Research results: Nursing home residents do not perform as well as older people living in the community in basic abilities such as vision, hearing, memory, attention and dexterity, according to a new study by the University of Limerick.
The authors of the report, Dr Kieran Walsh and Dr Thomas Waldmann, believe the reason the nursing home residents generally performed significantly poorer on ability assessments implies they had a reduced opportunity to do fundamental tasks like shopping, food preparation and housekeeping. "Because the nursing home is geared towards the most needy residents, there is a tendency for the staff to do everything for the client," according to Walsh.
"Older adults who are able to do tasks tend to go with the flow and allow staff to complete tasks for them like dressing and eating - batch living in essence."
He says they observed a certain form of "learned dependency" and the evidence from his study backs up this belief. "When only four out of 30 residents are able to do tasks, the higher number - the more dependant individuals - dictate the norm," he says. "It is the social network and the number of low dependency residents that dictate the way things run in any nursing home."
Dr Walsh says this study underlines the need for the state to provide a wider variety of facilities for older people who don't need full time nursing home care, but may simply need greater security and social support.
There is a need to look at distinct categories of long stay care such as sheltered housing, independent living, retirement homes and nursing homes, he believes.
"Regrettably while other countries possess distinct categories of care which cater for residents of each specific dependency level, in this country it is typical to find a wide range of older adults, varying in their abilities and afflictions, in a single facility."
A balance between security and autonomy would be far easier to achieve when centring all attention on a group of people with a similar set of health and dependency characteristics, he says.
One hundred people over 65 years-of -age were surveyed between 2003 and 2004. All came from the former Southern Health Board and Midwestern Health Board areas. Fifty were living in the community and 50 lived in different nursing homes. All were assessed for their core abilities, were free of any mental impairment and were able to answer freely for themselves.
One small group of six participants who were based in nursing homes did score similar in ability to older people living in the wider community, but they were the exception to the rule. The six were in four homes where they were well stimulated and relatively independent, a flexible approach was maintained and where the largest numbers of residents were low dependency.
The number of older adults in Ireland is expected to grow to over 800,000 by 2031 according to the CSO. The proportion in need of low dependency care is the section that will see the biggest growth by 2011, from about 10 per cent to 31 per cent. What the Limerick study really underlines, say the researchers, is that State provision of more low dependency facilities such as sheltered housing or independent-living long-stay homes, would be less costly and more beneficial to the greater well-being of older residents than high dependency nursing home care when it is not appropriate.