Dignity in care
Dignity factors - Social inclusion
Supporting people to keep in contact with family and friends, and to participate in social activities.
Her son had told us that music had been a very important part of her life. So we would sing a hymn to her, and she started again picking up those tunes again. It's given her back some of her dignity
Social inclusion in practice
- Promote and support access to social networks.
- Resolve transport issues so that they do not prevent people from participating in the wider community.
- Build links with community projects, community centres and schools to increase levels of social contact between people from different generations.
- Identify, respect and use people’s skills, including the skills of older people gained in previous employment.
- Give people ordinary opportunities to participate in the wider community through person-centred care planning.
- Involve people in service planning and ensure ideas and suggestions are acted upon.
Ideas you could use
- Use older people’s skills and experience
- Use the telephone to tackle social isolation
- Start a project that connects people with the wider community
- Encourage contact between older and younger generations
- Create opportunities for people to make new friends
- Train staff to provide extra therapeutic skills
- Invite people who use services to contribute ideas
- Try drama techniques to benefit older people with dementia
- Involve people in the improvement of services
- Run a workshop to involve the local community
- Give people who use services the chance to work
- Involve people who use services in staff training
Social inclusion and dignity - key points from policy and research
- Good relationships with family and friends, having a role, feeling useful, and being treated with respect are all important to older people (Office of the Deputy Prime Minister, 2006).
- Older people who live alone are particularly vulnerable to social isolation and loneliness (DH, 2006f).
- Social exclusion can increase the chances of mental illness, particularly depression (DH, 2006f).
- In a long-term study of home care, help to get out of the house was the most common unmet need (Patmore, 2005).
- Overall, the elderly are more likely to be socially excluded (Barnes, 2006).
Social inclusion and dignity - policy and research in more detailOpen
Older people have repeatedly identified social inclusion as important to their quality of life and independence. Opportunities to participate, and make a positive contribution to community and society, are integral to autonomy and therefore dignity. In the Department of Health (DH) online survey (DH, 2006d) older people raised a number of issues and concerns including lack of social contact with others, lack of activities and wanting to feel needed and to have a purpose.
In research that formed the basis of ''A sure start to later life' not working(SEU / ODPM, 2006) older people 'stressed the importance, amongst other things, of good relationships with family and friends, of having a role, feeling useful, and being treated with respect’.
The Social Exclusion Unit (Social Exclusion Unit and Office of the Deputy Prime Minister, 2006) defined social exclusion in terms of its causes such as 'unemployment, discrimination, poor skills, low incomes, poor housing, high crime, ill health and family breakdown’. The English Longitudinal Study of Ageing measured social exclusion across the following dimensions:
- social relationships (contact with family and friends)
- cultural activities (such as going to the cinema or theatre)
- civic activities (such as being a member of a local interest group, undertaking volunteering or voting)
- access to basic services (such as health services and shops)
- neighbourhood exclusion (feeling safe in your local area)
- financial products (such as a bank account, or long-term savings)
- material consumption (such as being able to afford household utilities and an annual holiday).
The Cabinet Office acknowledges that there is no clear definition of social exclusion but offers the following: Social exclusion is a complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole. Levitas et al. (2006)
Age discrimination, sometimes alongside other forms of discrimination, can contribute to the social isolation of older people. The risk of social exclusion is greater for people living alone (DH, 2006f) and the very elderly (Barnes, 2006). Some life events, such as bereavement, loss of work or poor health can also increase the risk (Office of the Deputy Prime Minister, 2006).
The research also associates ageism and other forms of discrimination with the lack of respect for older people and, clearly, there are implications here for wider society. Intergenerational community work has been suggested as one way of tackling ageism.
Employment promotes social inclusion and older people particularly, because of retirement, age or ill-health may be forced to stop working. Restrictions to existing age discrimination laws allow employers to compel people aged 65 or over to retire. The European Court of Justice ruled, in 2009, that this is lawful. The Government have committed to review the default retirement age this year and there is continued pressure from the Equality and Human Rights Commission for the government to abolish the through the Eguality Bill.(Equality and Human Rights Commission 2009)The resource allocation for older people in social care also reflects age discrimination and can restrict the provision of activities that promote social inclusion. For example, the cost of residential placements is generally much lower for older people for disabled adults of working age and this impacts on the ability of the service to support people to participate in community activities.
My Home Life: Quality of life in care homes (Owen, 2006) argues that: 'feelings of helplessness and powerlessness associated with chronic disability affect motivation levels and are compounded if there is a lack of structure and meaning to the day. These feelings can be alleviated by a motivating and challenging environment with opportunities to socialise and become involved in meaningful activity.’ Contact with local community centres, schools and volunteer organisations can support this, as can person-centred activity planning.
The promotion of social inclusion features prominently in current policy across government departments. The White Paper, 'Our health, our care, our say' (DH, 2006f) acknowledges that social exclusion, isolation and loneliness can contribute to the incidence of mental illness, particularly depression. The report emphasises the need for a universal approach to inclusion from services such as transport, health and housing.The government is clear that the involvement of members of the community with public bodies is vital to the implementation of its policies. 'Firm foundations' (Home Office, 2004) a report on capacity building, sets out a framework for development. The report defines community capacity building as: activities, resources and support that strengthen the skills, abilities and confidence of people and community groups to take effective action and leading roles in the development of their communities.
The Joseph Rowntree Inquiry (JRF, 2005) identifies: ’a need to engage locally with volunteers and like-minded organisations to tap the potential of local communities and community-development approaches’.The involvement of older people at all levels of service planning and delivery is an important part of getting it right. In addition, the participation of older people will provide meaningful activity, community participation and a civic role for the individuals involved. The inclusion of people from diverse communities will also bring a range of knowledge and expertise to service planning and delivery. Local authorities need to ensure that support is available to local communities to enable individuals and groups to develop the skills and confidence to facilitate active participation.