Dignity in Care: Innovations and Best Practices

Dignity in care means treating a person with respect and viewing them as an individual with universal human rights. Upholding dignity in a care setting is a fundamental cornerstone of patient-centred care.

Dignity in health and social care may look like:

• Using respectful communication at all times
• Treating people as autonomous individuals
• Respecting a person’s choices, preferences and lifestyle
• Ensuring that people have privacy, as far as is practicable
• Behaving in a caring and compassionate way

When a person requires care, whether that is due to old age, ill health, disability or some form of cognitive impairment or mental health challenge, maintaining their dignity is vitally important. Providing dignified care can improve patient outcomes, increase engagement, reduce resistance to interventions and lead to higher rates of patient satisfaction.

Current Challenges in Upholding Dignity

Common challenges faced by caregivers and institutions in upholding dignity include:

• Staffing shortages and high staff turnover in the care sector which results in a lack of continuity of care, people rushing to complete calls and not having the time to add that ‘human touch’
• Demographic changes across the globe that are putting increased pressure on the care sector
• Low pay – in the care sector wages are notoriously low, which often prevents skilled applicants from applying to certain roles
• Over-reliance on foreign labour in the care sector which can result in difficulties caused by language and cultural barriers
• Skills gaps and lack of training, especially regarding the importance of compassion, dignity and respect
• Resistance or interference from family members (even if this is well meaning)

Societal attitudes and perceptions towards the elderly or those with mental health challenges and disabilities can also affect the way dignified care is delivered.

The population is ageing across the globe; the number of people aged 80 and over is projected to rise from 126.5 million to over 446.6 million by 2050. In addition to people living longer, birth rates are falling in a number of countries including the UK, Singapore and Japan. This is causing concern for some governments including:

• Worry that there will not be a sufficient number of carers available to look after people in their old age
• The current state of the social care sector is unable to sustain these demographic changes
• Increased pressure due to ageing and shrinking populations may decrease the quality of care that people receive, resulting in less dignified care

Care is not delivered in exactly the same way in every part of the world and there may be societal and cultural barriers that influence the delivery of dignified care. Influential factors include:

• The perception of elderly care in some cultures (notably Southeast Asia and Africa) as being the job of family, resulting in resistance to accepting professional help and relatives taking on burdens they are not equipped for
• Economic factors, inequality and the level of government support allocated for at-risk populations
• Resistance to accepting mental health support or lack of understanding of mental health issues, especially amongst strict, religious communities
• Lack of comprehensive training and adequate resources for caregivers

Cultural and societal norms are not fixed and may shift or change over time. Innovations implementation of technology and digital tools may benefit those involved in the care sector leading to improved outcomes. Both societal and technological innovations can be used to support people’s wellbeing and help them to live more independently, with less intervention required from caregivers. However, to make the best use of technology within healthcare or social care settings we must ensure that it is both accessible and effectively implemented.

Innovations Enhancing Dignity in Care

Technology and digital tools are revolutionising the way care is delivered. Many older people report feeling distressed about having to move to assisted living; luckily, there are an increasing number of technological innovations that are allowing people to stay safely in their own homes for longer. For example:

• Ring cameras and surveillance cameras
• Door sensors
• Automatic medication dispensers
• Telehealth and e-health services
• Digital tracking apps

It is common for older people to struggle with mobility issues. Having to be physically moved, turned, placed into a hoist or wheeled around in a wheelchair by others can make people feel less dignified. Using technology such as phone calls or video calls for routine medical appointments allows people to have more comfort and less physical intervention from others.

It is important to note that older people may not be receptive or open to using technology or digital services. Some research out of Norway found that older people aged 75 and over reported that using new digital systems in healthcare made them feel more helpless and more dependent on others and that this dependence reduced their feelings of personal dignity.

It is important to consider that older generations who have not grown up as digital natives may find having to ask others how to use technology makes them feel less empowered and less dignified. Care has to be taken, therefore, on how such digital aids are rolled out and implemented to ensure that they are enhancing dignity rather than making elderly people feel more reliant on others.

Further research done by others has found similar results including how many of the older adults surveyed had concerns for their privacy and security when using technology or interacting with e-health services.

The above findings raise issues around privacy and consent. As new technologies are introduced in the care sector, it is important that consent is obtained and people are asked if they want to have, for example, a video call with their doctor rather than assuming they want to or telling them that they have no choice. Without consent, choice and autonomy, there is no dignity in care.

Best Practices for Maintaining Dignity in Care

Regulation 10 of the Health and Social Care Act 2008 sets out that all providers should treat their service users with dignity and respect.

Best practices for maintaining dignity in a care environment include:

• Understanding privacy and how to behave compassionately and appropriately in sensitive situations, such as whilst providing intimate care
• Improving training within health and social care and offering ongoing learning opportunities
• Actively seeking feedback from service users to gauge satisfaction levels
• Being culturally sensitive and treating people as individuals
• Making sure that carers have a fundamental understanding of appropriate communication methods and have good communication skills
• Encouraging a culture of continuous learning and a commitment to providing excellent service
• Understanding how to behave in relation to all of the protected characteristics in The Equality Act 2010
• Complying with the rules and regulations set out by the Care Quality Commission (CQC) and working in a collaborative way to deal with any shortcomings in care provided or any suggestions that arise after an inspection or complaint
• Having an open mind and a positive attitude
• Having an awareness of bias and stereotyping and avoiding them in day-to-day work

The six core principles of working in health and social care, referred to as the 6 C’s, have their part to play in maintaining dignity in care. The 6 C’s should underpin the training, education and work experience that care workers undertake. These six principles form the foundations of working in a person-centred way.

The six principles include:

• Care
• Compassion
• Competence
• Communication
• Courage
• Commitment

Using a person-centred approach to healthcare goes hand in hand with maintaining dignity. A person-centred approach includes:

• Treating a person as an individual
• Involving people (and their loved ones) in decisions about care and treatment
• Supporting a person’s autonomy by helping them to live independently
• Listening carefully and taking time to understand what a patient is saying
• Showing dedication and responsibility to your role as a carer
• Creating person-centred care plans for every service user

Examples of Successful Dignity Initiatives

The project ‘INNOVATEDIGNITY’ is a multimillion-euro project, financed by the European Commission. It involves experts in nursing from across the UK, Sweden, Denmark, Norway and Greece. Their aim is to collect research to educate the next generation with the skills and knowledge to ‘deliver innovations in dignified, sustainable care systems for older people, including new care models and digital applications’.

Their research will examine older people’s perspectives of care systems, focusing on several key areas:

• Dignity
• The potential for digital innovation that is person centred
• Exploring gender issues in care (including how they impact on leadership and delivery of care within the sector itself)

Additionally, they will analyse the efficacy of new care models on the wellbeing of older people.

Older people also report that they begin to feel invisible in society as they age. This is especially true when they have to make the move to assisted living and feel that they have lost much of their independence. There is little point in trying to make changes and improvements to improve dignity in care if the voices of the people at the heart of the issue are not heard.

The Titchfield Group on Ageing Statistics was created at the forty-ninth session of the United Nations Statistical Commission (UNSC) in March 2018. They collect data in connection with 58 National Statistics Offices/Systems from all around the globe.

Their aim is to improve data collection and harmonise international standards for collecting ageing-related data around the world. You can read the summary of their 2024 report on Improving the Visibility of Older Persons in Global Statistics here. Such reports are useful in giving a voice to older people and helping us consider the individual challenges they face in different parts of the world regarding issues such as health and care, violence, abuse and safety, participation in society and financial stability, all of which have an impact on dignity in old age.

These global organisations give us an insight into the experiences, feelings and perceptions of older people around the world and can help us to remove barriers or find ways to improve services to help them feel more seen and to live better and with greater dignity.

The Role of Policy and Advocacy

Advocates offer a voice to people who struggle to get their voices heard. They can put political pressure on governments and local authorities to improve standards in care and adopt better, more modern practices.

Advocacy plays a role in:

• Defending and safeguarding the rights of individuals
• Highlighting cases where failings have occurred and a person’s dignity has suffered as a result
• Lobbying for change to policies to make them more inclusive and effective

Although advocacy is vital for vulnerable people who are receiving care, workers within the care sector also need advocacy to ensure safe working conditions, adequate ratios and fair pay.

Care work is often stigmatised and seen as an unskilled, undesirable job. However, care work is vital in supporting the most vulnerable in society. Breaking these stereotypes and encouraging a new outlook that acknowledges the importance of care work may encourage more skilled and compassionate people to apply. It will also help those already in the sector to feel more valued and appreciated. In turn, this should improve standards of care, leading to better outcomes for patients and their families and more dignified care being delivered.

The Future Outlook

In the future, there may be a shift to a more holistic view of care that focuses on individuals as a whole, rather than focusing on the traditional care paradigm of personal and practical care delivered in conjunction with medical interventions, such as medication.

Using a holistic approach may mean an increased focus on overall wellbeing as a core part of care. This includes different aspects of a person’s life, such as:

• Spiritual or religious views
• Emotional and mental wellbeing
• Culture
• Political views
• Romantic/intimate relationships
• Family life
• Social life
• Physical life and desire to stay active

In order to promote a person’s wellbeing and ensure their dignity, it is vital that workers are able to consider all of the aspects that make up their identity, rather than using a more traditional ‘one-size-fits-all’ approach. This includes workers learning to be positive, empathetic and non-judgemental.

Further future trends in dignified care practice may include:

• Implementation of assistive technology, including surveillance, companion robots and artificial intelligence (AI)
• Making use of apps, games and virtual reality (VR) to enrich the lives of immobile or infirm individuals who may have previously only had four walls and a TV set to look at
• An increased focus on supporting the mental health and wellbeing of people who require care, including using a holistic approach
• The use of personalised, needs-based care plans as standard and a shift away from trying to fit service users into existing service models
• Further trials of less structured, more community-based care models such as the Landais Alzheimer village in France

If you work within the care sector, it is important to embrace change and work towards finding more dignified care solutions. This includes adopting innovative practices, staying up to date with current trends in the sector around the globe and advocating for change within your own organisation to enhance standards and improve outcomes.

Conclusion

Dignified, person-centred care is the type of care all institutions should strive to give, as standard. This means treating people as individuals, allowing them privacy and autonomy where possible and ensuring they have the opportunity to participate in enrichment activities.

By harnessing new innovations, especially those within technological and digital healthcare, care providers can enrich the lives of their service users, improving their wellbeing and helping them to feel more positive and valued. However, it is vital that this is done strategically, ethically and not at the expense of the safety or comfort of vulnerable service users.

We know that the global population is ageing, societal expectations are shifting and the future of dignity in care is subject to change. It is vital that all providers seek out and implement best practices and stay up to date with innovations to ensure that dignity remains at the forefront of the care they provide.