Involvement and inclusion promoting dignity in care

We know that people’s dignity depends on the knowledge that they are full citizens: with rights to privacy when they want it, support when they need it, and opportunities to take part in the life of the community.

The SCIE video looks at people doing everyday things like catching the bus or socialising with friends. In practice, social inclusion means promoting and supporting these activities by improving access to the community and social networks.

This section is about social isolation and social exclusion, and their impact on a person’s dignity. In short, it’s about relationships:

• Relationships between staff and people who use services, and their families and carers.
• Continuing contact with partners, relatives, friends and neighbours.
• Support with maintaining former interests and activities, as well as finding new ones.

Messages for practice

• Many older and disabled people are at risk of becoming socially isolated.
• People should be involved in all aspects of daily living so that they can live ordinary and fulfilling lives.
• People should be supported to become active members of the community.
• Care staff should support people to develop and maintain social networks.

Resilience and connectedness

Research has repeatedly shown that wellbeing and resilience – the capacity to survive an accident, or crisis, or plain bad luck – depend a lot on ‘social connectedness’ (see e.g. ‘The anatomy of resilience’, Social Services Improvement Agency, 2015).

‘Connectedness’ refers to being involved with other people, the local community, ordinary life and stimulating experience. It supports a person’s independence, dignity and self-respect. It doesn’t matter what kind of adult care setting or service we are talking about; the best ones remove the barriers between the service and the life going on outside. At the same time, they make sure that there are no barriers inside the service, holding people back. They don’t confuse privacy with isolation, or independence with neglect or unreasonable expectations.

Loneliness

We all know that loneliness can be a serious problem for people who have too little support and company as they grow older. In 2018 Age UK calculated from current figures that by 2026 the number of older people in England who are often lonely will increase to 2 million (‘All the lonely people: Loneliness in later life’ (Age UK 2018).

Loneliness can hit at any age. Any kind of loss or personal crisis can lead to isolation. Stigma, discrimination or any kind of exclusion can make this worse. Fear of the future, of loss of control, of strange surroundings or new people may all increase a person’s sense of being alone.

Exclusion and risk

Research shows that there is no automatic connection between independence and wellbeing. The goals of personalisation depend on care-based awareness, understanding and empathy with the individual’s need for relationships. The SCIE video shows how important relationships with care staff are to building the confidence and independence of people using services.

Messages for practice

• Practical assistance can help people to maintain independence and dignity.
• Help with small tasks can prevent people from needing a higher level of care.
• Helping people to look after their home and garden can reduce the potential for abuse to occur.
• Helping people to maintain links in the community can promote dignity and reduce social isolation.

Personal stories

Click on each drop-down to read about each person’s experience.

Over to you

All of the people from the above examples are making reasonable requests – and in the real world there is a solution to them all. Take a moment to consider each person in turn, and list the issues they raise that are relevant to that person’s dignity.

If funding or staffing levels prevent people living as they wish, what are the options?

The charity brap highlights that when we assume a resident can’t think or do something independently, we risk leading to ‘an infringement of their human right’ (Right in roles: resource pack: resident engagement).

We looked at positive approaches to risk more thoroughly in Freedom to choose/Free to take risks. The point here is that the argument that an activity may potentially be too ‘risky’ should never be used thoughtlessly: it can so easily be a barrier to choice and independence.

Activities, interests and ambitions

For many years, public policy has made the value of ‘meaningful’ or ‘quality’ activity to people using social care services very clear, particularly, but not only, to those in residential settings. In 2013, for example, the National Institute for Health and Care Excellence (NICE) published a quality standard which laid down what kind of activity a good care home would offer older residents.

Activities, in this context, were aimed at supporting people’s mental and physical heath. But the debates about wellbeing, and person-centred care, have clarified and extended this. ‘Activities’, in adult social care services must support a person’s dignity – their:

• self-awareness and self-respect
• autonomy, choice and independence
• connectedness, to their families, friends and networks, and to the wider community
• ambitions for the rest of their life.

Meeting people’s expectations and ambitions

A large part of dignity in care is making sure we understand each individual’s specific needs and wants. In short, dignity in care means:

• autonomy – making your own decisions including getting out when you want to
• choice – a range of opportunities
• retaining your personal history
• identity
• maintaining links to communities, families and friends.

Designing an activities schedule

In the video you will hear Andrea Sutcliffe, CBE, talk about how an imaginative approach to the creative arts can enliven residential care services – for both residents and staff.

See the full Arts and care homes project.

Here are some examples of types of activity you can consider, and of the contexts for the various types suggested

Arts and crafts

Domestic tasks

Music, singing, dancing and fitness

Books and learning

Intergenerational work and technology

Gardens

In addition to the examples listed above, there are a wide range of imaginative ideas out there: projects providing drama and entertainment, or transport and company, based in community centres or hubs. There are also breakfast clubs and lunch clubs, and groups extending leisure activities across boundaries that could otherwise separate them from people who use adult social services.

For many more ideas, and guidance, see Arts in Care Homes.

Finally

Dignity and inclusion: the connection is clear. In this section we have seen that inclusion means:

• being able to take part in everyday activities which most people regard as ‘normal’
• relationships between people and with the community support self-respect, autonomy and resilience
• protection from barriers to joining in, which are linked to outdated ideas of ‘risk’
• that all the ways of excluding people derived from stereotypes, fear of ‘difference’, racism and ignorance about rights to equality are recognised and shunned.

The section ended with examples of the many different ways on which providers are supporting inclusion and involvement through ‘meaningful activity’ in the community.

Further reading

• The anatomy of resilience: helps and hindrances as we age (Social Services Improvement Agency, 2015)
• All the lonely people: Loneliness in later life (Age UK, 2018)
• Creative Minds
• Exeter Care Homes Reading Project
• University of the Third Age
• Tangible Memories
• Arts in care home (SCIE)