Safeguarding dignity is one of the key features of successful integrated care for older people living at home. When a user’s (client’s) dignity is compromised, emotional reactions, such as anger, anxiety, and embarrassment may follow. This hinders the safety or well-being of everyone involved, including the user.
These 5 activities are outlined in the Roadmap, a practical representation of the research findings of the European project, SUSTAIN. This collaboration addressed the question, ‘How to improve integrated care for older people in Europe who are living at home?’ Vilans was involved in the research. You can find the extended version of the feature, ‘Safeguarding dignity’ in book 1 of the Roadmap, ‘Design of integrated care’.
Human dignity is inviolable
Despite the good intentions of care professionals, older persons still often find themselves in situations that breach their dignity and lower the standards of the care provided. They experience, for example, the inability to make decisions about their own lives, insufficient access to care, and negative consequences as a result of wrong assumptions. This is caused by stress, time constraints, and a lack of resources and skills among those caring for them. However, in the European Charter of the rights and responsibilities of older people in need of care and assistance, it is stated that human dignity is inviolable. It is therefore essential to safeguard dignity by implementing the following activities:
1. Conflict management – is important not only to maintain the quality of relationships among staff members, but also between the staff and users. This helps to achieve better outcomes in user satisfaction. Effective conflict management can make the difference between difficult situations and intolerable ones.
Examples from practice: Although none of the SUSTAIN improvement projects dealt with conflict management, the intervision meetings in the Netherlands helped to prevent conflict by encouraging discussions to increase understanding of each other’s roles and to limit misunderstandings among professionals.
2. Ensuring access to information about health and well-being – this means enabling users to freely access, use, and determine with whom this information is shared. Research shows that having access to their records can help users better communicate with professional staff, enhance knowledge about their health, and improve self-care. This is a positive step that will lower administrative barriers that aim to protect information providers.
For instance, in an Estonian improvement project, users could decide which professionals in the health sector would be able to view their records.
3. Fostering dignified care environments – by environment, we refer to the context in which the care activities are delivered. As people grow older, they spend relatively more time in their homes. They therefore develop strong cognitive and affective ties to their home environment, in which their sense of privacy and freedom can easily be violated.
An example from practice: the experience in Swale, UK with the ‘Home First’ project, showed that there is a need for professionals to be flexible in their approach to the user. Several users felt that some of the professionals who provided enablement service at home, lacked compassion. Although the project began with the aim of conducting an assessment within 2 hours of the patient’s return home, the care professionals realised during the process, that for some patients, this was not necessary or important. And for others, they even experienced that it was not appropriate because they were too exhausted.
4. Community consultation and outreach – these are the measures taken by services to investigate
the needs of the populations served. It is a form of outreach to the community to explore ways in which care can be expanded, strengthened, and improved. This ensures that services are tailored as closely as possible and contribute towards co-creation. This can be achieved by community consultations, including user-representatives in the governing bodies, and designating staff to network and develop intelligence about the community.
An example from practice: in an improvement project in Estonia, the manager takes an active role in providing input to the local authority on what is needed for the service to thrive. In turn, this manager also benefits by gaining insight into resources based on the input from other service providers attending those consultations.
5. Reflective practice and positive attitudes – is about care professionals going back over the events of the day, and critically examining and analyzing how they ensured safety, a positive user experience, and effectiveness of care. Reflective practice is particularly important for learning during complex problem-solving scenarios because it provides staff with an opportunity to assess if they could do things differently, and how they can improve their strategies. Care professionals highlighted positive attitudes in interviews as being important in driving these improvements.
For instance, the steering group of SUSTAIN carried out reflective practice. In each meeting, different participants would talk through cases, describe the experience from their point of view, and identify what worked well and what didn’t.
In the European project SUSTAIN (Sustained Tailored Integrated care for Older People in Europe) researchers, policy advisors and other partners from eight participating European countries analysed initiatives in the field of integrated care for older people living at home. The Roadmap is their end-product and enables policy and decision-makers to design and improve integrated care in their own community.
The SUSTAIN project was funded under Horizon 2020 – the Framework Program for Research and Innovation (2014-2020).