What intimate care teaches us about dignity

Caroline's research focused on one of the most intimate and least discussed aspects of long-term care: bathing assistance in nursing homes. Through years of ethnographic fieldwork, she not only observed care workers and residents, but also became a trained care worker herself, experiencing first-hand realities of intimate care. 

Dignity begins with recognizing the person not just the care task  

Helping someone to bathe, get dressed or use the toilet is among the most intimate forms of support provided in nursing homes. These activities involve evading the privacy of the person in need of care, require close physical contact and often take place when people are at their most vulnerable. 

Yet, while intimate care is a routine part of everyday practice, it receives relatively little attention in discussions about the experience of dignity of the care recipient as well as the care provider.  

For her ethnographic research, Caroline sat out to better understand what happens during these moments. Through observations, interviews and participatory fieldwork in nursing homes in Hong Kong, she explored how residents and care workers experience bathing care and what this can teach us about dignity. 

Caroline found dignity to be deeply connected with mutual respect. Drawing on philosophical perspectives on human dignity, she argues that dignity is present when residents are recognised and treated as individuals, regardless of their physical or cognitive condition. 'As long as the body is respected, there is dignity. Dignity is not necessarily about status or material conditions. It begins with recognising someone as a person.'

Whether residents were fully aware of their surroundings or living with dementia, the way the care was provided mattered deeply. One resident once told Caroline that bathing often felt purely functional. 'She [the resident] told me it felt like cleaning dishes. Taking off clothes, washing, and drying. She wanted something gentler, more respectful, something that recognised her as a person.' For Caroline, the message was clear, dignity is not only what care achieves, but also how care is delivered. 

Intimate care creates a unique ethical challenge 

One of the central concepts in Caroline's work is what she calls 'intimate objectification'. The term describes a paradox at the heart of personal care. To carry out personal intimate care safely and professionally, care workers often need to focus on specific physical tasks. Attention must be directed to practical tasks: washing skin, preventing falls, moving limbs or checking for injuries. In that sense, the body becomes an object of professional care. Yet reducing someone to a body alone would undermine the very dignity that care is meant to protect.  

'The body is often the focus of how care tasks are organised in practice, but it should never be separated from the person.' During her fieldwork, Caroline discovered that this conflict exists at multiple levels. She emphasised that intimate objectification is not simply the result of individual interactions between care workers and residents. In her view, it is also connected to broader societal and organisational developments. She points out that activities such as washing, dressing and personal care were traditionally often provided by family members or relatives. Today, much of this support is delivered by professional care workers within formal care organisations. 

This shift has brought many benefits, including access to specialised care and support. At the same time, it means that intimate care increasingly takes place within systems that heavily rely on schedules, procedures and professional responsibilities. In such settings, care workers are expected to complete a series of essential tasks within limited time. This can encourage care workers to focus on the practical aspects of care and have less room to engage with their own feelings and the person's identity and experience.  

From this perspective, intimate objectification is not merely an interpersonal issue. It is also related to the way contemporary care systems are organised around tasks, routines and responsibilities. 

'The ethical tension remains. It exists body after body, person after person. We first need to recognise these dynamics before we can improve them.' Furthermore, Caroline experienced that intimate care can confront caregivers with nakedness, bodily fluids, unpleasant smells and other situations that may evoke discomfort or feelings of disgust. In such moments, focusing on the body as an object can help care workers carry out these essential tasks. Yet this same mechanism can also create distance from the person receiving care, again illustrating the central paradox of intimate objectification. 

Care workers need recognition and pride 

While discussions about dignity often focus on residents, Caroline believes that care workers deserve equal attention. Bathing assistance is physically demanding, emotionally complex and often invisible work. Yet current systems typically measure only completed tasks and hours worked. 

Caroline argues that organisations should explore ways to recognise care practices more explicitly. Care workers who consistently demonstrate compassion and professionalism should receive visible acknowledgement. 'If someone provides outstanding care every day, why shouldn't that be recognised? Pride grows when good care becomes visible.'

Caroline reiterated that strengthening the professional and personal identity of care workers ultimately benefits both care recipients and care professionals. 

Technology should support relationships, not replace them. 

Caroline's dissertation resulted in 22 design guidelines for creating more ethical and dignified care environments. Technology plays a role in several of them, but not as a replacement for human contact. Instead, technology should reduce unnecessary exposure, support privacy and strengthen relationships. 

For example, she sees potential for smart monitoring systems that improve safety without invading personal privacy. 'What if technology only tells us that someone is safe, without showing intimate details of what happens inside the bathroom?' 

She also suggests systems that allow better matching between residents and care workers, helping people receive care from someone they know and trust. Another opportunity lies in documentation tools that protect both residents and professionals. However, she emphasises that dignity must remain the starting point for innovation. 'Technology should be designed around human dignity, not efficiency alone.'