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Ma Dignity In Care Presentation 2009 Slides


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A summary of the main findings from my 2008 MA in Applied Policy Research dissertation on dignity, older people, and care at home in Newcastle.

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Ma Dignity In Care Presentation 2009 Slides

  1. 1. Dignity, Older People, and Home Care in Newcastle Louise Reeve MA Applied Policy Research Dissertation
  2. 2. Introduction <ul><li>Title : “Dignity in policy and practice: Concepts of dignity and the provision of home care to older people in Newcastle.” </li></ul><ul><li>This project was done for my dissertation for my MA in Applied Policy Research at Newcastle University. </li></ul><ul><li>I will discuss: </li></ul><ul><ul><li>Why I chose this topic </li></ul></ul><ul><ul><li>How I conducted my research </li></ul></ul><ul><ul><li>Findings from academic literature and policy papers </li></ul></ul><ul><ul><li>What my interviewees told me about dignity </li></ul></ul><ul><ul><li>Implications for Newcastle City Council </li></ul></ul>
  3. 3. Aim of the project <ul><li>Why chose dignity, older people and home care? </li></ul><ul><li>Increased aging of the UK population. </li></ul><ul><li>Recent strong emphasis in policy on dignity for those receiving health and social care. </li></ul><ul><li>Home care is relatively under-researched, yet at the same time becoming increasingly important. </li></ul>
  4. 4. Facts and Figures <ul><li>There are now more people aged 65 and over in the UK population than people aged 16 and under (ONS). </li></ul><ul><li>Some projections suggest that the proportion of the population aged 65 and over will rise from 21% in 2001, to 25% in 2050. </li></ul><ul><li>Projected 60% rise in people aged 85 and over by 2027. </li></ul><ul><li>In Newcastle, there are 41,300 people aged 65 and over – 15% of the total population (Census mid-year estimate). </li></ul><ul><li>Of this group, 5,700 are aged 85 and over . </li></ul><ul><li>2,091 older people currently receive care at home from Newcastle City Council. </li></ul>
  5. 5. Why study dignity and home care? <ul><li>“‘ Though home is the principal site for the delivery of community care, it has remained under-theorised and under-researched.’ (Prof. Julia Twigg, 1999). </li></ul><ul><li>2006 : Launch of the dignity in care campaign. Broader definition of dignity: </li></ul><ul><ul><li>2005 Green Paper: “Keeping clean and comfortable. Enjoying a clean and orderly environment. Availability of appropriate personal care.” </li></ul></ul><ul><ul><li>2006 Dignity Challenge: “A state, quality or manner worthy of esteem or respect; and (by extension), self-respect. Dignity in care, therefore, means the kind of care, in any setting, which supports and promotes, and does not undermine, a person’s self-respect regardless of any difference.” </li></ul></ul>
  6. 6. Why study dignity and home care? <ul><li>2007 : “Putting People First” ministerial concordat. </li></ul><ul><li>Transforming adult social care: </li></ul><ul><li>“ In the future, we want people to have maximum choice, control and power over the support services they receive.” </li></ul><ul><li>Strong emphasis on personalisation and individual choice: “There is nowhere else I’d rather be [than in my own home] …I’m the one who’s in charge around here” </li></ul><ul><li>(Older person quoted by Dr R. Kane, 1999) </li></ul><ul><li>Thus, home care is likely to become increasingly important both due to an increase in the number of older people in the population, and because giving people control over their care will often mean enabling them to stay in their own homes. </li></ul>
  7. 7. Aim of my research <ul><li>Aim : </li></ul><ul><li>“ To explore the extent to which concepts of dignity expressed in central government policy papers on home care provision to older people reflect how dignity is understood by both older people receiving home care, and the care workers who provide it.” </li></ul><ul><li>A local need for this work: </li></ul><ul><li>“ The definition of dignity lacks clarity and needs to be defined in a clearer way, as it includes a spectrum of things from being disrespectful in not introducing oneself to a service user……………. to not abusing them.” </li></ul><ul><li>(2007 report to Health & Adult Services Scrutiny Panel.) </li></ul>
  8. 8. Methods <ul><li>Review academic literature on dignity, older people and home care. </li></ul><ul><li>Review central government policy papers (such as the SCIE “Practice Guide 9”.) </li></ul><ul><li>Conduct 10 semi-structured interviews with five older people and five workers from Newcastle’s Care at Home service. </li></ul><ul><li>Compare findings from both. </li></ul>
  9. 9. Concepts of dignity from previous research <ul><li>2004 Dignity and Older Europeans Project: </li></ul><ul><ul><li>Dignity of identity : “The dignity that we attach to ourselves as integrated and autonomous persons, persons with a history, and persons with a future with all our relationships to other human beings.” (Dr Lennart Nordenfelt) </li></ul></ul><ul><ul><li>Intrinsic worth : “A dignity belonging to every human being to the same degree all through his or her life.” </li></ul></ul><ul><li>2004 Jacelon et al: </li></ul><ul><ul><li>Reciprocal dignity : “When one behaves with dignity, others respond in like manner”. </li></ul></ul><ul><li>2004 Woolhead et al: </li></ul><ul><ul><li>Respecting autonomy : “’…They [social services] want you to do exactly what they want you to do, and that’s what I have really objected to’” (Older person). </li></ul></ul>
  10. 10. Concepts of dignity from policy papers <ul><li>Earlier we saw how definitions of dignity have been broadened. </li></ul><ul><li>The Dignity Challenges – aspects of dignity: </li></ul><ul><ul><li>No. 2 : “Support people with the same respect you would want for yourself or a member of your family”. </li></ul></ul><ul><ul><li>No. 3 : “Treat each person as an individual by offering a personalised service”. </li></ul></ul><ul><ul><li>No. 4 : “Enable people to maintain the maximum possible level of independence, choice and control”. </li></ul></ul>
  11. 11. Findings 1: Dignity as empathy <ul><li>I asked what people thought about the idea that good care is care you would be happy for a family member to receive. </li></ul><ul><li>“ Do our policies and practices emphasise that we should always try to see things from the perspective of the person receiving services?” </li></ul><ul><li>(Practice Guide 9) </li></ul><ul><li>Both older people and care workers agreed with this: </li></ul><ul><ul><li>“ I know I pay them, but they want as much respect from us as we do from them” (Older person) </li></ul></ul><ul><ul><li>“ I wouldn’t [like it] if it was someone coming to my home every day and going through my cupboards and wardrobe …You always remember that it’s somebody else’s home.” (Care worker) </li></ul></ul><ul><li>Is there enough time for this to happen – for care workers to carry out their “invisible labour”? </li></ul>
  12. 12. Findings 2: Dignity and autonomy <ul><li>Good care helps older people to exercise their “decisional autonomy” – their control over their lives. </li></ul><ul><li>Putting People First objective: “Supporting people to remain in their own homes for as long as possible.” </li></ul><ul><li>An older person’s own home is where they have ownership of what happens in a way that is not possible in other settings. </li></ul><ul><li>Good home care enables them to maintain this control: </li></ul><ul><ul><li>“ You’re there to help, not to take over.” (Care worker) </li></ul></ul><ul><ul><li>“ Not overstepping the boundaries by just sort of doing things …You don’t just put it [washing] in, you’ve got to remember to ask them, ‘Do you want this washing machine on yet?’’ (Care worker) </li></ul></ul><ul><ul><li>“ If you see them struggling a little bit, you go, ‘Right, I’ll just give you a little hand’ …they’re actually letting you help them, without you taking that little bit of independence off them.” (Care worker) </li></ul></ul>
  13. 13. Findings 3: Dignity and cleanliness <ul><li>There was a strong association between dignity and appearance, and dignity and cleanliness, for most of the people I interviewed: </li></ul><ul><ul><li>“ Would you like to be seen going from there to there with no clothes on?” (Care worker) </li></ul></ul><ul><ul><li>“ They wouldn’t leave me standing without covering me.” (Older person) </li></ul></ul><ul><ul><li>“ I don’t want my family coming round, and I’ve got my night attire on.” (Older person) </li></ul></ul><ul><ul><li>“ There is a lady who we go to, she’s still got her dignity, she still takes pride in her [appearance] …I put her make-up on for her in the mornings.” (Care worker) </li></ul></ul>
  14. 14. Findings 4: Personalisation and Dignity <ul><li>I asked about personalisation in the context of care workers varying the tasks they performed for their clients from visit to visit. </li></ul><ul><li>Patmore & McNulty: </li></ul><ul><li>“ Sometimes home care staff added thoughtful, ‘person-centred touches’ … a very disabled, housebound interviewee described how, on sunny days, home care staff would move his bed to the balcony, which he much appreciated.” </li></ul>
  15. 15. Findings 4: Personalisation and Dignity <ul><li>Generally speaking, when I asked about this, care workers stressed that they aimed to stick to the Care Plan: </li></ul><ul><ul><li>‘ Last week I was asked by a lady: ‘The other carer went to the fish shop for me last Tuesday, I like fried fish on Tuesday’ and I said ‘I’m sorry, I can’t do that, it’s not in the care plan’ …It’s drummed into us in training.’ (Care worker) </li></ul></ul><ul><li>Their reasons for this were as follows: </li></ul><ul><ul><li>“ You come out and you feel awful, but …if we did it for everybody, then we would be in from half past seven in the morning, and we never would get a break.” (Care worker) </li></ul></ul><ul><ul><li>“ They said to me when I started: ‘As much as you get close to your clients, what you have to remember is, when you go out of the door, you have to have your own life’. And I’ve always tried to do that.” (Care worker) </li></ul></ul><ul><li>This may be why several care workers said that, if it was possible, they would want to spend more time with their clients: </li></ul><ul><ul><li>“ Interviewer: ‘If you were trying to make things better for older people getting care, what you think would be important?’ </li></ul></ul><ul><ul><li>Care worker: ‘More time. More staff… it would make things a lot easier for them and for us.’” </li></ul></ul>
  16. 16. Findings 5: The Care at Home service <ul><li>The continued importance of regular care workers: </li></ul><ul><ul><li>“ My [health] condition can be very uncomfortable, so there’s certain ways of doing things that helps …they’re very good, they do make a difference to me.” (Older person) </li></ul></ul><ul><li>The continued importance of clear communication about changes in care: </li></ul><ul><ul><li>“ It just seems to be a pity that it happens every time their own people are off [regular care workers], there seems to be confusion.” (Older person) </li></ul></ul><ul><li>The need to increase older people and care workers’ feelings of being supported by “the office”: </li></ul><ul><ul><li>“ I haven’t seen a senior worker in my home for at least two years.” (Older person) </li></ul></ul><ul><ul><li>“ Sometimes I would like a bit more support from the office.” (Care worker) </li></ul></ul><ul><li>Can more time be given? Or could other services help to meet older people’s needs? </li></ul>
  17. 17. Conclusions 1: What have we learned? <ul><li>“ Dignity as empathy” is a good working definition: </li></ul><ul><li>“ The test I [have] frequently applied; if it wouldn't be good enough for my mother or father then it shouldn't be good enough for somebody else's loved one.” (Ivan Lewis MP) </li></ul><ul><li>Respecting dignity involves respecting people’s autonomy at every stage – from supporting them in their home to remembering to ask before putting the washing machine on. </li></ul><ul><li>Do care workers and older people have enough time together to allow care workers to get to know their clients and their personal needs? </li></ul>
  18. 18. Conclusions 2: What to do now? <ul><li>Consider the wording of the definition of dignity which Newcastle City Council and our partner organisations want to adopt. </li></ul><ul><li>Consider how best to provide training on dignity to care workers – look at exploring different aspects of dignity through role-play and hypothetical situations? </li></ul><ul><li>What are the needs of older people, and is home care always the best way to meet them – what other services are able to assist? </li></ul>
  19. 19. Thanks to everyone at Newcastle City Council who assisted me with my research, and to my interviewees.