Dignity in care

Stand up for dignity - The Dignity Challenge

A clear statement of what people can expect from a service that respects dignity

• 1. Have a zero tolerance of all forms of abuseOpen

  How? Ways and means

  This means:

  • Make respect for dignity important to everyone in the organisation
  • Provide care and support in a safe environment that is free from abuse.
  • Recognise that abuse can take many forms including physical, psychological, emotional, financial and sexual, and extend to neglect or ageism.

  Dignity Checklist

  • Number 1: Is valuing people as individuals central to our philosophy of care?
  • Number 2: Do our policies uphold dignity and encourage vigilance to prevent abuse?
  • Number 3: Do we have in place a whistleblowing policy that enables staff to report abuse confidentially?
  • Number 4: Have the requisite Criminal Records Bureau and Protection of Vulnerable Adults List checks been conducted on all staff?

• 2. Support people with the same respect you would want for yourself or a member of your familyOpen

  How? Ways and means

  This means:

  • Care for people in a courteous and considerate manner, ensuring time is taken to get to know people.
  • Help people receiving services to participate as partners in decision-making about the care and support they receive.
  • Encourage and support people to take responsibility for managing their care themselves (with care staff and other information and support services when needed).

  Ways to improve:

  • Treating people with respect should be fundamental to training and induction for all staff (including domestic and support staff) and followed up by supervision and zero tolerance of negative attitudes towards people.
  • Provide a service that revolves around people, not around services or tasks.
  • Ask people who use services how they would like to be addressed and respect this.
  • Use reminiscence activities to support people with dementia in maintaining their identity.
  • Care plans should include 'time to talk’ giving people a chance to voice any concerns or simply have a chat.
  • Involve older people in service planning and show respect for their views by putting their ideas and suggestions into action.
  • Support community activities and contact between different generations to tackle preconceived ideas and discrimination against older people.

  Dignity Checklist

  • Number 1: Are we polite and courteous even when under pressure?
  • Number 2: Is our culture about caring for people and supporting them rather than being about 'doing tasks’?
  • Number 3: Do our policies and practices emphasise that we should always try to see things from the perspective of the person using the service?
  • Number 4: Do we ensure people who use services are not left in pain or feeling isolated or alone?

• 3. Treat each person as an individual by offering a personalised serviceOpen

  How? Ways and means

  This means:

  • Make sure your attitude and behaviour help to preserve each person’s identity and individuality.
  • Tailor services to each individual, making them personalised not standardised.
  • Take time to get to know the person using the service and find out how formally or informally they would prefer to be addressed.

  Dignity Checklist

  • Number 1: Do our policies and practices promote care and support for the whole person?
  • Number 2: Do our policies and practices respect beliefs and values important to the person using the service?
  • Number 3: Do our care and support consider individual physical, cultural, spiritual, psychological and social needs and preferences?
  • Number 4: Do our policies and practices challenge discrimination, promote equality, respect individual needs, preferences and choices, and protect human rights?

• 4. Enable people to maintain the maximum possible level of independence, choice and controlOpen

  How? Ways and means

  This means:

  • Help people who use services to make a positive contribution to daily life and be involved in decisions about their personal care.
  • Treat people who use services as partners with whom you negotiate and agree their care and support.
  • Enable people to have the maximum possible choice and control over the services they receive.

  Ways to improve:

  • Treat adults who use services as equals who are in control of what happens to them.
  • Empower people by making sure they have access to jargon-free information about services when they want or need it.
  • Ensure that people are fully involved in any decision that affects their care – including personal decisions (such as what to eat, what to wear and what time to go to bed) and wider decisions about the service or establishment (such as menu planning or recruiting new staff).
  • Don’t assume that people are not able to make decisions.
  • Value the time spent supporting people with decision-making as much as the time spent doing other tasks.
  • Provide opportunities for people to participate as fully as they can at all levels of the service, including the day-to-day running of the service.
  • Staff should have the necessary skills to include people with cognitive or communication difficulties in decision-making, For example, 'full documentation of a person’s previous history, preferences and habits’ can be used by staff to support 'choices consistent with the person’s character.’ (Randers and Mattiasson, 2004).
  • Identify areas where people’s autonomy is being undermined in the service and look for ways to redress the balance.
  • Work with people who use services to develop local advocacy services and raise awareness of them.
  • Support people who wish to use direct payments.
  • Encourage and support people to participate in the wider community.
  • People who use services should be involved in staff training.

  Dignity Checklist

  • Number 1: Do we ensure staff deliver care and support at the pace of the individual?
  • Number 2: Do we avoid making unwarranted assumptions about what people want or what is good for them?
  • Number 3: Do individual risk assessments promote choice in a way that is not risk-averse?
  • Number 4: Do we provide people who use services the opportunity to influence decisions regarding our policies and practices?

• 5. Listen and support people to express their needs and wantsOpen

  How? Ways and means

  This means:

  • Provide clear information so people can make informed choices about their care
  • Be open to the opinions of people who use services and encourage them to participate in planning their care
  • Provide support and advocacy so people with communication difficulties or cognitive impairment can have their say.

  Ways to improve:

  • Ask people how they prefer to be addressed and respect their wishes.
  • Don’t assume you know what people want because of their culture, ability or any other factor – always ask.
  • Care plans should include 'time to talk,’ giving people a chance to voice any concerns or simply have a chat.
  • If a person using the service does not speak English, translation services should be provided in the short term and culturally appropriate services provided in the long term.
  • Staff should have acceptable levels of both spoken and written English.
  • Overseas staff should understand the cultural needs and communication requirements of the people they are caring for.
  • Staff should be properly trained to communicate with people who have cognitive or communication difficulties.
  • Schedules should include enough time for staff to properly hand over information between shifts.
  • If you produce information resources for people using services, ask for their feedback – is the information clear? Does it answer the right questions?
  • Provide information material in an accessible format (in large print or on DVD, for example) and wherever possible, provide it in advance.
  • Find ways to get the views of people who use services (for example, through residents’ meetings) and respect individuals’ contributions by acting on their ideas and suggestions.

  Dignity Checklist

  • Number 1: Do all of us truly listen with an open mind to people receiving services?
  • Number 2: Are people who use services enabled and supported to express their needs and preferences in a way that makes them feel valued?
  • Number 3: Do all staff demonstrate effective interpersonal skills when communicating with people, particularly those who have specialist needs such as dementia or sensory loss?
  • Number 4: Do we ensure that information is accessible, understandable and culturally appropriate?

• 6. Respect people's right to privacyOpen

  How? Ways and means

  This means:

  • Ensure that people have access to personal space when they need it.
  • Respect areas of sensitivity which relate to modesty, gender, culture or religion and basic manners.
  • Provide care and support in a way that ensures people are not made to feel embarrassed.

  Ways to improve:

  • A confidentiality policy should be in place and followed by all staff (including domestic and support staff).
  • Issues of privacy and dignity should be a fundamental part of staff induction and training.
  • Only those who need information to carry out their work should have access to people’s personal records or financial information.
  • Where people have personal and sexual relationships, privacy should be respected, with careful assessment of risk to vulnerable people.
  • Interpreters should be chosen with the consent of the person using the service.
  • Staff should get permission before entering someone’s personal space.
  • People’s personal possessions and documents should only be viewed with the owner’s expressed consent.
  • Space should be provided for private conversations and telephone calls.
  • Make sure that people receive their mail unopened.
  • Single-sex bathroom and toilet facilities should be available.
  • En suite facilities should be provided where possible.
  • In residential care, respect people’s space by enabling them to individualise their own room.
  • If a person requires close monitoring or observation, issues of privacy should be carefully considered.

  Dignity Checklist

  • Number 1: Do we have quiet areas or rooms that are available and easily accessible to provide privacy?
  • Number 2: Do staff actively promote individual confidentiality, privacy and protection of modesty?
  • Number 3: Do we avoid assuming that we can intrude without permission into someone’s personal space, even if we are the care giver?
  • Number 4: Can people who use services decide when they want 'quiet time’ and when they want to interact?

• 7. Ensure people feel able to complain without fear of retributionOpen

  How? Ways and means

  This means:

  • Give people the information and advice they need.
  • Support people to raise their concerns and complaints with the appropriate person.
  • Provide opportunities for people to access an advocate.
  • Respect concerns and complaints and answer them in a timely manner.

  Ways to improve:

  • Encourage people to raise their concerns – forums for people who use services may help people to feel more comfortable in raising concerns.
  • Act promptly when people raise their concerns – this reassures people that their complaints will be listened to and that it is not necessary to ‘make an official complaint’ to get a good response.
  • Offer advocacy or support to the complainant where required.
  • Ensure the complainant is kept informed of progress.
  • Give a clear report of the outcome and information on what to do if the complainant is not satisfied.
  • Staff should be properly briefed on the complaints procedure.
  • People from seldom-heard groups (e.g. people with dementia or people from

  Dignity Checklist

  • Number 1: Do we have a culture where we all learn from mistakes and are not blamed?
  • Number 2: Are complaints policies and procedures user-friendly and accessible? Are complaints dealt with early, and in a way that ensures progress is fully communicated?
  • Number 3: Are people, their relatives and carers reassured that nothing bad will happen to them if they do complain?
  • Number 4: Is there evidence of audit, action and feedback from complaints?

• 8. Engage with family members and carers as care partnersOpen

  How? Ways and means

  This means:

  • Welcome relatives and carers and enable them to communicate as contributing partners.
  • Keep relatives and carers fully informed and provide them with timely information.
  • Listen to relatives and carers and encourage them to contribute to the benefit of the person receiving services.

  Dignity Checklist

  • Number 1: Do employers, managers and staff recognise and value the role of relatives and carers, and respond with understanding?
  • Number 2: Are relatives and carers told who is 'in charge’ and with whom issues should be raised?
  • Number 3: Do we provide support for carers who want to be closely involved in the care of the individual, and provide them with the necessary information?
  • Number 4: Are we alert to the possibility that relatives’ and carers’ views are not always the same as those of the person using the service?

• 9. Assist people to maintain confidence and a positive self-esteemOpen

  How? Ways and means

  This means:

  • Provide care and support in a way that encourages people to participate as far as they feel able.
  • Aim to develop the self-confidence of the person using the service and actively promote health and wellbeing.
  • Provide adequate support with eating and drinking.
  • Encourage people to maintain a respectable personal appearance – and do the same

  Ways to improve:

  • If someone needs assistance with eating, provide it discreetly. Use serviettes, not bibs, to protect people’s clothing. Offer finger food to people who have difficulty using cutlery, and provide adapted crockery and cutlery to enable people to feed themselves where appropriate.
  • Socialising during mealtimes should be encouraged, but offer privacy to people who have difficulties with eating, if they wish, to avoid embarrassment or loss of dignity.
  • There should be enough staff available at mealtimes to provide assistance to people who need it.
  • If there are not enough staff to support people who need it, a system of staggered mealtimes should be introduced.
  • Support people to maintain their personal hygiene and appearance, and their living environment, to the standards that they want.
  • When providing support with personal care, take the individual’s lifestyle choices into consideration – respect their choice of dress and hairstyle, for example.
  • Don’t make assumptions about appropriate standards of hygiene for individuals

  Dignity Checklist

  • Number 1: Are personal care and eating environments well designed for their purpose, comfortable and clean?
  • Number 2: Do we maximise individual abilities at all times during eating and personal care and hygiene activities?
  • Number 3: Do we ensure people who use services wear their own clothes wherever possible rather than gowns etc.?
  • Number 4: While respecting the wishes of the person using the service as far as possible, are they respectable at all times and are staff tidy and well presented?

• 10. Act to alleviate people's loneliness and isolationOpen

  How? Ways and means

  This means:

  • Offer people enjoyable, stimulating and challenging activities that are compatible with their individual interests, needs and abilities.
  • Encourage people to maintain contact with the outside community.
  • Help people who use services to feel valued as members of the community.

  Ways to improve:

  • Social networks should be promoted and people should be supported to access them.
  • Transport issues should be resolved so they do not prevent people from participating in the wider community.
  • Links with community projects, community centres and schools should be built to increase levels of social contact between people from different generations.
  • People’s skills should be identified and respected, including the skills of older people gained in previous employment.
  • People should be given ordinary opportunities to participate in the wider community through person-centred care planning.

  Dignity Checklist

  • Number 1: Do we provide access to varied leisure and social activities that are enjoyable and person-centred?
  • Number 2: Have we reviewed the activities we offer to ensure they are up to date and in line with modern society?
  • Number 3: Do we provide information and support to help individuals engage in activities which help them participate in and contribute to community life?
  • Number 4: Are responsibilities of all staff towards achieving an active and health-promoting culture made clear through policies, procedures and job descriptions?

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