“Small” things matter: Residents' involvement in practice improvements in long-term care facilities Femke Boelsma ⁎, Vivianne E. Baur, Susan Woelders, Tineke A. Abma VU University Medical Center, EMGO + Institute for Health and Care Research, Department of Medical Humanities, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands article info abstract Article history: Received 27 March 2014 Received in revised form 8 August 2014 Accepted 8 August 2014 Available online xxxx Purpose of the study: The process of involving older clients with regard to their care arrangements has been the subject of previous studies. However, a more general overview of the issues addressed by older people living in long-term care (LTC) facilities, in order to inform practice improvements, is missing. This article explores which aspects of care that older people in LTC facilities want to improve, by means of a collective policy agenda-setting project, during which the participants voice their own experiences and concerns regarding LTC. Design and methods: Seven LTC facilities for older people in the Netherlands joined a collective agenda-setting project in which a total of 58 residents participated. Qualitative methods were used: participant observations (80 h in total) and semi-structured interviews (n = 16), which were analysed according to the principles of a qualitative content analysis. Findings: There were many similarities between the seven organisations with regard to the proposed practice improvements. Nine topics were found to be important in improving the lives of older residents: a sense of community, feeling at home, social contacts between residents, independence, maintaining own hobbies and lifestyle, interpersonal conduct between residents and caregivers, being informed, security within the LTC facility, and food. Implications: Narratives about the daily lives and experiences of residents provided a rich understanding of what living in a LTC facility means, as well as the changes the residents wish to see. We found that according to the residents, the relatively ‘small things’ in life may have a big influence on improving the quality of life within LTC facilities. © 2014 Elsevier Inc. All rights reserved. Keywords: Agenda-setting Practice improvements Resident involvement Long term care facilities Qualitative research Introduction The involvement of clients has become a key principle in improving and designing healthcare services (Bate & Robert, 2006; Crawford et al., 2002). In order to attune care to the client's needs, it is essential to understand the perspectives and life-worlds of clients. While some client groups are very capable of voicing their own concerns, this can be more problematic for older people living in long term care (LTC) and assisted living settings. Physical and cognitive decline complicates their active involvement. Also, residents are in a vulnerable position and their dependence on others creates unequal power relations between themselves and the professionals. Furthermore, resi- dents can feel that they lack personal control due to an institutionalised environment (Baltes & Wahl, 1992; Kane & Wilson, 2001; McDermott, 1989). In several countries, older people living in LTC facilities can influence decision-making processes through resident councils. In the Netherlands, for instance, the involvement of clients has been regulated by legislation since 1996 (Wet Medezeggenschap Cliënten Zorgsector) (Van der Voet, 2005). Resident councils work on the basis of representation, and council members are chosen as representatives for the total population of residents. They are expected to speak on behalf of other residents and Journal of Aging Studies 31 (2014) 45–53 ⁎ Corresponding author. Tel.: +31 20 44 48217; fax: +31 20 44 48394. E-mail addresses: femke.boelsma@vumc.nl (F. Boelsma), v.baur@vumc.nl (V.E. Baur), s.woelders@vumc.nl (S. Woelders), t.abma@vumc.nl (T.A. Abma). http://dx.doi.org/10.1016/j.jaging.2014.08.003 0890-4065/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Aging Studies journal homepage: www.elsevier.com/locate/jaging