Brenda Currill is a family carer, part-time Care Assistant for one of the large groups and a Founding Director of Medoris, a leading provider of innovative caring products for the elderly. She became Care Innovator of the Year in both 2003 and 2008.

I define dignity, comfort and respect as “…what I would want for my mother…”. The dictionary will define dignity as a state worthy of respect and self-respect.

Care homes today provide comfort and care and are improving the activities available (not just the TV or music.) But we have to remember the reasons for elderly people going into care; self neglect, incontinence, and dementia.

What is it like to be elderly in a care home….?

The chart below indicates some of the issues encountered by the elderly…

A lot of these are self-explanatory but “incarceration”….? - care homes have to be secure. A “shrinking world” - we can only talk about what we know  which, with loss of mobility, means our own world shrinks to concern for health, food and conditions in the home. With short term memory loss due to ageing, these subjects are repeated continually.

A “changed world” to-day means mixed race, culture and immigration with racial discrimination illegal and the need to be politically correct.

In the western world, there is not the same respect for elderly family members as there is in the east – India, China etc. This respect enables the elderly to retain dignity. It is threatened by dementia which is increasing as we live longer. Jackie Pool has estimated 75% of all care home residents have dementia and the Alzheimer’s Society states that 425,000 people with dementia are living at home.

Other factors are listed in ‘Dignity in Care’ SCIE Practice Guide 9.1 I have some observations…..

Some elderly people are already embarrassed by their predicament and dependence, hiding soiled garments and apologising for clothes being put on in an incorrect sequence. Not all of the older generation are racially or culturally neutral. We forget we are all a function of our experiences. They may not easily welcome dependence on a person of different race or culture.
Not all elderly people are gentle old ladies who like to knit. If you were a “difficult” person when younger, you may also be in old age.

What can be done to improve the dignity of the elderly in care homes…..?

Government: Do not depend on government intervention. Anti-aging legislation, emphasing equal rights, particularly in the medical area, yes, but how many elderly people in care homes use a postal vote in an election…? Philosophy: Pursue a philosophy that recognises the service user as a unique individual, doing things with them rather than for them and that respects, values and needs, even if they differ from one’s own.

Leadership: Provide leadership by example of the Area Managers/Senior Management of care home groups, by visiting the homes to discuss with staff at Care Assistant level as opposed to Care Manager level; not only day staff, but night staff as well, who often feel isolated. Perhaps some groups need a ‘mystery shopper’.

Staff: Train the Care Assistant staff who may not have been born in this country, or who may be young, to respect the wishes of the service user. Many residents were born before the war and may not wish to be called by their first name.

Role reversal: Train the Care Assistants to imagine themselves as being elderly, dependent and in pain, and to work out how they themselves would feel. I know someone who imagines the elderly men as soldiers having once defended their country and elderly ladies as 20’s Flappers or 40’s Land Girls. One should “see” a person as they are or as they were, rather than just the “illness they have”.2

Whistle blower: Look at how to take advantage of the honest “whistle blower” in the staff without firing them as the wrongdoer.

Key worker: The role of the ‘Key worker’ is so important. By involving the Key worker in the overall picture of what the resident’s needs are when they enter the care home environment, we can give that continuing level of care. This is so important in such areas as whether the individual concerned liked their hair to be styled and cut regularly or ensuring their interest in make-up continues. Supervise closely the “Key worker” Care Assistant who is responsible for a resident’s needs (no soap….? someone else’s underwear…?) and the family purchases which will make the resident’s life more comfortable.

Valuing the staff: By ensuring staff feel valued, the service user will be valued, thus raising the level of care and respect for and dignity of the residents. The importance of realisation by families and senior staff that a Care Assistant’s job is often extremely challenging and involves tasks which many would find hard to do for a member of their own family, let alone doing it for their fellow human being – and doing these tasks continually day in and day out and not on a ‘one off’ basis.We all need to feel loved and needed – whether that is a child in its formative years or an elderly person coming to the end of their lives – or a Care Assistant carrying out often unpleasant tasks - and respect follows through from being loved and needed.

Reward and thank staff who do a good job. “Care staff need to feel valued”.3

Family and partners
Improved medical care has created longevity for the elderly which changes the family roles of parenting – the child becomes the parent, the parent becomes the child.

Family remember the elderly as they were when they enter the care home and may well not recognise the deterioration. Carers spend more time than the family with residents in the last few years of their lives and know them better.

Remember….
For the staff, a family member critical of the home practices may be a good thing. If criticism is justified we all need to be kept on our toes. I have met some very good daughters-in-law.

Products which enhance dignity….
The Senior staff and Key workers should be aware of products which serve a need but also provide dignity.

There are products designed to make elderly life as normal and dignified as possible. For incontinence there is a seat cushion which absorbs urine and is anti-slip and looks like a soft cushion. There are ladies open-back skirts making toileting easier for wheelchair users. I cannot understand why major continence companies market a blue, pink or turquoise bed pad which is not full width. It tells a visitor that the resident is incontinent. My company sells only white and full width ones and also offers a drainage pocket which can be concealed under bed clothes rather than a bag stand.

Advancing age often means thinning hair and there are specialist wig providers. I have known some glamorous ladies in care homes and why not? Card systems are on offer for non-verbal communication. Who wants their mum exposing her thighs when a short skirt rolls up, or an open back nightgown with its risk of exposure. Whilst it might be easier not to put pyjama bottoms on a catherterised gentleman it is much more dignified to do so. Our specialist care pyjamas with poppers at the crotch and absorbent fabric in the event of catheter bypass provide a solution. The issues of pad shredding and inappropriate undressing with dementia can be addressed in three ways – drugs, confinement to their room, both of which are unacceptable – or easy-care attractive all-in-one garments for the wearer who is padded. The all-in-one pyjamas and daywear for men and women are among our best selling products.

Wearing a traditional bib, or a disposable bib, is by far the most undignified. But it is more dignified to wear the Catchkin ‘napkin’ bib which looks like a traditional napkin tucked in at the neckline. There is also the ‘tee-shirt’ bib which looks like a traditional tee-shirt worn under a shirt or blouse and is waterproof to protect the skin; a far more dignified alternative to a bandana or towel. With palliative care, it is possible to use, for minimal disturbance, the open back nightwear, micro-beaded hand grips used as ‘comforters’, and the micro-beaded positioning aids, all of which when used together, raise the level of
dignified care.

‘Dignity’ and ‘respect’ are recognisable in so many ways. An example I witnessed recently was of a Care Assistant ‘leading’ by the hand a particularly elegant and intelligent resident who sadly, because of her advancing dementia, had not long entered the care home. The Care Assistant was a couple of paces in front of the lady and the lady was coming up the rear holding on to the Care Assistant’s hand. How much better it would have been if the Care Assistant had offered the lady her arm to link with and they had walked, arm in arm, up the corridor together…… ‘dignity’ and ‘respect’ come in many guises……

Bibliography:
1’Dignity in Care’ Elaine Cass et al. SCIE Practice Guide 9 2006
2’Dignity in the Terminally Ill’ H M Chochinov et al. Social Science & Medicine, Feb 2002.
3Sandra Lawton in discussion with Phil Hope, Minister for Care Services www.publicquestion.com 20.01.09.
Department of Health ‘Dignity in Older Age’ Gillian Woolhead et al.Age & Ageing Vol.33 No.2 British Geriatrics Society 2004 ‘Dignity and Care for Older People’ Lennart Nordenfelt 2009

Brenda’s products can be seen at
www.medoris.co.uk and
www.medoriscare.co.uk (new website under construction)
brenda@medoris.co.uk or tel: 01993 774939