Autonomy, quality of care, life satisfaction, and depressive symptoms among long-term care residents: a comparative study of selected facilities in Poland and Slovakia

Introduction The quality of long-term care encompasses not only safety and meeting the health needs of residents, but also the opportunity to preserve autonomy, agency, and influence over daily life. The aim of the study was to evaluate the association between selected aspects of institutional care quality, autonomy, and functioning of older adults with life satisfaction and the severity of depressive symptoms, taking into account differences between residents of facilities in Poland and Slovakia. Material and methods A multicenter, cross-sectional comparative study was conducted involving 322 residents of six long-term care facilities: 127 in Poland and 195 in Slovakia. A original study questionnaire assessing selected aspects of care quality and autonomy was used alongside standardized scales: ADL, IADL, SWLS, and GDS-15. The analysis utilized the Mann–Whitney U -test, Pearson's chi-squared test, and Spearman's rank correlation. Additionally, multivariable analyses were performed using a General Linear Model (GLM/UNIANOVA), incorporating study group, sex, length of stay in the facility, and the circumstances of the admission decision. Results Among the residents of the six participating facilities, individuals residing in Slovakia rated most of the analyzed aspects of care higher, including living conditions, safety, staff availability, social contacts, and engagement activities. The greatest differences concerned autonomy, particularly the influence on daily routine organization and participation in decisions regarding their own care (both p < 0.001). In the study sample, residents of the Slovakian facilities also obtained higher life satisfaction scores (SWLS: 23.33 vs. 19.98; p < 0.001) and lower scores for depressive symptom severity (GDS-15: 5.50 vs. 7.30; p < 0.001) compared to residents of the Polish facilities. Conclusions The observed differences in the assessments of care quality, autonomy, and psychosocial wellbeing pertain to the residents of the participating facilities and cannot be generalized to the national long-term care systems in Poland and Slovakia. The results highlight the need for further research into the significance of autonomy, shared decision-making, and social relationships for the wellbeing of residents in institutional care.