Ana Paula Gil is the International Journal of Care and Caring/Transforming Care Conference Best Paper winner 2018. Her article ‘Care and Mistreatment – Two Sides of the Same Coin? An Exploratory Study of Three Portuguese Care Homes’ was published in IJCC vol 2:4.  The article shows how important it is to provide care, support and recognition to those who work in the care industry.

Due to the increase of life expectancy, the number of people above 80 has risen in Europe. Seven out of ten people living in institutions are women over 80, with cognitive and physical impairments.

The main objective of the study was to analyse how the nursing homes are structured, the interpersonal features of care providers and how they both impact on the residents´ quality of life. We were looking for answers to the questions that an ageing society has to deal with:

How can we get older in a nursing home with quality of life and well-being?

Is this the model of institutions that we want, when one day we need care?

How can we tell which institutions provide good and bad care? 

The article shows initial results of an ongoing research study named ‘Ageing in an institution: an interactionist perspective on care’, done in the Metropolitan Area of Lisbon. In an exploratory phase in 2017, in-depth interviews were conducted with managers, professional staff, care workers and residents in three no-profit nursing homes providing care to physically and mentally dependent people (80% of residents suffers of dementia).

There is still uncertainty on how organisations, staff and residents interact between themselves and what effect this has on care practices. Studies of long-term care quality has been guided by Donabedian’s conceptual approach, encompassing structural features of the settings, services delivery process and outcomes, although empirical attention has not been given to all components simultaneously and the residents´ quality of life. This has led to criticism of there being too much focus on clinical aspects rather than quality of life in nursing homes.

To balance this I explored the ‘underground’ world of care, using interviews and a data survey to gain the perspectives of care workers, professional staff and managers. Significant themes emerged from the narratives:

There is a distant model of personalisation of care, where basic needs, defined collectively, overwrite the individualisation and relational aspects, for example where daily routines are centralised and organised in collective tasks.

Nursing homes are a place of prohibitions: admission happens, in most of cases, without future resident consent, residents are discouraged from keeping personal goods due to the risk of theft, they can be kept fastened in the chair to avoid the risk of falling down, a practice done without systematic supervision by health professionals and staff.

The factors affecting care practices and leading to the institutionalisation of a care omission culture and the risk of neglectful care are:

a) low public investment in the care sector;

b) limited monitoring system of care practices;

c) lack of social recognition of care work as a profession;

d) difficult working conditions, poor training and a low salary resulting in high staff turnover;

e) conflictual organisational climate with poor communication.

What we have learned is that the care system is not focused on people  and this has negative impact on their physical and mental health, job satisfaction, work environment and so the quality of service provided. Without human resources, training and motivation it is impossible to provide good care.

The care system can be only improved through higher investment, laws that relate to reality, improved resources, training, quality control, teamwork, effective decision making, reward and recognition). Quality of care practices should be a key priority of long-term care policy.

 

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