Dignity in Care: When the Routine Takes Over

I remember being a young carer and just knowing that you didn't talk over somebody while you were supporting them. You spoke to the person, involved them in what you were doing and treated them as an individual. Nobody needed to quote a regulation at me or explain what dignity meant. It just seemed obvious that the person sitting in front of you should be part of what was happening.

I think that's why I still notice it so much when I see the opposite now.

I've seen two members of staff helping somebody get ready while having a conversation between themselves about what they did at the weekend, what's happening on the next shift or who's covering lunch. The person they're actually supporting barely gets a look in.

I've also seen people moved through their morning in much the same way. Wash, dress, breakfast, medication, next person. I don't think people usually set out to be disrespectful. More often it creeps in when a service is busy, people are trying to get everything done and the work gradually becomes more about the tasks than the person.

This actually makes me cross! because somebody can have all of their care needs met and still be left feeling as though things were done to them rather than with them.

People receiving care still want the same things the rest of us want. They want a conversation, a laugh, an opinion and some control over what happens to them. They might want to finish talking before you start doing something, choose the green jumper even though the blue one is easier to get to, or simply be asked rather than told.

The problem is that once a routine becomes established, people can stop noticing how it feels to the person on the receiving end of it.

If everyone gets up in roughly the same order because that's what works for the shift, it starts to feel normal. If staff routinely talk across residents rather than including them, that starts to feel normal too. If somebody is hurried because there is still a lot to get through before lunch, eventually that can start to feel normal as well.

I've seen this happen in services where the staff were kind, committed and genuinely cared about the people they supported. That is exactly why it needs calling out. Dignity can slip in good services too, simply because nobody has stopped and looked at what has gradually become normal. We sometimes discuss dignity as though poor practice only happens where people don't care, but that isn't really what I've seen over the years.

If I were managing that service, I'd want to know what mornings actually looked like, not just whether everybody was up, washed, dressed and had eaten breakfast. I'd want to know whether Mary had been able to finish her cup of tea before somebody started helping her get dressed, whether Bill had chosen to get up at 7am or whether that's simply when staff got to him, and whether people were included in the conversations taking place around them.

A lot of this you only notice by actually being around the service. Sitting in the lounge for a while, walking through at breakfast, listening to how staff speak to people when they're busy and nobody thinks they're being observed.

I've learnt more about what life in a service is actually like from sitting talking to residents and relatives than I ever have from anywhere else. Those ordinary conversations often tell you a great deal about how mornings feel, whether people get enough choice and whether staff have time to stop and chat.

People don't always complain about these things. Sometimes they put up with them. They often assume that's simply how things work when you live in a care home, and get used to excusing it, I find that really hard to accept.

For me, dignity and respect have always been found in the everyday things. Knocking before entering a room and waiting for an answer, we wouldn't just walk into someone's house. Giving somebody time to speak and listening to them, taking a moment to ask rather than assume. Not treating every morning as a race to get everybody ready.

I still find it slightly mind-blowing that we have to train people to treat somebody with dignity and respect. Of course staff need to understand expectations, rights, communication and how poor practice can creep in, but surely the starting point should be more basic than that. The person in front of you is a person. Talk to them, include them, listen to them and treat them as you would expect someone to treat you.

I understood that as a young carer before I ever knew what Regulation 10 was,

and after all these years, I still think that's the best place to start. Not with the regulation itself, but with whether the person receiving support feels listened to, involved and respected.