• Rory Coughlan and Linda Ward.
• Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, Ont., Canada K9J 7B8. rorycoughlan@trentu.ca
• Int J Nurs Stud. 2007 Jan 1;44(1):47-57.

BackgroundCanadians overwhelmingly support universal coverage for health services and seniors' entitlement to high standards of care in long-term care facilities (LTCFs). Government rhetoric reflects these values, but claims of fiscal prudence often means translation into policy and improved care is uneven. Ontario is moving towards standardized "quality of care" measures, but such measures often ignore residents' views and socio-psychological issues.Objectives And SettingAssessment of residents' experiences in a new "state of the art" LTCF and their understanding of "quality of care" shortly after relocation from two older hospital style facilities.Design And MethodsUnobtrusive observations of activities of residents and staff in the LTCF by several researchers generated an analysis of field notes. In addition, one-on-one, in-depth, semi-structured interviews with residents generated qualitative interview data, analyzed utilizing a grounded theory approach.ParticipantsAll residents deemed either moderately cognitively impaired or not impaired were invited to participate. Of these two groups, 18 seniors (five male and 13 female) with a mean age of 84.35yr agreed to be interviewed. Participants were all Caucasian and from a wide variety of social-economic levels.ResultsTwo meta-themes "Relationships are the foundation of quality care" and "Waiting, activity & grieving loss of personhood" best explained residents' experiences of the LTCF. The two meta-themes were inter-connected and reflected the centrality of socio-psychological "quality of life" issues, especially resident-staff relationships as prominent aspects of seniors' understanding of quality of care. Improvements in facilities and programs were undermined by inattention to staff-patient ratios and continuity in staffing.ConclusionsSeniors said little regarding the fabulous new facility, but discussed quality of care as a socio-psychological concept intimately connected to staff relations. Government and administrative inattention to issues of sufficient funding for staff, relationship needs and continuity of care for seniors threatened to undermine residents' experiences of meaning, as well as any potential benefits from facilities and program improvements.

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