Defining dignity in care
The term ‘dignity’ has always been hard to define. A good place to start by looking at our general human rights: 'Human rights are universal – they belong to everyone. They guarantee the fundamental rights of each individual' Equalities and Human Rights Commission (EHRC 2015).
Regulation 10 under the Health and Social Care Act 2007 specifies the kinds of care and treatment that ‘ensures dignity’.
Here's what the Care Quality Commission says about Regulation 10:
To meet this Regulation … providers must make sure that they provide care and treatment in a way that ensures people's dignity and treats them with respect at all times. This includes making sure that people have privacy when they need and want it, treating them as equals and providing any support they might need to be autonomous, independent and involved in their local community.Care Quality Commission (CQC 2017)
Where does ‘dignity’ fit in with other current policy priorities?
Dignity is fundamental to current social care policy. A focus for all adult social care and support was set out in the Care Act 2014. The Act begins by defining the primary responsibility of local authorities as the promotion of individual ‘wellbeing’.
Wellbeing is defined as a broad concept relating to a number of factors, such as personal dignity, including treating the person with respect.
In the same way, the emphasis on choice and control through a person-centred approach underpins wellbeing. It supports the person’s sense of self-respect, as well as the provider’s commitment to treat the person with dignity and respect.
How can being treated with dignity help?
Care with dignity supports the self-respect of the person, recognising their capacities and ambitions, and does nothing to undermine it. It includes respect for what they can do, who they are, and the life they’ve lived. It’s seen as a central part of quality in care work.
Surveys involving people who receive or provide social care frequently emphasise relationships above all: between the person needing care and their carer, within groups in residential care, and between the people receiving care and the wider community.
Get these right – they say – and attitudes, behaviour and high-quality care follow.
Care from the heart: older minoritised women’s perceptions of dignity in care (ResearchGate, 2015) describes how older people who had migrated to this country found that they distinguished between professional care and the type of generous, respectful care they received from family members. ‘Care from the heart’, they called it, protected their dignity.
The concept of personalisation sets out to capture these qualities of respect and compassion, and identifies care practice that supports independence, self-esteem and dignity.
This can be a good test of the degree to which social care staff really understand what life is like for the people they work with. Are microwaved frozen meals, or sandwiches on paper plates really like mealtimes? Are care homes the sort of places we think of when we think of ‘home?’ What makes life for people receiving adult social care services a real, satisfying life?
We all want this kind of personalised care for our families. But all families are different.
Stories for discussion
Read the following stores and reflect on the questions. It may good to discuss these with your colleagues.
Grace is 89 and is struggling to manage at home. She has become very forgetful and, more recently, unsteady on her feet. Her son, George, is worried she may fall. Grace and George are visiting care homes in the area, but she’s very worried about the thought of moving.
Grace has several good friends in her neighbourhood who knew her during her long career working for the NHS. She has been a loyal member of her local church, and receives support from the minister and some of the congregation, as well as from a daily home care service. She loves talking about her childhood, before she came to England from Grenada, and although she doesn’t eat much, she will always accept food that she recognises from her youth. She also enjoys visits from her grandchildren.
Over to you
Imagine Grace has come to visit your care home:
- You have a chat with Grace and George. What do you think they might want to know?
- What if George and Grace have different priorities?
- How might you think about meeting Grace’s needs?
Mary has always cared for her son Daniel who is 48 and has physical and learning disabilities. Mary and Daniel have a dog, who they both are very attached to. Daniel works at a local gardening project and he has a good friend there. He loves football and supports the local team – a friend of Mary’s will often go to a match with Daniel. Mary is worried about what will happen to Daniel when she is no longer around. She is already finding the daily routine a real strain, despite the help they are able to buy with their personal budgets (PBs). Mary and Daniel’s social worker have been talking to him about whether he might like to move to supported living.
Over to you
Imagine you are working in supported living. Daniel comes to visit with Mary and the social worker.
- You have a chat with Daniel and Mary. What do you think they might want to know?
- What if Daniel and Mary have different priorities?
- How might you think about meeting Daniel’s needs?
Eric knows that his husband’s Alzheimer’s is progressing. Don has been a successful professional musician, and music is still very important to him – it helps to ease his distress and anxiety. Before his illness reached this stage, they talked about the kind of residential care Don might need in the future. However, Eric remains nervous and uncertain; he worries that a care home would not be respectful to their relationship. How will Don be treated by care staff and other residents? Will he be stigmatised, excluded or harassed because he’s gay? Will Eric be accepted as his partner and next of kin? And will Don be allowed the privacy he values, and to have classical music playing in his room all night? Will Eric be able to stay over?
Over to you
Imagine you work in a care home and Eric and Don come to visit:
- You have a chat with Don and Eric. What do you think they might want to know?
- What if Don and Eric have different priorities?
- How might you think about meeting Don’s needs?
These stories present very different situations, but there are also important things they have in common.
- Each of the stories describes a unique individual, whose history, career, skills, interests and routines need to be recognised and respected. They have care and medical needs, but that is not who they are.
- All of them have existing support networks, and relationships they value.
- None of them fits easily into an institutional pattern. They can’t just be ‘slotted in’ to whatever local services currently offer.
- All of them need information about what’s on offer and what it will mean for them.
- Each story raises issues of equality, as well as dignity and respect.
Grace, Daniel and Don – as well as their carers – all demand a response that is thoroughly personal to them. At the same time, they are looking for what a modern social care system can offer: an approach to care that is positive, respects their strengths and experience, understands their rights and supports their independence. How can social care managers and workers develop a culture in the workplace that supports this approach?
Better life in the community
Let us have a look at a real-life example of listening to each individual to provide dignity in care.
- Guidance on human rights for commissioners of home care (Equality and Human Rights Commission, 2013)
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10: Dignity and respect (Care Quality Commission, 2017)
- Care from the heart: older minoritised women’s perceptions of dignity in care (International Journal of Migration, Health and Social Care, 2015)