Dignity in care

Older people need timely information about what they are entitled to and what they can expect from services in order to maintain control and independence. Good experience is partly dependent on having information to make choices, to feel confident and to feel in control. The way in which information is communicated, and the way in which day-to-day communications take place, will have an impact on the maintenance of dignity. It is important that people who work with older people learn to identify barriers to effective communication with older people in care and how to avoid these.

The Essence of Care (DH, 2003c) defines communication as “a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings or other information through both verbal and non-verbal means, including face to face exchanges and the written word”. Older people want to be treated with respect and the way they are spoken to influences this. Research has highlighted concerns about staff and family attitudes, and patronising and disrespectful ways of addressing older people.

Concerns have also been raised about acceptable levels of English among health and social care staff. Research has shown that relatives of residents in care homes had concerns about the language barrier between residents and staff caused by the numbers of overseas workers. Even where staff are fluent in English, strong accents may affect the older person’s ability to understand, particularly for people with dementia, communication difficulties or hearing impairments. Difficulties with staff recruitment and retention in health and social care are widespread and the value of overseas workers cannot be underestimated. But it is important to ensure that these workers receive support and training to ensure that their communication skills are adequate.

Good written communication between workers is also vital to providing a consistent service in line with service users’ needs and preferences. Again, employers should ensure that workers have adequate literacy skills in English.

Additionally, there may be difficulties where a service user is unable to speak English. Where there are no staff who speak the same language as the service user, translation services should be provided and, where the care is provided on a long-term basis, culturally appropriate services should be sought.

Issues of continuity – a key aspect of good communication – have also been highlighted in relation to staff retention. Residents feel more secure when they see the same faces every day. In a study into the views of health and social care staff on dignity, some problems associated with the use of agency staff were highlighted, such as extra expense, a lack of continuity of care, and a lack of interest in and personal involvement with patients.

Good communication is vital in ensuring person-centred care and this presents particular challenges for managers, in terms of recruitment, retention and training for frontline staff.

Key points from research and policy are:

● Dignity is threatened by “treating adults ‘like babies’ because of actual or assumed incapacityusing patronising tones of voice”. (Research overview)

● Using respectful language and gestures promotes dignity (Tadd, 2005).

● Consistent assignment of workers can improve communication and facilitate the building of positive relationships between service users and staff (PG Professional and the English Community Care Association, 2006).

● The national minimum standards for domiciliary care require that: “The skills and experience of care staff are matched to the care needs of each service user and they are able to communicate effectively with the service user using the individual’s preferred method of communication” (DH, 2003b).

● Essence of Care gives an excellent breakdown of things to consider when communicating with hospital patients (DH, 2003c).

Further information

● Practice Guide 9: Dignity in care

● Practice Guide 11: The participation of adult service users, including older people, in developing social care

● Practice Guide 2: Assessing the mental health needs of older people

● English Longitudinal Study on Ageing

● Age Concern 

● Nursing Older People

● Help the Aged 

● DH (2003b) Domiciliary care: National minimum standards. In Department of Health (Ed), The Stationery Office.

● DH (2003c), The Essence of Care: patient-focused benchmarks for clinical governance. NHS Modernisation Agency,

● Tadd W (2005), Dignity, older people, health and social care. Dignity and Older Europeans, Cardiff University

● PG Professional and the English Community Care Association (2006) Care Homes: through the eyes of the consumer, London, English Community Care Association