Standard 7: Privacy and dignity

Amara Dignity is one of those words that is easy to agree with and hard to pin down. Where is it actually lost?

Nadia Almost never through cruelty. That is the thing people get wrong. It is lost in small operational decisions that nobody records. The door left ajar. The commode in the lounge with a screen that does not quite reach. The conversation about somebody's bowels held across them as though they had left the room. The meal cut up without asking. The towel that does not quite cover.

Amara None of which anyone would defend if you pointed at it.

Nadia None. And that is why the fix is noticing rather than caring more. Everybody in the building already cares.

Amara Is there a regulation?

Nadia Regulation 10. Treated with dignity and respect, including privacy, support to be autonomous and independent, and involvement in the community. It is very short and inspectors use it constantly.

Amara Take me through a personal care episode properly. What should it look like?

Nadia Start at the door. Knock. Say who you are. Wait for an answer. Enter. Explain why you are there. Five steps, and I want you to do all five even when the person cannot answer you.

Amara Why, if they cannot answer?

Nadia Because you do not actually know what they take in, and because habits do not survive being switched on and off. The carer who knocks for everybody is the carer who knocks when it matters.

Amara And inside the room?

Nadia Door and curtains, both, not one. Expose only the part you are working on and cover it again before you move on. Keep saying what happens next. Offer the flannel so the person washes what they can still wash. And ask before touching, every time.

Amara Continence is the one I would find hardest to get right.

Nadia It carries the most risk of humiliation and the biggest reward for getting it right. Two absolute rules. Never discuss continence in a shared space. And never use the word nappy, or changed, about an adult. Pads are pads. Adults are supported.

Amara Now let me push. Independence takes longer. If I let Mrs Okafor wash her own face it adds four minutes, and I have eleven other people.

Nadia You are right, and I am not going to pretend the arithmetic away. Doing it for her is faster today and expensive over months, because function that is not used is lost, and in later life it does not come back easily.

Amara So what do I do with eleven other people?

Nadia Be targeted rather than heroic. Pick the tasks where independence matters most to that particular person and protect those. For most people it is eating, washing the face, and getting to the toilet. Protect three things properly instead of protecting everything badly.

Amara That is manageable. Last thing, and I want your honest answer. What do you see in services that everybody has stopped noticing?

Nadia Talking over somebody during a transfer as though they were furniture. Referring to people by room number, or by condition. Communal clothing that comes back from the laundry and goes to whoever it fits. Blanket bedtimes. Bowel charts on a wall. Care plans written about a person in the third person and never once shown to them.

Amara Some of that I have seen and said nothing about.

Nadia Everyone has, and here is why. You are only able to see it for about a fortnight. So if you are new to a service, write down everything in your first two weeks that would horrify a visiting relative. Keep that list. In two months you will have stopped noticing, and that list will be worth more than any audit the service ever commissions.