Remember the iconic Australian song from the early 80’s by Moving Pictures? ‘What About Me?’ … yes, sorry in advance for the flashbacks to bad eighties hair and a pretty ordinary video clip.
However, the song itself and the ‘voice’ it gives to this statement is one that sticks in my mind when I think about the new Aged Care Standard ‘Dignity and Choice’. There is a line in the song towards the end: ‘Can’t you see? I want to live!’ Just because someone is ageing or frail doesn’t mean they should be unseen, unheard and not respected. And just because someone is old doesn’t mean they are getting ready to die.
I am treated with dignity and respect, and can maintain my identity. I can make informed choices about my care and services, and live the life I choose. – Standard One
There was a lot of discussion generated within the Standards Advisory Group about the language used in this particular standard – including what it needed to convey. I’m sure there was a lot of discussion amongst other groups too, especially amongst consumer advocates and at pilot sites.
This Standard is essentially about the ‘me’, the person at the centre of the care and support.
What about me?
Let’s think about the person as ‘you’ or ‘me’. If you were in hospital or living in an aged care facility and needed to rely on others for care and support, would you like to be recognised as someone who has value, as a person with feelings, with a past and a life of meaning? Would you become frustrated, angry, or fearful if your dignity was compromised, if people ignored you, if you were not engaged or consulted about decisions that involved you?
I think the answer would be a resounding ‘yes’.
Let’s unpack this a bit further and look at the key words used in this Standard.
What does ‘identity’ mean?
All people are shaped by where they have come from, what’s happened throughout their lives, the relationships they have or had, the group and culture they have grown up in or been a part of. Our identity includes what we believe in, our language, family and community connections, gender and sexual orientation. Social, religious, spiritual and psychological elements also play a part in shaping who we are.
This means we are all ‘diverse’, unique and different in many ways.
We need to recognise that those we support will not be a homogenous group. Yes, there will be similarities through common shared experiences, however our support teams need to understand the ‘me’ in each of their clients and ensure the planning and delivery of care recognises and respects the person’s identity.
What does ‘respect’ mean?
When you google the term ‘respect’ there are a lot of descriptors and examples that come up. For example:
- Responding to individuals in a courteous, sensitive and caring way;
- Behaving in a way we would expect to be treated ourselves;
- Showing people respect and treating them with dignity;
- Treating people as individuals with individual needs;
- Involving people in decisions about their own care (courtesy of Wikipedia).
These are all great phrases. But how can they be translated into the care and support you and your team provide?
Would the following statements accurately describe your services?
Are you and your team culturally aware and show sensitivity to the person’s background? Are you mindful of their likes, dislikes?
- Are you accessing and matching staff to clients and are your staff aware of and upholding the individual’s preferences?
- Do you help your staff gain cultural competency?
Do you support the person to make informed choices about what their needs are and how they want to access support, such as:
- Resources that clearly describe services and supports in a format that is accessible to the person, e.g. in their language of choice.
- Providing the person with a range of options where possible and assisting them in identifying the best option for them, not your organisation.
Is information communicated sensitively, in a way that the person can understand, and is the person encouraged to ask questions as well as provide direction about the care they want?
- Do you have processes in place that help people to understand the care and support you provide, such as using interpreters or cultural brokers?
- Do you actively engage with consumers and ensure they are satisfied with the service they are receiving?
What about ‘dignity’?
Let’s revisit the example of being in hospital, as most of us have been there at one time or another, or have had a family member or friend end up there.
Would you like to be wheeled through Emergency or a Ward with nothing but a flappy gown on, to have everyone gawking at you as if to say, poor bugger, you look done for – I’m glad that’s not me!
Well, the same goes for a person coming into your centre for personal care. One of the most challenging things that we face as we age can be a sense of losing control, of not being able to do the things we used to do. Even within a person’s home when providing support to someone, we should be mindful that people want to retain as much independence and dignity as possible.
What might this look like in your service? Consider what a service that supported your own dignity might look like to you. Perhaps it would mean:
- A friendly service, one where people were polite and caring, who talked to you and practiced active listening.
- If you raised an issue or concern, it would be responded to in a way that showed people understood what you were asking and were happy to help you.
These are basic ways to show respect and support someone’s dignity and sense of self-worth.
What about ‘risk’ and how does this balance with choice, safety and control?
When we support people to actively make decisions, we need to recognise that it can involve an increase in risk.
While we want to try to minimise risk to vulnerable clients, don’t we all face and accept risk each and every day? It’s something we consider each time we decide on a course of action and we weigh up, often subconsciously, the pros and cons. There’s risk in driving a car, crossing the road, jumping in a swimming pool, getting on a pushbike, or lining up to do a tandem skydive. I’ve personally done all of these things and I weighed up the risk to me in those situations, then ‘exercised my choice’ to do them.
‘Dignity of risk’ respects a person’s wishes to do something that may have negative consequences. It supports the individual to make informed decisions. It can mean outlining (respectfully) where you and your service may be able to support them, and where you may not.
Let’s look at an example set in a small remote community.
Archie likes to walk to the local community store to get some of his groceries every couple of days. He has had some minor falls in the past, and can be a little unsteady on his feet. The local dogs can also get a bit over excited and the temperatures during summer often sit around the 40 degree mark, so there are a few risks to contend with. However getting out and walking to the store helps Archie feel independent and in control of his life. He can also meet and interact with other people along the way and at the store, which keeps him connected to his family and friends.
Sometimes we just have to be creative in the way that we manage risks, like getting Archie a walking stick to help him steady himself and wave it at any cheeky (aggressive) dogs that get too close. Maybe it’s making sure the Meals on Wheels driver keeps a look out for Archie on those really hot or cold days, offering him a lift home when he may need it. What about rostering a staff member or volunteer to accompany Archie on his walk? Perhaps it’s advocating to the Local Council to install benches along the route to the store to allow for rests.
Standard One is all about remembering that the person is still a person – they are just older.
I hope you have enjoyed this insight into Standard One ‘Consumer Dignity and Choice’ and my song pick. Look out for next week’s post when I take inspiration from another great tune for ‘Ongoing Assessment and Planning’.
This blog post is part of a series on the New Aged Care Standards, where we investigate how and why they were developed and take an in depth look at each of the Standards to give you ideas for implementing these effectively within your organisation. If this is of relevance to you and you’re not signed up for our short email alerts, fill in the quick form at the bottom of the page and we will let you know when the next post is released. We also send a monthly round up of blog posts and videos.
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