and personal control (Langer and Rodin, 1976;Schulz, 1976;Rodin and Langer, 1977;Schulz and Hanusa, 1980;Slivinske and Fitch, 1987) were found to influence older adults' outlook toward institutional living in a favorable direction.…”

Factors influencing quality of life of elderly people with dementia and care implications: A systematic review

“…Moreover, as a highly significant outcome of health service, QoL has become the focus of dementia research. Increasing dementia researches concentrate on pathways or interventions that can improve QoL (Kane, 2001;Rabins and Black, 2007). To successfully improve QoL of elderly people with dementia by interventions, identifying factors that associated with their QoL is essential.…”

“…Connections with families may help them to recall their past memories, and also may allow them to have association with the community, reminding them of their existence in the outside world (Kane, 2001). Therefore, health care providers could support family visits and encourage relatives to visit residents with dementia.…”