SCIE Practice guide 09: Dignity in care

Hygiene and personal appearance

Hygiene and personal appearance were highlighted in the Department of Health (DH) online survey (DH, 2006d) as factors in maintaining dignity for older people. An analysis of UK data (Woolhead et al., 2004) from the Dignity in Older Europeans study (Cardiff University, 2001 - 2004) found that the self-respect of older people could be undermined by neglect of patients’ appearance and clothing and that, even in death, maintaining a respectable appearance is very important to people.

A person’s appearance is integral to their self-respect and older people need to receive appropriate levels of support to maintain the standards they are used to. Personal preferences should be respected, as well as choice in how support is provided. For example, choosing when and how to carry out personal care tasks, using your own toiletries, choosing what to wear and how to style your hair and having clean, ironed clothes that fit are all ways of maintaining control and identity. Particular care should be taken in residential settings to ensure that personal laundry is treated with respect and not mixed up or damaged.

Appearance and hygiene also affect the living environment: a clean and tidy house and a well-kept garden are important aspects of maintaining dignity in daily living. Poor garden maintenance alone can give out the message that a person is unable to cope. The report 'Now I feel tall' (522kb PDF file) (DH, 2005b) showed that hospital patients valued 'getting good treatment in a comfortable, caring and safe environment’. The Older People’s Inquiry, 'That little bit of help' (108kb PDF file) (JRF, 2005), found that: 'older people really valued support which enabled them to live in their own homes - for example, help with cleaning, DIY, gardening, care of pets, chiropody, transport and befriending’.

Key points from research and policy

• Having a clean and respectable appearance and pleasant environment is key to maintaining the self-esteem of older people.
• Cleanliness in hospitals is one of the top five issues for patients (DH, 2004d).
• Having a clean home is particularly important to older women in terms of maintaining their dignity and self-respect (Godfrey et al., 2000).
• A little bit of help can make a big difference. This includes low-level, flexible services such as help with cleaning, ironing, garden maintenance, foot care and assistance with caring for pets (JRF, 2005).
• The proper care of laundry is a key issue for many care home residents (PG Professional and the English Community Care Association, 2006).
• 'Hygiene and cleanliness is seen as a key indicator of standards within a [care] home’ (PG Professional and the English Community Care Association, 2006).
• The national minimum standards for domiciliary care (249kb PDF file) require that 'personal care and support is provided in a way which maintains and respects the privacy, dignity and lifestyle of the person receiving care at all times’ (DH, 2003b).
• The national minimum standards for care homes (340kb PDF file) require that 'the premises are kept clean, hygienic and free from offensive odours throughout’ (DH, 2003a).
• The NHS Essence of Care (384kb PDF file) benchmark for personal and oral hygiene focuses on assessment of need, planned care based on negotiation with patients, the care environment and appropriate levels of assistance (DH, 2003c).
• 'Towards cleaner hospitals and lower rates of infection' sets out a number of initiatives to improve hygiene standards in hospitals (DH, 2004d).

Practice points

• Ensure that older people have the support they need to maintain their personal hygiene and appearance, and their living environment, to the standards that they want.
• Ensure that the lifestyle choices of the individual are taken into consideration when providing support with personal care - for example, respect for a person’s choice of dress and hairstyle.
• Don’t make assumptions about appropriate standards of hygiene for individuals, and cultural factors should be taken into consideration during needs assessment.

Ideas from practice

Practice examples are self-reported and have not been evaluated.

• Sole Mates (Age Concern)
• Raising the bar on hygiene and cleanliness (Caterham Dene Community Hospital)
• Adopting the Behind closed doors leaflet (Southampton University Hospital NHS Trust)

Other resources

'Now I feel tall' (DH, 2005b) offers practice examples on 'getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way’.

Link: 'Now I feel tall' (522kb PDF file)

The Alzheimer’s Society training pack, Yesterday, Today, Tomorrow, includes a 90-minute video/DVD and 130-page training manual providing eight training sessions. The pack has been designed to help deliver training at a time that is convenient to the home/ward/department. Session five of the pack particularly focuses on supporting personal care. The session aims to guide staff working with people with dementia to respect their right to independence and encourage them to carry out their own personal care tasks. The pack is available from the Alzheimer’s Society.

Link: Yesterday, Today, Tomorrow

Previous: Privacy
Next: Mealtimes