How Residents’ Quality of Life are Represented in Long-Term Care Policy: A Novel Method to Support Policy Analysis

Abstract

In one's final years, quality of life (QoL) is a fundamental desire. In Canada, a publicly-funded long-term care (LTC) system is governed provincially through multiple policies about housing and care provision. A pan-Canadian research team investigated federal and provincial policies' influence on the QoL of older people living in residential LTC in four provinces: British Columbia, Alberta, Ontario, and Nova Scotia. Objective(s): This paper describes a novel method of policy analysis developed by the authors to analyse the inclusion of QoL domains within these LTC policies, and assess implications for residents, their families, and staff. Method(s): Within the novel method mentioned there were four stages in the method that consisted of an iterative and collaborative approach to understanding the relationships between LTC regulations and resident QoL domains through four perspectives (resident, staff, family, volunteer). At first, inclusion/exclusion criteria were applied to select appropriate policies, and secondly, policy texts were to coded according to Kane's (2001) QoL domains. The third stage involved assigning a level of regulatory power, with the final stage interrogating the policy categorisation data from four perspectives: residents, families, volunteers and workers. Findings: The outcome revealed a dominant discourse of safety, security, and order over other domains such as dignity, privacy, and spirituality. Limitations: Policies dictate regulatory and guiding principles, and are only one part of the story. How these policies are implemented is beyond the scope of our research, but we recognize that understanding these implementation practices are essential to fully capture the experiences of residents, their families, and staff. Implications: This novel method is useful in exploring how QoL is supported across a high number of complex cross-jurisdictional policies. We conclude that our approach to policy analysis enables a re-examination of policies affecting LTC and assesses whether these policies reflect the values of the residents and society at large.

Towards equitable representation in long-term residential care: widening the circle to ensure “essential voices” in research teams

“…SALTY's diverse range of qualitative and quantitative methods included: analysis of quantitative government LTRC data, Delphi panels composed of advisors with essential voices vocalizing priorities around burdensome symptoms in the last year of life [ 42 ], rapid ethnographic fieldwork involving tours of LTRC facilities [ 9 , 40 ], supporting the use of resident-centric frameworks to analyze existing LTRC policy [ 43 ], and evaluating a palliative care intervention [ 44 ] to examine and conceptualize quality of life on multiple scales and across diverse domains. The emphasis on the resident-centric perspective, as situated within care relationships, contributed to a more equity-oriented, inclusive research approach.…”

“…However, SALTY organized three in-person meetings where advisors’ travel, food, and accommodation was covered by research funds. SALTY’s essential voice advisors are acknowledged in SALTY publications where they played a direct advisory role, with some publications specifically discussing the role that essential voice advisors played in analysis and knowledge production [ 31 , 43 ] Advisors were co-leads in knowledge translation activities, including academic workshops [ 45 , 46 ] and other project related presentations as the project wrapped up.…”

Canadian Long-Term Residential Care Staff Recommendations for Pandemic Preparedness and Workforce Mental Health

“…Workers can guide further understandings of how existing policy is expressed and embodied in organizational contexts through identifying beneficial local practices which are "disappeared" from the medium of policy and also identifying how existing policy contradicts tenets of the person-centered approach in ways that create harms to worker wellbeing and mental health. Some promising groundwork has been laid for this by Taylor and Keefe's (2021) delineation of an assetbased, interpretive foundation for policy analysis which can be used to re-assess Canada's unwieldy collection of LTRC policies and determine whether these policies reflect the values of residents, workers, and society (p. 382). Engaging with workers to reassess and reimagine policy in this way entails a shift into a more co-creative vision of LTRC by expanding what counts as policymaking and evidence, and who are considered policy actors and decision makers.…”