Dignity matrix

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Dignity matrix
A new framework for assessing progress with
dignity in care
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Academic definitions of dignity are a start

• a state, quality or manner worthy of esteem or
  respect and (by extension) self-respect.

SCIE 2008
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but in practice it is often easier to see when
dignity is missing

• I remember being taken to the toilet in
  hospital and they left the door open. They
  couldnt understand why I was concerned about it.
  The nurses were having a conversation while I
  was on the toilet as if I didnt exist

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What do people tell us about later life?

• 76 of people think that care home residents tend
  to be forgotten by society
• 45 of people believe once you reach very old age
  you are treated as a child

A carer comes and they wont listen to youthey
will do it how they like to do itnot the way I
want the thing to be done.
They treat you as if you were nothing
I think what makes it so difficult for people to
carry on caring at home is that services are so
disjointed youre lost in a sea of people. You
dont know whos meant to be doing what.
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Policy response

• Not because they are old
• Essence of Care
• National Service Framework for Older People
• National Minimum Standards
• Standards for Better Health
• The Dignity Challenge

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But what progress?
Daily Mail
Yorkshire Post
Runcorn Weekly News
The Daily Telegraph
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Questions

• Thoughts on national policy in relation to
  promoting dignity?
• What is the local response?

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Going forward - dignity in practice

Help the Aged dignity framework
Autonomy / choice Communication Eating and
nutrition End of life care Pain and symptom
control
Personal hygiene Personal care Privacy Social
inclusion
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Focus on eating and nutrition

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Measures of good practiceolder peoples views

Choice of what, when and where to eat
Availability of additional snacks
Respect for religious and cultural beliefs
Appropriate and sensitive assistance to eat
available when required
Presentation of food
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Focus on pain and symptom control

Residents who had experienced constant pain 40
Theres such humiliation in pain
A doctor or nurse had never talked to them about
how to treat pain 85
Never been asked about pain by nursing home staff
responsible for day-to-day care 57
Clare Rayner, OBE
Picker Institute 2007
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Measures of good practiceolder peoples views

Choice of types of pain relief
Opportunity to reject pain relief medication
Responsibility for own pain relief if desired
Appropriate and timely relief of pain/discomfort
Avoidance care practices that cause pain e.g.
hoists
Availability of a range of treatments to manage
pain
Staff ask about/acknowledge pain
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Safeguarding and promoting dignity

A new approach to involving older people
Making better use of complaints
Respect and recognition for staff and others who
care for older people
Advocacy
A new approach to education for staff working
with older people
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Safeguarding and promoting dignity

Policy levers
Practice

• Quality accounts and metrics
• End of life care strategy
• Care Quality Commission
• World Class Commissioning
• Ageing strategy
• Safeguarding

• Dignity champions
• RCN practice resource pack
• Essence of care benchmarks

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Questions

• Thoughts on approach
• Are the indicators right?
• What is the best way of capturing information?
• Is dignity currently assessed?
• Other areas for action?

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Help the Aged resources

• Research
• The challenge of dignity in care
• On our own terms the challenge of assessing
  dignity in care
• Practice guides Dignity on the ward
• Promoting dignity in hospital
• Working with hospital patients with dementia or
  confusion
• Pain and older people
• Death and dying
• Bereavement and loss
• Working with older people from ethnic minorities

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Thank you

• Charlotte.potter_at_helptheaged.org.uk
• www.helptheaged.org.uk