Dignified care, in a modern social care system, means knowing about and supporting what people and communities can do for themselves, rather than focusing on what they cannot do.
It is imperative that social work practice with adults embeds and uses rights and strengths-based approaches. This must be underpinned by our skilled involvement with individuals and their families if it is to have relevance to their needs and expectations. The quality of these relationships has a definitive impact on health and wellbeing outcomes. This has always been core to social work.
Chief Social Worker for England Annual Report 2018 (DHSC, 2018)
What people can do for themselves is central to the Care Act 2014. It expects local authority assessors to use a ‘strengths-based’ approach before deciding on a plan for additional care and support to identify:
- the strengths and capacities of the person including their personal social network
- opportunities provided by their wider community.
There is more work to be done to establish what the outcomes for individuals and communities are from working in this way.
But there is already evidence that a strengths-based approach can:
- promote wellbeing and independence
- build resilience
- support the ways in which communities work
- improve health and quality of life.
There is also evidence that a ‘deficit approach’ to social care – always emphasising the negative – can be self-fulfilling.
What does the CQC look out for?
How do people, or those with authority to act on their behalf, contribute to planning their care and support, and how are their strengths, levels of independence and quality of life taken into account?
CQC KLOE: R.1.1
Why are strengths and skills so important to dignity?
A person’s dignity is supported by care that is tailored to their individual, personal needs. The connections between strengths-based care and person-centred care are clear.
Finding out about and supporting the skills and strengths a person brings to their new situation helps them retain their contacts with their past, and realise their ambitions for the future. Interests shared with friends can continue.
I was put in the garden. I didn’t want to go in the garden. They didn’t ask me if I wanted to sit in the garden…
What’s it like to live in a care home? (Healthwatch, 2017)
Some of the staff listen to me, but not always. They think they know best. Sometimes I resent being told what to do and I rebel.
What’s it like to live in a care home? (Healthwatch, 2017)
These two quotes illustrate what was found by Healthwatch investigators in some of the homes they visited. This approach, now completely out of tune with modern practice, denies the right of the individuals to continue developing their own lives and has sometimes been described (unpleasantly but honestly) as ‘warehousing’ people.
People often connect what they do (or used to do) with who they are. If a person is enabled to keep in touch with their past working life by continuing to use skills they used at work, this helps them to retain a sense of their own identity. This is a basic principle of a person-centred, strengths-based approach.
The term ‘strengths’ means a whole range of resources that a person can bring to their situation: particular skills and capabilities; ways of approaching change or difficulty in life; drawing on resources around them – among their family, friends, and community.
All of these factors help to build resilience – a capacity to face change, accident or decline in a positive way – and support a person’s individual identity. All of them are part of modern, dignified care.
Over to you
Watch this SCIE video about making a cup of tea. It sounds simple, but raises important questions about choice, independence and personal history, and how they support an individual’s dignity.
Supporting an individual's dignity
Think for a few minutes about why it is important to Emily to make her own cup of tea.
- Why is she so keen to do what she has always done?
- Why must she do it herself, without obvious help?
- How does she benefit from the activity?
- What would it mean to her if she was prevented from making tea, or told that she was too old or too frail to continue?
- Does she have the right to continue, whatever the circumstances?
- What are the risks to her and to others?
- How have the staff dealt with the risk in this case?
What does the CQC look out for?
How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?
CQC KLOE: S2
How is technology used to support people to receive timely care and support? Is the technology (including telephone systems, call systems and online/digital services) easy to use?
CQC KLOE: R1.6
Meaningful activities
The CQC KLOEs outlines the kinds of activities people in adult social care settings should be able to expect. Activities should be ‘meaningful’ – that is to say, not random or inappropriate for the age, culture, level of intelligence or experience of the people using the service. They should relate to the known strengths, skills and interests of participants, and be developed in collaboration with them.
Mental wellbeing of older people in care homes (NICE, 2013) emphasises the special importance of ‘meaningful and culturally appropriate activities’ in relation to mental wellbeing on wards and in care homes. It draws attention to the innovative work of the charity Alive in homes for older people.
Co-production in social care: what it is and how to do it (SCIE, 2015) explains and provides guidance on co-production, which supports the development of more equal partnerships between people who use services and those who provide them.
The following shows how ideas of co-production and personalisation, and an emphasis on strengths, can work in practice to support the dignity and independence of people in a range of adult care settings.
The workers … came in friendly … not telling us what we need or how to do things … they helped us and worked with us …We trusted the Forever Manchester people… it just fitted … felt right what they were saying … it put us more in control of ourselves and things we wanted to do.
(Community member, Forever Manchester) Head, hands and heart: asset-based approaches in health care (Health Foundation, 2015)
Dignity in care: emphasising strengths
Over to you
Here is an outline list of what you need to set up a programme of ‘meaningful’ activities.
Add to the list from your own experience. What are the key points from good practice you know about? What are the particular challenges in the area you know best?
- informed leadership
- planning which starts with the people who use the service and the local community
- knowledge of local resources
- space
- a budget
- dedicated staff time
- a positive approach to innovation and new technology
- an understanding of risk enablement.
The projects and services summarised above are just a few examples of the innovations that are being tested across the country. They are very varied, but have a number of features in common. They aim to:
- support people in improving their own lives
- promote activities that are relevant in every way to the people who use the service
- break down distinctions between generations, and between ‘able’ and ‘not able’
- remove the barriers between ‘services’ and ‘real life’; and
- look to the surrounding community for spaces, facilities, volunteers, mentors and co-workers.
What does the CQC look out for?
How do people, or those with authority to act on their behalf, contribute to planning their care and support, and how are their strengths, levels of independence and quality of life taken into account?
CQC KLOE: R1.1
Where the service is responsible, how are people supported to follow their interests and take part in activities that are socially and culturally relevant and appropriate to them, including in the wider community, and where appropriate, have access to education and work opportunities?
CQC KLOE: R1.3
Asset mapping strengths and skills
An asset-based approach places the emphasis on the assets of the individuals and communities, alongside their needs. It is a great starting point to support the creation of a dignity in care plan that focuses on a person’s strengths and skills. Asset-based places: A model for development (SCIE, 2017) covers the principles of asset-based development and ways of mapping, linking and developing community assets.
Finally
Best practice in adult social care recognises that the person who needs support:
- has gifts, skills and strengths
- identifies themselves in terms of what they used to do and can do now – not just what they may have lost
- can have a future, as well as the present and the past
- should be able to continue to draw on resources in the neighbourhood and community to maintain the life they want.
This section has touched on a group of ideas that are fundamental to care which treat the person using services with dignity and support their self-respect. They include:
- assessment of the ‘strengths’ or ‘assets’ of an individual as the first step in planning dignified care
- co-production in care planning between the individual and the professional
- the rights of individuals to choice and control in planning their lives
- risk and the role of technology
- resilience and wellbeing
- ‘work’ and meaningful activities
- analysis of the resources which a community has to offer, to support a person’s right to a life which is as independent and rewarding as possible.
Further reading
- What’s it like to live in a care home? (Healthwatch, 2017)
- Head, hands and heart: asset-based approaches in health care (Health Foundation, 2015)
- Mental wellbeing of older people in care homes (NICE, 2013)
- Co-production in social care: what it is and how to do it (SCIE, 2015)