Dignity in senior care is on the minds of many healthcare professionals in skilled nursing centers, assisted living communities, home health care and hospice agencies. I have often stated when I present this topic to audiences of nurses, social workers, administrators and others, that I firmly believe no one drives to work each day contemplating how to deliver undignified care. That would be unethical and potentially illegal. While the vast majority of employees in senior care do their best to provide the best to their residents, things get in the way and obstacles to dignified care can unintentionally occur.
What is Dignity?
For most people, dignity is equivalent to respect and being worthy of something, such as nursing care or end-of-life care. Dignity involves behaviors like treating others without judgment, and as human beings. Dignity can also refer to privacy. Some experts believe that dignity is a psychosocial state of being – a complex combination of personal, social and interpersonal qualities and exchanges.
What is Undignified Care?
Some healthcare professionals may not be aware they are delivering care that might be viewed as undignified. For example, some care centers may still use overhead paging systems and use it late on second shift or early on third shift. This would be noisy and disrupt a resident’s sleep. Another example is talking to another employee while caring for the resident or assisting with meals, instead of interacting with the resident as well.
Other examples of undignified care, yet mostly unintentional, include:
- Lack of concern with gender differences
- Exposing the resident’s body
- Not using lap robes
- Looking at the clock or one’s watch while providing care
- Lack of thought about the resident’s appearance
- Leaving food on the resident’s face or clothing
- Dirty eyeglasses
- Soiled linens
- Discussing resident issues out loud in public areas
- Allowing facial hair on female residents
- Providing unpleasant food
More serious, and perhaps intentional acts of undignified care include the following examples:
- Negative attitudes from care staff
- Providing rushed care with no regard to the resident’s abilities or needs
- Leaving the resident’s needs for another shift to care for
- Disregarding call-lights
Obstacles to Dignified Care
Since the person-centered movement gained steam in the U.S., the first “big picture” obstacle to providing care that could be considered undignified is not embracing the philosophy that the resident’s need comes first and all else is second. There is no such thing as “person-second care”, and there never should be.
Another obstacle comes from human nature itself is complacency, or the attitude that the care provided is as good as it’s going to get. Any service or care delivered to residents in senior care can be improved. Still another obstacle rooted in human nature is the tendency towards conflict, especially among and between caregiver staff. Differences between employees have no place in a person-centered model of care, because it leaves out one important element – the resident.
Mood among staff members may also create issues in delivering dignified care, because their mood is the most important thing, not the resident. Another obstacle that may be somewhat common due to more severe forms of Alzheimer’s disease, dementia and various forms of mental illness involves caregiver annoyance with who they perceive to be “high-maintenance” residents.
Other obstacles to dignified care:
- No awareness that dignity issues exist
- Heavy caseloads
- Working short
- Organizational restraints
- Lack of resources
- Cultural differences
- Lack of training on dignity, sensitivity and resident rights
Final Thoughts on Dignity in Senior Care
To live a full and independent life and then require care in a senior community from staff who lack dignity in their approach should not be part of a resident’s daily experience. While the majority of healthcare professionals do their best to deliver high-quality care and services, human nature sometimes gets in the way of dignified care. That’s why it’s important to always keep dignity at the forefront of one’s mind and to continually strive to improve person-centered care… with dignity.
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