My Home Life & Care England Series: Thriving with Dignity

We’re on week 5 of our series shining a light on the ways that older people are flourishing in care homes, revealed in My Home life England’s ‘Thriving in Residential Care’ research.

Our penultimate theme is ‘Thriving with Dignity’:

Dignity is an important quality which shapes all dimensions of care. In our research series so far, we have so far seen how meaningful connections, inclusive practice and having choice and autonomy over what happens in one’s daily life are critical for the wellbeing and dignity of older people living in care homes. We now focus on aspects of dignity relating to personal hygiene and managing other aspects of daily living, such as household chores.

Care home manager Lynette recognised a “degree of self-neglect” in some of the older people in her care who had previously lived alone. Many of the older people we spoke to had been struggling with personal care and continence, but now had support with things like bathing and using the toilet. Having an ensuite bathroom was very important to some, including 84-year-old Rainee who said that getting to the bathroom by herself supported her independence. 94-year-old Angela laughed when she told us “that’s my best friend – the toilet!”.

Amina appreciated how the carers helped her to stay clean and dry, and how they put her pad on for her. 84-year-old Fifi also appreciate the support in managing her incontinence. When asked what good care meant to her, she replied, “The carers are a wonderful bunch. Unfortunately, I have to wear pads. So, they’re a big part of me wearing pads, which I didn’t want to wear, so I am very dependent on the carers, who, here, I must say do a wonderful job.”

86-year-old Margaret’s bath was previously replaced by an accessible shower, but now at her care home she enjoys a “lovely” bath twice a week. Bathing also appeared to offer an opportunity for creating caring bonds between older people and care team members. Care team member Nicole prided herself on her bathing care and had the nickname ‘Bath Queenie’, sharing “I like to make sure everybody always feels that little bit better when they’ve had a warm bath. I put on the ladies smellies and their creams, making sure it’s just the way they would have done beforehand.”

One of the most challenging, and often unanticipated, aspects of adult children providing care for a parent is having to attend to their personal care needs, and how intimate care can change the relationship between family members. However, with the right support from the care team, some family members found a role in continuing to provide intimate care for their parent, and this could be a bonding experience as it created new levels of trust, safe-touch, and connection, like for Gladys, who regularly brushed her mum’s hair.

Others emphasised the importance of physical appearance to their self-esteem, and the benefit of having easy access to services such as a hairdresser. Support with physical appearance is an often-underappreciated aspect of care, yet it seemed to play a critical role in supporting self-identity, and this in turn impacts on how likely someone is to engage socially with others.

Older people also told us about the importance of having support with tasks which were becoming increasingly difficult to do themselves, including household chores like laundry, and constantly making and re-making a bed. They really valued that these things were now taken care of; “I don’t have to worry about my washing, whether I’ve got heat or anything”; said Maureen, and 74-year-old Peter described his relief now that “everything is looked after”.

The greatest challenge to supporting dignity was for staff to remain person-centred working in a busy care home with routines and often depleted resources. Some older people spoke about there not always being enough staff to facilitate the routines they would like. For example, having to get up earlier or not being helped to shower at their preferred time. This was carefully negotiated in care homes as a matter of “compromise”, with care team member Elsie recognising “we’ve got a lot of people to look after”, but that “with the best will in the world, we try to fit around what everybody wants and needs”.

Discrete and sensitive approaches are important in helping people to feel comfortable and safe with intimate forms of care, and highlights the need to promote independence and person-centred, appropriate support. Being able to bathe as they wished and manage continence was vital for the wellbeing and dignity of older people living in care homes, further boosted by easy access to services like a hairdresser. Assistance with chores and laundry are often neglected when listing the benefits of a care environment but, for the older people in this study, this was one of the most commonly cited benefits of living in residential care, and allowed them to live with dignity.

In all the care homes we visited, we heard powerful stories of how, with the right support, people’s health actually improved. Our final article next week spotlights the theme of ‘Thriving Healthily’ all the way to end-of-life, and how the proactive and pre-emptive medical care provided by care homes is having a transformative effect.

At the end of the series, we are holding a webinar exploring how all these ‘Thriving’ themes can be embedded into care services. Sign up here.

To read the full report, please click here.