SCIE Practice guide 09: Dignity in care

Social inclusion

Key points from research and policy
Practice points
Ideas from practice
Other resources

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' (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’.

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).

For people living in residential care, participation in the community outside the home, as well as within it, is an important part of maintaining well-being. 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 Social Exclusion Unit (Social Exclusion Unit and Office of the Deputy Prime Minister, 2006) defines 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)

(Barnes, 2006)

The following glossary definition of social exclusion summarises the above points well:

marginalisation from employment, income, social networks such as family, neighbourhood and community, decision-making and from an adequate quality of life (Kerry County Development Board, 2006).

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.

Key points from research and policy

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).
Over all, the elderly are more likely to be socially excluded (Barnes, 2006).
In applying the national minimum standards for domiciliary care (249kb PDF file) 'regulators will consider... how the organisation collaborates with other services/professionals to maximise independence and ensure the individual’s inclusion in the community’ (DH, 2003b).
The national minimum standards for care homes (340kb PDF file) require that: 'The routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities’ and that 'service users maintain contact with family/friends/representatives and the local community as they wish’ (DH, 2003a).

Practice points

Promote access to social networks for older people.
Address transport issues that act as barriers to community participation.
Interlink community projects, community centres and schools to increase levels of intergenerational social contact.
Identify and respect the skills of older people, including those gained in previous employment.
Ensure people are given ordinary opportunities to participate in the wider community through person-centred care planning.

Ideas from practice

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

Other resources

Digital Unite specialises in 'socialising IT' - making it relevant to anyone and everyone, but particularly those people who might otherwise get left behind in our increasingly digital world. DU has trainers all over the UK and a rolling trainer recruitment and continuous professional development programme. All DU trainers must be mature, experienced, empathic - this means they are usually also in the older age-groups. DU works a great deal within social housing where clients include residential social landlords, community groups, charities, local authorities and national organisations. The DU brochure outlines how it has helped older people feel more socially included.

Link: Digital Unite website

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 four of the pack particularly aims to guide staff working with people with dementia about why activities are important and explores the key principles in using activities. The pack is available from the Alzheimer’s Society.

Link: Yesterday, Today, Tomorrow

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