A Dignity Code for Older People?

Old hands

The Daily Telegraph today prints a letter which sets out the need for a ‘Dignity Code’ in Health and Social Care calling on Hospitals, Care Homes and other institutions to prevent ‘issues of abuse and neglect’.

The article accompanying the letter, the Telegraph says, will encourage care workers to have this code written into their contract.

It is a laudable aim.  The letter itself says

“For too long, too many of those people have been ignored, denied the basic right to speak for themselves or make up their own mind,” the letter warns. “In this era of human rights, too many older people have seen their basic human dignity undermined in situations where they are treated as objects rather than people.”

Very hard to disagree. The article which is definitely worth reading goes on to describe the litany of poor treatment meted out to older adults in our society where abuse and neglect seem to be profligate.  And, the article helpfully tells us that those who sign this, the ‘great and the good’ of the sector, are demanding that this abuse and lack of dignity stop.

Ok, to a letter saying that abuse is a bad thing and should stop isn’t exactly earth-shattering.

What I want to know is what those who sign up to this letter intend to actively to about it other that write out a ‘code’ of conduct for care workers.

Does Paul Burstow, a proud signer, include the need to put more money into care for older adults – remember Mr Burstow, he’s the one who said there was ‘no funding crisis in care’, but to cut him some slack for a moment, money isn’t the only issue regarding dignity – however in a care system that does consistently regard older people as commodities, it is not hard to see how this objectification came into play.

I’m sure Burstow would bleat about personalisation and his desire to move everyone onto direct payments. I would reply that yes, this is a wholly laudable goal which should be encouraged and potentially allows a geniunely different way of regarding people who use care services but as long as I see local authorities stick to the same ‘managed budgets’ with ‘block contracts’ type of support package with no alternative options for older adults (particularly those who might lack capacity to manage budgets and not have family/friends/advocates to assist) this will just be cheap talk.

So what will actually improve the consideration that older people have in hospitals and in care homes?

Old couple

I have some ideas – but they may involve money, I’m afraid, Mr Burstow. Let’s see if your money is where your mouth is.

  • Increased and mandatory use of advocates – particularly for those who don’t have family.  Help people to know about their rights to decent and humane treatment. Allow safe complaints to be made. This should be accessible within hospitals and care homes and must include, as a priority, non directed advocacy for those who lack capacity.
  • On a related issue, I would  appoint a ‘champion’ in every care home and hospital. This must be someone absolutely committed to the care of older adults who can speak to the people who use the services and complain in more general terms. Ideally it would be someone independent.  These would be people on the ground at all times. The difference with an advocate is that this person would be responsible beyond the individual for the group experiences of care.
  •  Improve information and accessibility for family carers where they are around. Improve support for carers. It is one of those areas where you spend more to save more – improving quality of life along the way.
  •  A wider societal appreciation of older adults. This takes longer and is a part of the longer term goal. Age doesn’t have to be feared and certainly isn’t to be swept under the carpet in the hope that it will go away. We need to regard older people as individuals worthy of respect and not ‘burdens’ on the state. While people discuss the ‘crisis’ of the ‘ageing population’ we are at risk of shifting blame onto those who are older and unwell.

Similarly, the setting off of ‘baby boomer’ generation against today’s youth sometimes encourages rather than closes these generational gaps. There is more than unites us than divides us.

I made a somewhat flippant comment a few weeks ago relating to the BBC documentary ‘Protecting our Children’ about child protection social workers in Bristol wondering if there would ever be interest enough in a parallel ‘Protecting our Parents’ type programme which looks at the work which goes on in Adult Safeguarding. Of course it was a rhetorical question.

I would have concerns about programmes which reflect painful realities in the lives of the people filmed and have a certain ethical concern with a fly on the wall programme which would show these matters so I don’t want to see such a programme commissioned  but on a broader matter, safeguarding work in adult social care (which I do a lot of, for the record) doesn’t carry the same emotive pulls.

I think there’s an inherent human fear of the ageing process. I feel it myself. Some people like to think it will never happen to them. Or their parents. Until it does. As a society we really need to face up to how our system treats older people and the inherent ageism that exists that allows different standards to exist for abuse dependent on the age of the person who is violated.

When we eliminate ageism, we eliminate the need for a dignity code. Until then, it feels like lip service from the top to castigate care workers and nursing staff at the bottom of the ‘chains of command’ so politicians and leaders can absolve themselves of the responsibilities they face in creating systems that lack such dignity.

The old fisherman

Photos by daoro, fatseth and  Filippo Maver

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3 thoughts on “A Dignity Code for Older People?

  1. This has been done to death before only a couple of years back – in fact the stickers and posters are still around on notice boards. As James Naughty so aptly put it on the Today programme this morning ( I paraphrase) if staff already treat old people with dignity they dont need to be told to, and if they dont, no amount of stickers, champions, training courses e-petitions or buzzwords will make them.

    I would go further and say that as a social care person I have found all the lectures about personalisation, dignity etc over the past few years pretty ruddy patronising.

    How about paying a decent wage to care workers for a start so homes can be a bit more selective about who they recruit? or enough community hospital beds so that my neighbours brother, who has just had a stroke and suddenly been found not to need any rehab ( although they thought a couple of days ago that he did) isn’t dumped back in his flat without a careplan despite his obvious mental confusion.

  2. Yes, the elderly gentleman who was carried through my grandfather’s ward at the Hastings Conquest hospital at the weekend naked from the waist down for all to see would agree, I’m sure.

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