Sleep in Residential Aged Care: A Secondary Qualitative Analysis of Data from the Australian Royal Commission into Aged Care Quality and Safety

Background: Sleep is a crucial healing and restorative component of older person care but is often negatively impacted through the effects of institutionalization in residential aged care (RAC). Currently, information about how sleep occurs is limited. Methods: Through the lens of person-centered care, this study examined submissions to the Australian Royal Commission into Aged Care Quality and Safety. The Commission was established in 2018 with the aim of protecting and improving the safety, quality of life, and well-being of people receiving aged care. The commission received 10 000+ submissions from a range of stakeholders, including consumers, family members, expert witnesses, healthcare professionals, and industry. Using a big qualitative data approach with 33 sleep-related keywords, submissions were analyzed using thematic analysis to understand how institutional practices impact individual sleep experiences. Results: Three themes were identified highlighting tensions between institutional requirements and person-centered care: (1) Care practices of RAC staff may impact residents’ sleep, (2) Tensions between provision of overnight care and preservation of sleep, and (3) The dignity of choice of residents including autonomy of sleep timing and their sleep environment. Conclusion: Opportunities to improve the quality of sleep experience and associated outcomes in Australian RAC exist. Improved staffing, planning for person-centered timing of care, and addressing the competing tensions of safety surveillance activities and person-centered care implementation in a home environment are needed.