DOI: 10.1111/ajag.
12325
Research
Older peoples’ experiences of living in a residential aged care
facility in Australia
Helen Walker
Deakin University, Melbourne, Victoria, Australia
Penelope Paliadelis
Federation University Australia, Ballarat, Victoria; and University of
New England, Armidale, New South Wales, Australia
Aim: The objectives of the study were to investigate the
lived experience of older people in residential aged care
facilities (RACFs) in Australia, to explore their perceptions
of their lives in RACFs and how care might be improved.
Methods: This qualitative study used a phenomenological
approach to explore the lived experience of older persons in
RACFs across two Australian states. In-depth interviews
regarding independence, dignity, autonomy, communication
and relationships were conducted with 18 participants. The
interviews were audiotaped, transcribed and thematically
analysed.
Results: Three themes emerged reflecting the reality of
RACF life for these participants: (i) loss of autonomy,
dignity and control; (ii) valuing important relationships;
and (iii) resigned acceptance.
Conclusion: Older people were not included in decision-
making and found it difficult to maintain their autonomy
and dignity, and forge meaningful relationships. They
traded their independence and dignity for the safety and
assistance they needed; however, they accepted this trade-
off with stoicism and remained positive.
Key words: aged care, older people, phenomenology,
quality of life, residential facilities.
Introduction
The purpose of this study was to investigate the experi-
ences of older people who live in residential aged care
facilities (RACFs) and to interpret the meaning of those
experiences. While a major goal of government policy is to
allow older people to remain in their homes for as long as
possible, with community support, physiological decline
renders some older people in the position of needing resi-
dential care. RACFs are viewed as promoting a person-
alised experience of being at ‘home’; however, the reality is
that older people often experience a loss of autonomy and
connectedness, and an increase in dependence [1,2]. Chal-
lenges for older people include maintaining a sense of well-
Correspondence to: Dr Helen Walker, Deakin University, Centre
for Research in Assessment and Digital Learning (CRADLE).
Email: h.walker@deakin.edu.au
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being and identity; having an acceptable quality of life
(QoL); preserving autonomy, dignity and self-esteem; and
retaining meaningful relationships, all of which are more
difficult given the constraints of living in an institutional
environment governed by policy and regulations [3].
Reforms of aged care systems aim to adopt a more humanistic,
person-centred model of care, in place of the traditional
archetypical medical model [4,5]. Government decisions tradi-
tionally have been subject to the influence of political and eco-
nomic structures that perceive older people as being highly
dependent and financially burdensome [6]. This suggests a lack
of understanding of successful ageing that would promote per-
sonal ageing identity [7–9] and the need to improve care
through more proactive policy recommendations [10] to
address problems within aged care service provision [11].
Reports suggest that the regulatory framework remains com-
plex and fragmented [12], and health and personal care is less
than optimal [11]. It is important to understand that an ageing
population, characterised by increased prevalence of comor-
bidities, chronic illness, dementia and disabilities [13] and an
increase in life expectancy itself, is not problematic; rather, it
is the demand on health and social systems which needs to be
addressed through policy reforms.
A sentinel research project based on data gathered via a
national survey of QoL of older people in the UK [14]
identified the main elements of QoL as having good social
relationships, a positive psychological outlook, a pleasur-
able home life, health and mobility, and individual inde-
pendence [14,15]. Resident satisfaction surveys of over
4,000 residents in Australian RACFs identified four key
themes integral to QoL: physical environment, social envi-
ronment, governance and support for active living [16].
Bowers et al. [17] explored issues of voice and choice of
older people in long-term care in the UK and found that
older people’s voices were ‘practically silent’, when com-
pared to those who spoke on their behalf, such as family
members and health professionals. In their vision of a
‘good life’, residents valued personal identity, meaningful
relationships, control, personal surroundings, meaningful
life and personalised care as important [17].
Challenges facing older people in maintaining well-being in
RACFs include the loss of contact with family and friends,
complex health issues, loss of control [18], increased loneli-
ness, and loss of identity and purpose in life [19]. For
example, interactions between staff and residents which are
primarily based on providing instrumental care, can result
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in a culture of ‘doing for’ rather than ‘being with’ and cre-
ate the antithesis of a ‘home-like environment’ and perpet-
uate dependence and loss of autonomy [20]. The literature
suggests older people may have neither participated nor
been engaged in the decision to move into an RACF, effec-
tively removing their control over the transition [20,21].
This has implications for preserving resident choice, auton-
omy, control and efficacy, as well as treating older people
politely and with respect [22, 23].
There has been limited contemporary Australian research
into the lived experiences of older people in high-care
RACFs in Australia since Fiveash’s [24] study in 1998, and
it remains an under-researched area. Fiveash [24] identified
issues such as abandonment and loss of home, and loss of
autonomy and privacy, as key concerns facing older people
who need residential care. Therefore, this study seeks to
add to what is known about living in an RACF, and such
associated issues, from the perspectives of those who are
currently residents in such facilities.
Methods
Study design
This study used qualitative methods to explore the lived
experience of older people in high-care RACFs and aimed
to understand the meaning of that experience. A phe-
nomenological approach was used to investigate the con-
struct of experience. An interpretive paradigm was used,
incorporating relativist ontology and a subjectivist episte-
mology, whereby the researcher and respondent co-create
understandings [25]. The framework used to guide this
study, developed by van Manen [26,27], reflects the philo-
sophical assumptions of phenomenology. The phenomeno-
logical approach was used as it explores experiences from
the participants’ perspective, taking into account the con-
text and subjective milieu that the participating older peo-
ple bring to making meaning of their situation. It aims to
uncover meaning from the life world and the essence of
human experience to understand its meaning and nature,
rather than merely seeking positivist, empirical explana-
tion. It is through retrieving lived experience that inves-
tigators may achieve understanding of meanings and
perceptions of another person’s world [26,27].
van Manen’s approach to phenomenological investigation,
used here, included turning to a phenomenon, investigating
experience, reflecting on essential themes, describing phe-
nomena through writing, staying related to the phe-
nomenon and returning to the parts and the whole of the
research context [26,27].
Ethical approval to conduct this study was granted by a
University Human Research Ethics Committee and by the
management of each RACF where data were collected.
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p e o p l e s ’ n u r s i n g h o m e e x p e r i e n c e s
Setting and recruitment of participants
The study was conducted in 2012–2013 in five government
funded, high-care RACFs in Victoria (with a total of 149
high care beds) and Queensland (with a total of 181 high
care beds). Given the participatory limitations of some
high-care residents in meeting inclusion criteria and the
need to recruit enough participants to reach data satura-
tion, it was necessary to involve five facilities.
A purposive sampling method [28] was used to invite those
residents to participate who met the following selected cri-
teria; people who were aged 65 plus years, had lived at the
facility for 3 months or more and who were able to answer
questions. This sampling technique focussed on the judge-
ment of the facility staff in collaboration with the research-
ers to determine eligibility when selecting participants by
focussing on specific characteristics of older people relevant
to the aims of the study. People with moderate to advanced
dementia, who the staff advised were not able to engage in
an interview, were excluded from the study. All partici-
pants gave written, informed consent to participate in the
study.
Data collection
Data were collected by the researcher via semi-structured
individual interviews with 18 older people. Eight partici-
pants were males aged between 77 and 89, three of whom
were widowed, one had a partner, one was single, and two
were currently married. Ten participants were female, aged
between 79 and 96, seven were widowed, and three were
still married. All participants had lived in the respective
facilities between 4 months and four and a half years. All
participants were physically frail while being cognitively
able to participate in interviews.
Interviews were guided by the participants’ own thoughts
and reflections on their experiences which emerged within
a dialectical relationship [29]. The audiotaped interviews
were transcribed.
Data analysis
Transcripts were analysed thematically to discover the
essence of the phenomenon using strategies suggested by
van Manen [26]. Firstly, a holistic approach was used to
find the overall meaning of the text; secondly, phrases that
stood out were marked; and last, a detailed line-by-line
interpretation was conducted to identify the key themes
that emerged [26,27].
Results
The three major themes which emerged from the analysis
are presented here: (i) loss of autonomy, dignity and control;
(ii) valuing important relationships; and (iii) resigned accep-
tance. This suggests that resident experiences still reflect the
same key concerns as identified by previous research.
E7

The first theme focuses on the participants’ perceptions of
losing control over making life choices, with many of them
reflecting on the transition to an RACF. For example, John
commented: They (family) said I had to go straight to the
nursing home, and they arranged it. I wasn’t too keen to
come here, to be honest. I had no choice. Other partici-
pants described what they missed about home, for example
Odie said: Well, I’d like to (have) freedom to get around,
and get around the back yard and little things like that but
can’t bear it when you’re locked, you’re locked in, you’re
just in all day in the room. Leo’s comment reflects the
experiences of many of the participants of losing indepen-
dence: . . .the shock in so far as losing your independence
and, it takes a heck of a time to get adjusted to it.
All the participants had concerns about loss of dignity
and privacy in terms of the challenges of living with
others, some of whom encroached on their personal
spaces. Hyacinth described an incident that upset her: I
had a man come in here once, he came in here in the
‘nuddy’ one night. He got into bed with me, and I, I rung
the bell and I tried to get him out. Nellie also was upset
by the actions of others: They come in and take
things. . .and they were annoying me and getting to the
stage where I, I thought, oh God, I couldn’t stand it and
I shut the door.
The second key theme that emerged from the data was about
the importance of meaningful relationships and close bonds
with significant others and staff. Continuity of staff was an
issue as participants preferred to be cared for by permanent
staff. Nellie commented: But at the moment we’ve got
agency ones, but they’re not so hot. Development of mean-
ingful relationships with the RACF staff was important.
Derek expressed what a majority felt: They are friends of
ours and they treat us like that, they’re company and they
don’t just take the sheets off and clean up and take off again,
they stop and stay here for 10 or 15 minutes.
Maintaining their relationships with their friends and fami-
lies was also very important. Beryl said You want your
friends and family not too far away. Participants who did
not have family visits experienced loneliness and a loss of
identity. Leo commented: you get smaller, smaller and
smaller and in the end you couldn’t care less about
whether you’re alive or dead.
The third theme focuses on the participants’ acceptance of
their invidious situations. This was about acknowledging
their own mortality, accepting that they would never return
home and their time in the facility was finite. Gerry
commented: Oh, well, what can you do? You can’t do
anything. You sit in your room on your own. . . I knew I
had to get used to it because I knew I’d be here till they
cart me out. Likewise Leo said: It’s a part of it now. . .But,
no, you know beforehand when you get here, that it’s the
last stop.
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W a l k e r H , P a l i a d e l i s P
While the participants accepted death as part of aged care
facility life, they were more concerned about the deteriorat-
ing conditions affecting the dying. Maude commented:
They put a dog down when he gets too old or too ill, but
these people are left here. Isabelle also expressed distressing
emotions: It is upsetting to see people decline. I don’t
allow myself to get close.
The participants tried hard to make the best of their situa-
tion, Fred explained: So I haven’t got that much longer to
live so. . .so I’ll be alright. Yes, that’s what I mean, so I don’t
worry about that. It’s as good as I’ll get. Isabelle’s comment
reflects the essence of this theme of resigned acceptance and
having a positive attitude, ruefully saying: But that’s life,
‘cos I’m quite happy here. Really. I’ll be carried out.
Discussion
The findings indicate that the respondents felt they had lit-
tle option but to enter the facility. They experienced a loss
of home life, which reduced their autonomy, independence
and sense of identity. As discussed in the literature, adjust-
ment to aged care facility life is closely linked to the older
person’s ability to take part in the decision-making process
and a more successful transition is achieved if the older
person has a sense of control over the move to an RACF
[21]. The lack of a partnership approach in decision-mak-
ing in transition and associated care planning led to feel-
ings of apprehension and loss of control.
Bowers et al. [17] found that personal identity, control and
personal surroundings contribute to a ‘good life’. Accord-
ing to Edwards et al. [22], older people placed significance
on familiar things and when they have to give them up,
they experienced feelings of loss and a reduced sense of
autonomy and identity. Organisational provision of person-
alised activities, in partnership with residents, to promote
autonomy and independence could constitute core strate-
gies of care planning.
It was also clear from the findings that the impact of living
in the facility elicited strong emotions for these partici-
pants, even though they had resigned themselves to the
constraints of living in a RACF. Being at ‘home’, having
enduring relationships and doing familiar things were
important to the participants, and they suggested that it
would ‘make a hell of a difference’ to go back home for a
short period of time or go on outings as examples. Practi-
cal ways to address their loss of autonomy and ameliorate
their sense of grief would be to operationalise care plans
(activities and outings) specifically orientated towards each
resident’s specific preferences.
Australia’s aged care system is dominated by regulations
that contribute to a reduced sense of identity and this has
had a significant impact on the participant’s experience of
RACF life. The importance of autonomy and preserving
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 O l d e r
choice for improving QoL and well-being is clear
[3,22,23]. As part of government policy, the majority of
care provided in Australia to older people is with commu-
nity care support, in order to enable older persons to
remain at home for as long as possible. It was clear that
participants in this study wanted to remain at home, but
acknowledged their decline in health and their need for res-
idential care, but it remains very concerning that they
seemed to accept that this came with reduced privacy and
dignity. The findings of this study support earlier studies
which suggest that lack of choice and control and mainte-
nance of dignity and privacy affects the QoL of those living
in an RACF [22–24].
The literature indicates that QoL is strongly influenced by
relationships with others [19,22] and that meaningful rela-
tionships are a vital element for a ‘good life’ [17,18]. Par-
ticipants in this study felt that a lack of consistent carers
was problematic as it affected their ability to form mean-
ingful relationships with staff. Continuity of staffing
appears as a significant barrier to sustaining relationships
and strategies to promote sustainability of staffing, such
provision of careers paths, would benefit both carers and
residents.
The literature suggests that there is an overemphasis on
aged care facility staff providing clinical services and com-
pleting documentation rather than nurturing social interac-
tions with and between older persons [11,13,20]. In this
study, the participants felt that staff provided adequate
clinical care, but did not always have sufficient time to
engage in meaningful social interactions and could not
actively engage in building friendships. Furthermore, they
suggested that talking to staff who knew you assisted in
adapting to RACF life. Therefore, RACFs need to ensure,
as much as possible, continuity of carers, so that staff can
forge trusting relationships. As discussed in the literature,
older people appreciated friendship and empathy from staff
and value close relationships and intimacy as an expression
of positive care [17].
In this study, participants’ non-negotiable resigned accep-
tance of reduced privacy and lack of dignity illustrates their
experiences of accepting their mortality; witnessing death
and dying; and coping with distressing emotions and beha-
viours, all while still maintaining a positive attitude. Their
acceptance also stems from their understanding of the final-
ity of place.
There were some elements of RACF life that the participants
felt made a positive difference to them, and it appeared that
optimism prevailed in the face of their own frailty and
mortality. This concurs with the findings of Kane et al. [23]
that QoL is always affected by ones’ living environment. The
literature suggests that for successful transition and
adaption to RACF life, older people must participate in
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© 2016 AJA Inc.
p e o p l e s ’ n u r s i n g h o m e e x p e r i e n c e s
decision-making [18,20,21]. Organisational strategies pro-
moting partnerships in participatory decision-making in the
transition and associated care planning would assist in ame-
liorating such concerns.
The limitations of this study revolve around the decision
not to include people suffering dementia or those from
diverse cultural backgrounds, due to the unfunded and
time-limited nature of this study. Further research could
add to these findings by exploring the experiences of these
older people. The results of this study are not intended to
be generalisable to others ‘experiences of RACFs, rather
the findings highlight the participants’ particular
experiences.
This study had added to what is known about the experi-
ences of older people who live in RACFs, particularly in
relation to their perceptions of independence, dignity, deci-
sion-making and well-being as they relate to these partici-
pants’ lives. Furthermore, the importance of meaningful
relationships and the wisdom to accept their situation with
good grace mitigated some of the negatives for these partic-
ipants. However, the fact that they were aware that they
had to trade their autonomy, independence and dignify in
order to receive the care they required is a damning indict-
ment on the current state of residential health-care services
in Australia. It is significant that the same issues have been
identified as problematic for residents in many studies,
reflecting the difficulty of RACFs in addressing those con-
cerns. This study is important given the limited amount of
research into the lived experience of aged care facility life.
The results of this study will be used to inform policy
regarding delivery of aged care services to meet expecta-
tions of older people.
Key Points
• Higher consumer expectations reflect an increase
on the demands on a highly regulated aged care
system.
• Exploring lived experiences from the residents’
perspectives add to this under-researched area
and reflect the meaning that they bring to resi-
dential aged care life.
• The reality for residents is that they sometimes
had to endure suboptimal care, a loss of endur-
ing relationships and a lack of control over deci-
sion-making which affected their perception of
care and quality of life.
• It is clear that fundamental issues of concern for
residents still exist and residential aged care facil-
ities have made little progress in addressing their
less than optimal lived experience.
E9

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