PEACH: Promoting Excellence in All Care Homes

The Promoting Excellence in All Care Homes study focuses on the position of staff in care homes, and the influences upon them. The care home workforce has a pivotal role in the quality of care provided to residents of care homes, which in turn is a major influence on quality of life. This large work-force, of probably over a half a million people, carry out work that is often seen as unattractive, at rates of pay that are seen as under-valuing the contribution made, without a clear career structure, in a sector that is marked by constant change. Individual staff members are influenced by their personal attributes and resources, their own families, relationships and social networks, but also by the social climate in their work-place and by the organisational environment. Burn-out and low job satisfaction have been related to negative attitudes to residents and lower quality of life. The sector often attracts unfavourable publicity in relation to reported instances of abuse and neglect, although estimating the extent of such problems is challenging. Training is often viewed as a vehicle for reducing the risk of abuse and neglect, and to increase the value afforded to those undertaking this work

Dignity on the wards: improving hospital care for older people

Despite improvement in the care and experience of older people being prominent features of NHS health policy over recent years, a number of high level reports show the effectiveness of such policy initiatives has been limited and the provision of dignified care for older people remains difficult to translate into practice

Clarifying the concept of human dignity in the care of the elderly: A dialogue between empirical and philosophical approaches

The need for dignity is frequently mentioned in policy documents relating to the care of the elderly. It is also described as an important value in professional codes. Yet concerns about the standards of care for an important number of elderly people abound, despite global ageing being a challenging phenomenon. Not least among these is how to ensure that the elderly will be able to live out their days with dignity. In the present paper, we begin with an empirical exploration of the meaning of human dignity as experienced by older Europeans and their professional caregivers. Thereafter, we discuss the meaning and relevance of these empirical research findings from a care ethics perspective

‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals

Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs