Background
For residents: “Which aspects create an optimal sense of home in the nursing home for you?”For care professionals: “Which aspects contribute to a sense of home of nursing home residents, and how can care professionals help create these things for the residents, and, at the same time, have an optimal place to work?”For relatives: “Which aspects contribute to a sense of home of your loved-one, and consequently, what makes it a place you like to visit?”
Methods
Settings and participants
Photography
Joint procedure at the start
Interviews with residents
Focus group sessions with relatives and care professionals
Data analysis
Results
Residents | Relatives | Care professionals |
---|---|---|
Building and interior design | Building and interior design | Building and interior design |
Eating and drinking | Eating and drinking | Eating and drinking |
Autonomy and control | Autonomy and control | Autonomy and control |
Involvement of relatives | Involvement of relatives | Involvement of relatives |
Engagement with others and activities | Engagement with others and activities | Engagement with others and activities |
Quality of care | Quality of care | Quality of care |
Connection with nature and outdoors | Connection with nature and outdoors | |
Coping | Coping | |
Organization and facilitation of care | Organization and facilitation of care | |
To matter | To matter |
Building and interior design
“Yes, my room is a bit small. Not so large. But still, it is my own stuff. It is my own and it is safe from others.” [resident]“I brought as many things from home as I possibly could.” [resident]
“It is important that my table is full of stuff, and that I am allowed to leave it full of stuff.” [resident]
“Now that the room is all decorated, she has a peace of mind. And she is very content.” [relative]
“The office of the care staff is always locked. There should not even be a door! Always shut! It is all covered up. You cannot see them sit in there.” [relative]
“Having your own key is essential. I now have the key to my mother’s room, we always had a key.” [relative]
“One of the residents said: ‘Finally, I have my old belongings back again.’ It was actually stuff from a second hand shop.” [staff]“And this hospital corridor? It absolutely does not allude to home. I think this corridor represents what people do not want. It symbolizes a sense of institution.” [staff]
“Some group rooms are too small to accommodate the residents. And many relatives take their loved-ones to their private rooms.” [staff]“I don’t understand that you put all these obstacles in the corridor. Lately, the corridor has been empty, and I thought that was a positive thing.” [staff]
Eating and drinking
“My husband hates mashed potatoes. He likes boiled or baked potatoes, but no mash. He simply can’t swallow it. And still he gets the mash.” [relative]
“If you live at home and you like this raisin bread, you just eat the whole loaf. Mum asked how much she was permitted to have. Staff told her that all she could have was one slice.” [relative]
“Sitting around a table together. And having conversations together. It is something you do at home. The larger the seating arrangement, the less people talk” [staff]
“What I find important at home, is a refrigerator full of food and drinks that I like.” [staff]“Just being able to pick fruit from a table. It is there for people to take. And they do! And you shouldn’t feel bothered if you find an apple that is missing a bite…” [staff]
Autonomy and control
“Things are always done for you before you can decide yourself. When you are at home, you make decisions yourself. Now, when something needs to be done, you need to talk it through and then there is a meeting”. [resident]
“No, there is no such thing as self-direction here. After 5 o’clock things shut down in this building. The door is simply being locked. You don’t lock your own living room at 5, do you?” [relative]“Even though my mother wants a specific type of incontinence material, she gets another type she does not want. As the other type would be too expensive, and is available for nighttime only. This is not beneficial to feeling home.” [relative]
“There is difference in existing and new clients. In our ward, the recent arrivals want to go to bed late.” [staff]“Yes, we all say that people are free to do this and that. These are nice phrases and intentions, but it cannot be realized in practice” [staff]
Involvement of relatives
“This place needs to be as attractive as possible for the children”. [resident]“If I want see my daughter, all the way in New Zealand, then I can use a computer. I can use Skype”. [resident]
“In the early days when we played cards with my uncle, we brought our own coffee. The staff asked us what we were doing. We answered by saying that we were not allowed to take coffee ourselves. And then the staff responded by saying that that was about to change right away! Ever since, we were allowed to make coffee ourselves.” [relative]“Having to fight for your loved-one has nothing to do with a sense of home. It is a pile of frustration. Which keeps on piling up.” [relative]
“I wish we had a positive collaboration with the relatives (laughter)… I would like that so much.” [staff]“The moment you enter the room, and you see the family sit together with mother, and they bring something nice to eat, and the daughter is making a cup of tea. Yes I love seeing that [as a care professional].” [staff]
Engagement with others and activities
“In the living room, people often sing songs. I sang along aloud and danced a lot”. [resident]“A sense of home is being together”. [resident]
“In the morning, I spend my time cleaning.” [resident]
“When no one comes to visit, it can be the most homely place but it is no good.” [relative]
“We should bring the neighborhood indoors!” [staff]
“I often think of them as a group of people. All of them are individuals, and came here with a totally different background, and still they live in a sort of family situation. And when someone passes away, there needs to be another place for someone else.” [staff]“A sense of home. Familiar faces. All very important. Well, this is something we hear often from residents at the moment. ‘Another stranger again!’ ” [staff]
Quality of care
“Of course, I can say ‘no’ [to the care professionals], but when you need their help at a later moment, then they will turn down on you, too.” [resident]“The mood the staff is in is important.” [resident]
“As long my mother is taken care of well, I feel comfortable too.” [relative]“Staff are the most important! They take care of the atmosphere in the nursing home and that is so important.” [relative]
“It is about being able to put a smile on the face of the resident. It is the small things that matter most.” [staff]“You can have a lot of colleagues with many qualities, but if they don’t have a heart for my residents, then I don’t want them to be around me too.” [staff]
Connection with nature and outdoors
“Yes, I love being outside”. [resident]“I have a good view of the road and the round-about. So from that chair I can see everything, and I like that”. [resident]
“This is the new greenhouse of the nursing home. She always had one herself at home, as well as a vegetable garden. Until a year ago she had chickens as well. About three. And she always had fresh eggs. To her this is a homelike thing.” [relative]“I was not allowed to bring my dog. The ‘non-sense’ of home.” [relative]
Coping
“Well, it is nice here, but I will never get used. I’d rather return to home, but it increasingly getting difficult. You just know you no longer can do it.” [resident]
“She always did the [cleaning] at home, but not for some time when she came to live here. But now, she speaks of this place being her home. She no longer needs to leave. And when she came to accept her conditions, she regained some of her old tasks.” [relative]
Organization and facilitation of care
“The office of the care staff is always locked. There should not even be a door! Always shut! It is all covered up. You cannot see them sit in there.” [relative]
“Everyone who needs something from you, clings to you. And so that makes you react differently towards other people. You are becoming curt with someone, as there are a hundred thousand other things waiting for you because it is you and four other flex workers.” [staff]
To matter
“Well, this man has his private room, but he sits in the living room all day long and he says nothing and no one says anything to him because he gets completely ignored because he cannot speak.” [relative]
“The people who are with us are taken out of society. They are placed within the walls of an institution, and they, if it were, I’m sorry to say, stop existing. […] The only thing they still have are the nurses who are there for them every day. […] They should have a connection to society, and have the feeling that they still exist”. [staff]