"Small" things matter: Residents' involvement in practice improvements in long-term care facilities

Purpose of the study: The process of involving older clients with regard to their care arrangements has been the subject of previous studies. However, a more general overview of the issues addressed by older people living in long-term care (LTC) facilities, in order to inform practice improvements, is missing. This article explores which aspects of care that older people in LTC facilities want to improve, by means of a collective policy agenda-setting project, during which the participants voice their own experiences and concerns regarding LTC. Design and methods: Seven LTC facilities for older people in the Netherlands joined a collective agenda-setting project in which a total of 58 residents participated. Qualitative methods were used: participant observations (80 h in total) and semi-structured interviews (n = 16), which were analysed according to the principles of a qualitative content analysis. Findings: There were many similarities between the seven organisations with regard to the proposed practice improvements. Nine topics were found to be important in improving the lives of older residents: a sense of community, feeling at home, social contacts between residents, independence, maintaining own hobbies and lifestyle, interpersonal conduct between residents and caregivers, being informed, security within the LTC facility, and food. Implications: Narratives about the daily lives and experiences of residents provided a rich understanding of what living in a LTC facility means, as well as the changes the residents wish to see. We found that according to the residents, the relatively 'small things' in life may have a big influence on improving the quality of life within LTC facilities. (C) 2014 Elsevier Inc. All rights reserved.