Resident Challenges with Functional Limitations and Pain in Chinese Residential Care Facilities

Problem: The demand for residential care facilities is high and still increasing in China. However, the quality of care in these facilities is concerning due to lack of quality control and regulations and insufficient funding. To achieve high-quality care in these facilities, knowledge is needed about residents’ care needs and current efforts to address residents’ care needs in these facilities. Studies from other countries have reported the high prevalence of functional limitations and pain among residents in residential care facilities. This suggested that residents’ care needs relating to functional limitations and pain are potentially substantial in residential care facilities. Therefore, this dissertation aimed to: (1) synthesize existing literature on residents’ care needs and current care, and (2) describe residents’ care needs related to functional limitations and pain.

Methods: Chapter 2 describes a systematic literature review that synthesized evidence on resident characteristics and care needs and staff characteristics and care, and defines areas where research is needed. Chapter 3 describes a qualitative exploratory study that described residents’ challenges with daily life in Chinese residential care facilities. Chapter 4 describes a mixed-method, observational study that explored residents’ descriptions of challenges with pain and functional limitations.

Results: The systematic review revealed that frontline workers received little systematic training for resident care. Chinese residential care facilities had few qualification standards for staff preparation for their roles in these facilities. Also, chronic conditions were prevalent among residents in Chinese residential care facilities. The two observational studies provided three major findings: (1) residents reported significant care needs with functional limitations and pain; (2) residents adopted a substantial number of self-management strategies to address these care needs; (3) residents faced significant barriers when adopting these self-management strategies, including inaccessibility of health care, unsupportive facility policies and administrators, and lacking staff care.

Summary: Knowledge from this dissertation enhances understanding of residents’ care needs with physical limitations and pain in Chinese residential care facilities. This knowledge informs changes to achieve high-quality care in these facilities. This dissertation provides important implications for practice and policy, including: (1) building a resident assessment system with valid tools to comprehensively capture residents’ care needs with functional limitations and pain; (2) incorporating into staff training programs knowledge and skills about how to manage functional limitations and pain;( 3) developing facility policies to support residents’ self-management and frontline workers’ strategies; (4) integrating health care into residential care facilities; (5) modifying physical environment to be resident-centered.