Participation of Older People Living in Residential Long-term Care (RLTC) - An Ethnographic Exploration and Analysis

Participation of Older People Living in Residential Long-term Care (RLTC) - An Ethnographic Exploration and Analysis

Background Authorities and civil society in Switzerland are called upon to develop new strategies that

promote “healthy ageing” based on the recognition of the human rights of older people and the United

Nations principles of independence, participation, human dignity, care and self-autonomy (Bundesamt für

Gesundheit, 2019; United Nations, 1991). The canton Basel-Stadt declares in its vision “ageing well and

together” [gut und gemeinsam älter werden] the need for social participation (Kanton Basel-Stadt, 2023).

With increasing age, older people can be confronted with chronic health problems that call for long-term

care (LTC), making them dependent on the support of others. This can undermine their autonomy

(Fjordside & Morville, 2016). In Switzerland, LTC includes professional home care, assisted living insti-

tutions and residential long-term care (RLTC). RLTC institutions are used particularly in the last years of

life when physical or cognitive decline requires more support (Bundesamt für Statistik, 2023). The per-

ception of RLTC institutions as places of powerlessness has increased since the measures taken to protect

older people in RLTC during the SARS CoV-2 pandemic (Peduzzi & Staudacher, 2020; Tauzer, 2023;

Vollenwyder, 2020). Although civil and governmental organizations are calling for more participation,

little is known about how RLTC institutions can foster participation of older people with physical or men-

tal disabilities and socio-economically disadvantaged persons (Bundesamt für Gesundheit, 2023;

Bundesarbeitsgemeinschaft der Seniorenorganisationen, 2020; Der Bundesrat, 2024).

Objectives As part of the research project EPICENTRE- PARTICIPATIO¹, this PhD thesis aims to 1) De-

scribe how and by whom participation of older people in RLTC is being understood, discussed and practiced

by residents, relatives and staff. 2) Define potential inequalities related to participation of older people in

RLTCs that are unjust and unfair. 3) Develop and design ideas and approaches to promote equitable partic-

ipation of older people living in RLTC.

Methods This study covers the first two steps (exploration and preparation) of the Exploration, Preparation,

Implementation, Sustainment (EPIS) implementation framework as a basis for developing measures to fos-

ter participation (Aarons et al., 2011). Applying an ethnographic approach to grasp the everyday discourse

and practice in RLTC will allow among others the inclusion of residents with cognitive impairments in their

natural setting. Data will be analyzed in an iterative process presenting cases in thick description. As part

of aim 1 and 2, the project team will conduct a narrative review on participation of older people in RLTC.

In addition, semi-structured interviews, informal conversations with residents, relatives, staff and leadership

as well as observation, participation and document analysis of three RLTC institutions in Basel-Stadt and

Basel-Landschaft will be conducted, in particular to uncover inequities and understand their mechanisms

(Black et al., 2021; Blommaert & Jie, 2020; Skinner, 2014). For aim 3, at least eight workshops with a

transdisciplinary advisory group will be held based on the results of aim 1 and 2, ensuring the incorporation

of various perspectives and the dissemination of the results of the study beyond an academic audience.

Significance/Expected results and dissemination This ethnographic dissertation will allow an in-depth

understanding of participation and its interrelationship between the different actors in RLTC and promote

equitable participation of older persons in RLTC as part of a societal duty.

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