Dignified treatment means treating the person who is using the service you provide as a respected, individual citizen with a past and a future. This is a key part of the person-centred care (also referred to as personalisation) agenda.
A briefing by Healthwatch, based on visits to 197 residential care homes of all kinds, ‘identified two lessons that care homes can focus on to help improve residents’ experiences’. The first of these is ‘Treat residents as individuals, and ensure all of their needs are met’ (Healthwatch 2012). The visits uncovered examples of very good practice. However, ‘ … in other places, interaction between staff and residents seemed much more limited’.
What is personalisation
Personalisation for people with a physical disability
What does the CQC look out for?
Do staff know and respect the people they are caring for and supporting, including their preferences, personal histories, backgrounds and potential?
CQC KLOE: C1.4
Maintaining identity as part of dignity
Everyone experiences changes to their sense of personal identity at times in their lives. Some of these changes can be difficult and painful; for new parents, for example, or at retirement, divorce or when losing a partner. Apart from the obvious loss of freedom, income or companionship, we may feel that our identity has shifted in a way that somehow downgrades us in the outside world.
The ways in which institutions of all kinds – hospitals, schools, prisons, armies – can attack or even destroy our individual sense of self has been well researched.
Individual self-esteem can be attacked very simply by assigning us to a group identity that carries stigma: ‘old people’, ‘patients’, ‘people with disabilities’ or with ‘mental health problems’. Recently it has been found that even a diagnosis of ‘frailty’ may attack a person’s self-esteem so that they feel bound to act and feel ‘frail’ (Warmoth et al. 2016)
The ‘little things’
In one study undertaken by Glasgow University, older people interviewed in a variety of care settings also identified the ‘little’ ways in which their personal status and individuality was not recognised.
I feel sometimes when we talk about dignity we look at the big things but I think it’s addressing people, addressing your patients like ‘good morning Mr Smith, how are you today?’ or ‘Can I help you with something?’. To me that is treating the patient with dignity. I don’t know if that is too simplistic…just to not acknowledge them.
Kinnear D et al. 2014
In one study undertaken by Glasgow University, older people interviewed in a variety of care settings also identified the ‘little’ ways in which their personal status and individuality was not recognised.
Getting the so-called ‘little things’ right is absolutely basic to treating a person as an individual who has a right to respect. It’s not always easy – here are three obvious, everyday examples.
What does the CQC look out for?
How are people involved in decisions about what they eat and drink and how are their cultural and religious preferences met?
CQC KLOE: E3.1
The memory of the individual
Remembering your life history is an important part of your identity. Where people are at risk of losing their personal story, treating them with dignity involves supporting them in maintaining and celebrating it.
I had no idea then just how much I would come to rely on the photographs, that I would develop a disease that would steal memories from me, that every day something more cherished than any of my possessions would be lost. That’s what Alzheimer’s does: it’s a thief in the night, stealing precious pictures from our lives while we sleep.
‘Somebody I used to know’, a memoir of living with young onset dementia, by Wendy Mitchell, with Anna Wharton, Bloomsbury 2018
How life stories are lost
‘Life story work’ has been a familiar part of social care with children and adults since at least the 1960s. This century, in combination with other ‘reminiscence’ therapies, it has become more and more significant in the care of people living with dementia.
I’m a different me today from the one I was six months ago. A different one from the one I was a year ago. I’m losing my sense of self, and that is more frightening than anything.
‘Somebody I used to know’, a memoir of living with young onset dementia, by Wendy Mitchell, with Anna Wharton, Bloomsbury 2018
Think about ways and places in which people become more likely to lose their personal stories, or find them fading:
- change of accomodation after an accident, illness or gradual physical decline
- change of role after retirement or bereavement
- advancing age, often with increasing loneliness
- mental health issues, often carrying stigma to add to distress
- dementia and cognitive impairment.
Getting to know the person with dementia: the importance of memories
In each of these cases, think about how the person’s situation leads to changes in their own sense of who they are. What factors can lead to a loss of personal history?
Social care agencies have developed a number of new approaches to reminiscence, stimulated by the needs of people living with dementia, and their carers.
Case studies
Recognising difference in dignity
The need for adult social care is not restricted to one kind of person, and services should be as diverse as the people who need and use them.
Equally outstanding, equalities and human rights – good practice resource (CQC, 2018) argues that human rights principles of fairness, respect, equality, dignity and autonomy are ‘at the heart of good care provision’.
Working with lesbian, gay, bisexual and transgender people: older people and residential care: Roger's story
Thinking about the services you provide, consider how you would meet the needs of the people described above. Are their gaps? What more is needed? Is there a need for a different approach?
What the CQC says about equality and human rights
When we inspect services, we take into account how they consider your:
- age
- disability
- gender
- gender identity
- race
- religion or belief
- sexual orientation (whether you are lesbian, gay, bisexual or heterosexual)
- pregnancy and maternity status
Thinking about the services you provide, consider how you would meet the needs of the people described above.
- Are their gaps?
- What more is needed?
- Is there a need for a different approach?
Equality and human rights (CQC, 2019)
Case studies
Standard provision for everybody and treating everyone the same does not promote equality. Instead, every kind of adult social service has to come to terms with and meet the needs of a changed, diverse population. This includes people of many races and ethnicities, any gender or gender orientation, every sexual orientation and many faiths.
It shouldn’t need to be said that all people have an equal right to inclusive, dignified care tailored to their personal and cultural needs.
What does the CQC look out for?
Does the service have, and keep under review, a clear vision and a set of values that includes a person-centred culture, involvement, compassion, dignity, independence, respect, equality, wellbeing and safety? How do leaders make sure these are effectively embedded into practice? Do all staff understand and promote them?
CQC KLOE: W1.6
How does the service make sure that a person’s care plan fully reflects their physical, mental, emotional and social needs, including on the grounds of protected characteristics under the Equality Act? These should include their personal history, individual preferences, interests and aspirations, and should be understood by staff so people have as much choice and control as possible. CQC KLOE: R1.2
Finally
Respect and support for every person’s individual identity and history is essential to treating them with dignity. Personalisation, wellbeing and equality support this. This section has shown:
- how identity can be undermined
- the importance of so-called ‘little things’ to maintaining self-esteem
- how personal history can be lost, or supported and celebrated
- the place of memory and reminiscence in preserving our identities, and
- the critical importance of recognising and respecting increasing diversity in our society.
Further reading
- Key lines of enquiry, prompts and ratings characteristics for adult social care services (Care Quality Commission, 2017)
- The meaning of dignified care: an exploration of health and social care professionals’ perspectives working with older people (BMC Research Notes, 2014)
- Equally outstanding: Equality and human rights (CQC, 2018)