Assessing and Improving Quality of Life Indicators and Assessments: a case study of an adult day care centre

Objectives: This paper presents the findings of a post graduate research degree study in the School of Psychology and Social Science (SPSS) at Edith Cowan University (ECU). The primary purpose of this study was to collaboratively explore the ways in which a group of aged clients and service providers perceived the concept of Quality of Life (QOL) amongst older people. Moreover, another aim of the research was to ultimately use this information to expand and reform the existing QOL indicator, currently being utilised by Community Vision (CVI) - the Referral and Assessment Form. CVI is a large aged care non-government organisation, operating in the northern suburbs of Perth, Western Australia (WA). The third facet of the study was to evaluate the global phenomenon of an ageing society and the implications it would have for maintaining the QOL of aged clients in the future. These objectives and the outcome of the research are important to the management and delivery of services to older populations and to related public policy. Design and Setting: The research was purely qualitative, comprised of an extensive literature review, a series of face-to-face, semi-structured interviews and survey interviews conducted by e-mail. The same question guides were utilised in both interview types. The sample group included a small cohort of older people, as well as members of staff and managers from CVI's adult day centre and administrative offices. Key informants from three peak WA aged service providers were also included in the study. Informal participant observation was conducted at the adult day centre prior to the actual research taking place. Results: New objective and subjective QOL indicators were identified in the literature review and interviews. Both tangible and personal measures of QOL were discussed by the participants. Based on an analysis of the primary and secondary data, it was determined that the objective indicators used in the CVI referral and assessment form were universally significant to the measurement of QOL amongst older people. Additionally, subjective dimensions of QOL were described as being equally important to the evaluation of QOL. However, such individualised measures appeared to be lacking in the CVI QOL indicator. The research further suggested that the QOL of older people may be negatively impacted upon by the effects of an ageing society and that minimal government funding and poor recruitment rates in human services would severely limit the quality of aged care, and minimise the QOL of aged clients. Conclusions: Overall, QOL frameworks and assessment instruments were deemed inadequate if they failed to individualise older people and when aged care agencies were themselves non-consultative about their use. In both the primary and secondary data, subjective and objective QOL indicators were found to be intrinsically linked to each other. Despite this, it appeared that many existing assessment tools remain focused on quantifying the QOL of aged clients and it is recommended that future assessments need to focus on qualitative or individualistic instruments as well. Ultimately, the wellness approach and the technique known as 'reminiscence' were presented as avenues that would promote the individuation of care and foster egalitarian relationships between aged clients and their service providers. The Honours thesis identified new and more appropriate ways to analyse and refer the aged (referred by aged care service agencies), using individualised QOL frameworks. New ideas relating to QOL measurement, service provision and an ageing population were highlighted as pertinent areas for future research and policy discussion in Australia.