Table 2 Categories and units of meaning extracted from the researchers’ records on the ‘institutional context’ theme

Social role played by LTCFs

The institutions play a fundamental role in the reintegration of older people who, in many cases, experienced a situation of negligence and loneliness. (R1)

Ambience of LTCFs

Each institution has a schedule and routine, with fun activities, such as singing circles, bingo, reading sessions, and stimulating activities, such as physiotherapy and activities that simulate school classes. (R3)

The caregivers perform dances, music and provide beauty care for the residents. (R5)

The LTCF has a large space in which the residents can walk around freely. Others are very small, with no adequate open space that fits all the residents. Some have a leisure area with comfortable armchairs for each resident, a TV area, large rooms with two beds; others had rooms with five beds and no adequate leisure area. (R6)

Clinical-functional profile of older people living in LTCFs

The rapid decline in the health status of some residents was also an obstacle in some homes; we arrived on one occasion for data collection and when we returned, we were unable to continue the process with some of them because they had been hospitalized, had died or were bedridden. (R3)”

Trying to collect data on more than one occasion; on some days, the resident refused or did not demonstrate any interest in answering. It is important to respect this. However, the same person is willing to participate on another occasion. (R4)

(…) some residents died during the period of the study. (R5)

Many do not know where they are, what year it is, what day it is. They live in their own world. (R3)

The issue of dementia combined with the senility process and the fact that the majority of institutionalized older people have grade 2 and 3 dependence and are cognitively compromised, which was evident during the administration of the Mini Mental State Examination and in situations of moods swings and traces of violence that we witnessed. (R1)

It was not possible to perform the clinical examination, since cognitive capacity was very affected. Some refused to cooperate, did not understand the purpose of the tests, became weary during the steps, deviated the purpose of the visit to talk or were even violent. (R6)

Oral health of older people living in LTCFs

We found most residents with needs for complete dentures, with ill-fitting, loose, worn, old dentures without chewing function and dirty. Those with teeth had calculus, active caries and root remnants marked by inflamed periodontal tissues. There were also residents with hyperplastic lesions and fungal infections in the perioral region, angle of the mouth and even in the submandibular region. (R4)

The quantity of residents that do not have teeth and do not adapt to the prothesis, the lack of hygiene of the prosthesis and teeth, the quantity of plaque and calculus on the teeth is astonishing. (R1)

We witnessed the breakdown of one woman, who we later found out was schizophrenic. When we talked to her and performed the examination, her behavior and response were extremely calm. She was very responsive and cooperative as well as affectionate. The episode of being out of control was marked by throwing objects, pushing chairs, screaming and agitation. It was apparently for having been left out of a ‘selfie’ that took place among a group of residents. (R2)

Access to oral care by older people living in LTCFs

The caregivers do not pay proper attention to the brushing of the prostheses and teeth of the residents – whether due to a lack of time or knowledge. (R5)

Hygiene is complicated. It is done once a day at bath time. There are many residents and most depend on the assistance of the caregiver, which impedes brushing more times a day. (R6)

Many residents can perform their own oral hygiene, but the fact that the caregiver does everything, the residents begin losing their autonomy and leave oral hygiene up to the caregiver, who often is unable. (R3)