2.2 The principles underlying daily life in a
continuing care setting
Some basic principles underlie the rights which should be accorded
to all who find themselves in the care of others.
2.2.1 Respect for privacy and dignity
The importance of preserving the privacy and dignity of residents
should be paramount. This means that they should have their own
individual private space and the opportunity to choose how they
dress, what they eat, when they go to bed and get up and how they
spend their day. Dependence on staff for help with personal care
should not mean that their dignity is compromised or that their
privacy is not respected. Residents should be treated as adults,
never as children. Staff should always avoid adopting patronising
attitudes and behaviour towards residents. Residents should determine
how they want to be addressed by staff, other residents and visitors
to the home.
2.2.2 Maintenance of self-esteem
The preservation of self-esteem amongst those who depend on the
support of others hinges upon the status they are accorded. Staff
and management should not make the mistake of seeing residents
only as frail old people who simply need help. They should value
the contribution which individuals with their personal qualities,
talents and rich experience of life can make to the life of the
home. Residents' self-esteem will be enhanced if they feel valued
and in this way their morale will be maintained. Staff should
treat residents courteously and respect their privacy and their
right to hold and express opinions or to keep them private.
2.2.3 Fostering of independence
It should be assumed that residents can look after themselves
and handle their own affairs until it has been shown otherwise.
They may need time to do things themselves but staff and relatives
should resist the temptation to 'take over' unless absolutely
necessary; otherwise they make residents unnecessarily dependent.
2.2.4 Choice and control
Wherever possible, residents should be able to make for themselves
the major decisions affecting their lives. They should also be
able to choose how they spend their time from day to day. For
example, this means that individuals should be free to decide
how far they participate in the common life of the home and how
far they maintain relationships with family, friends and the local
community. This exercising of choice is a right which will often
require a partnership between resident, relatives and staff in
which choices can be negotiated. Some residents particularly
those who are very frail and vulnerable will need help to express
their wishes and preferences. All residents should have access
to external advice, representation and advocacy. Even deeply held
views and aspirations may not be expressed if staff do not encourage
such links outside the home. Residents should have opportunities
for emotional and sexual expression and for intimate and personal
relationships within and outside the home.
2.2.5 Recognition of diversity and individuality
Even though residents are living in a home with other people,
they remain individuals with their own likes and dislikes. Staff
should be responsive to the requirements of individual residents
and not merely impose regimes which are dictated by the needs
and preferences of the majority of residents or implemented for
the convenience of managers, staff or relatives. Ethnic, cultural,
social and religious diversity should be recognised as an integral
part of home life. Residents should feel that their needs will
be responded to willingly by staff who understand the value of
maintaining a sense of continuity and identity based on past traditions
and practices. For their part, living in a community with others
requires that residents should recognise and respond to the rhythms
and needs of other people. It may be helpful for residents to
have some knowledge of the life experiences of staff to act as
a bridge between them. This emphasises personal connections outside
the home and their relevance to those within.
2.2.6 Expression of beliefs
Opportunities should be made available for religious and political
beliefs to be expressed and pursued. This may involve observing
particular dietary and dress requirements and facilitating practices
such as prayer and contemplation which require privacy and quiet
or enabling residents to attend places of worship. It may include
displaying posters at election time.
2.2.7 Safety
Residents should be kept safe and feel safe. Wherever possible,
fears and anxieties should be acknowledged and relieved while
recognising at the same time that over-protectiveness and undue
concern for safety may lead to infringements of personal rights.
2.2.8 Responsible risk-taking
Responsible risk-taking should be regarded as normal and important
in maintaining autonomy and independence. Residents should not
be discouraged from undertaking certain activities solely on the
grounds that there is an element of risk. The balance between
risk and safety has to be carefully maintained. Anxieties raised
by staff and relatives should be discussed, where possible, with
the individual resident concerned and agreement reached which
balances the risks against the individual's rights.
2.2.9 Citizens' rights
Living in care does not in any way reduce residents' normal rights
to statutory health and social care services. Neither are their
other rights participation in the general civic and democratic
process, access to information and so on diminished. Residents
should be enabled to vote in elections if they wish to do so,
in person, by post or by proxy, with full confidentiality assured.
Homes which cater for a specific group of people should ensure
that admission and administrative procedures are not in conflict
with any law such as, for example, the race relations and equal
opportunities laws. In all matters, the criminal and civil law
apply. Some aspects need special vigilance for example, protection
against and prevention of abuse, theft, exploitation and fraud.
Each resident should have a formal agreement (provided by the
homeowner or the care manager if the formal contract is held by
the social services/work department) setting out the care to be
received in the home, the conditions of residence and the fees
payable.
2.2.10 Sustaining relationships with relatives and friends
A good home values the role which relatives and friends can continue
to play in the lives of residents. Their participation should
be encouraged wherever residents wish it and their contribution
recognised as an important part of the residents' care.
2.2.11 Opportunities for leisure activities
Provision for leisure activities in and, where appropriate, outside
the home is essential. This should be sensitive to individual
tastes and capacities and flexible enough to match them. Resources
existing in the neighbourhood should be engaged to help meet the
needs of residents. The quality of life in a home will be enhanced
by inclusion of the widest possible range of normal activities,
particularly those with which residents have been familiar in
the past. It should include opportunities to go on outings, to
go shopping, and attend places of worship if it is within the
individual's capacity to do so.
2.3 High standards of care
Individuals must receive the level of care which their own situation
requires. It should meet high standards and satisfy the full range
of physical, clinical, personal, social, spiritual and emotional
needs of the individual.
2.3.1 Necessary care
Care and treatment should be provided only if it will be positively
beneficial. Care should not mean unnecessary restraint. Treatment
(the administration of certain drugs, for example) must never
be given for the convenience of the home. Residents should have
ready access to appropriate care given by an appropriate person
from within or outside the home. It should always be provided
with respect for the individual's privacy and dignity.
2.3.2 Continuity of care
Wherever possible, and whatever the resident's declining state
of health or financial position, continuity of care should be
assured. Residents should not have to move out of the home to
receive additional care (unless dictated by their medical needs).
If possible, it should be brought into the home by external services.
Residents should never have to be moved because of financial disputes
between funding agencies. Where a home cannot provide all necessary
care, or is not intended to (as in the case of respite care),
transitions between the home and the person's own home, or the
home and a hospice or hospital should be as smooth as possible.
2.3.3 Care which is open to scrutiny
Residents (and their relatives or advocates) should be able to
complain about the care they receive without fear of being victimised
or being asked to leave.
