Equality and Human Rights Commission

This guidance establishes principles for best practice in the care of older people in both community and hospital settings. Its dominant themes are dignity, respect and communication. It aims to provide clarity for all nurses, specialist community public health nurses and midwives, and should be read in conjunction with the Nursing and Midwifery Council's 2008 code setting out standards of conduct, performance and ethics for nurses and midwives, to which the guidance is extensively cross-referenced. The guidance is primarily for nurses and midwives who are registered with the Council; however, it is also suggested for use in both pre and post registration training and as a benchmark for principles of care delivery by all members of multidisciplinary teams, including healthcare support workers. This guidance can be used as a tool to challenge poor standards of care and provides employers - and patients - with a set of principles against which to judge performance.

• Care should be focused on the needs of the individual, and older people should be equal partners in their own care.
• Privacy and dignity should be protected at all times. Many older people who contributed to this guidance mentioned the embarrassment, shame, humiliation and loss of respect when privacy was denied, for example in relation to washing, dressing and using the toilet.
• It is essential that nurses do not take away the self-respect of older people and return them to the status of a child, but rather should respect them as an adult.

Human rights in the care of older people

This guidance makes frequent reference to the human rights principles that underpin all international human rights treaties:

• fairness
• respect
• equality
• dignity, and
• autonomy

It also refers to the obligations placed on public authorities by the Human Rights Act (HRA) 1998 - implemented across the UK in 2000 - which incorporated most of the rights in the European Convention on Human Rights into domestic law.

It explains that the rights most relevant to the care and treatment of older people are:

• the right to life
• the right to not be subjected to inhuman or degrading treatment, and
• the right to respect for private and family life.

Using the guidance

The guidance covers three main areas:

• people: the skills and qualities of nurses who provide care
• process: different aspects of that care, and
• place: the different environments where care is delivered.

The guidance asks nurses to:

• challenge negative attitudes to older people
• promote a healthy lifestyle for older people
• value and respect older people as individuals
• be mindful of older people's dignity
• show kindness and compassion in their behaviour
• communicate effectively and respectfully, and
• be committed to equality and diversity.

It explains that care should be focused on the needs of the individual, and older people should be equal partners in their own care.

It says nurses need to have the will to provide compassionate, dignified care and actively to challenge poor practice.
The guidance is based on the views of more than 300 people, including older people, carers and organisations. Illustrative quotations from older people are helpful to convey the importance of the principles outlined and the reasoning behind them.

For example, the guidance explains that communication was something that older people said was important to them; nurses should avoid patronising older people or automatically using terms of endearment and should first check how older people wish to be addressed, as they would with other adults.

It emphasises that some older people may require others to care for them in a way that they have not required since childhood, and that is essential that nurses do not 'make the mistake of taking away their self-respect and returning them to the status of a child but rather ... respect them as an adult'.

Related equality messages

The guide notes that commitment to equality and diversity means providing care in a 'non-discriminatory, non-judgmental and respectful way'. It explains that equality is about making sure that all older people are treated fairly and that care given is person centred, valuing each individual and meeting their specific needs rather than treating everyone in the same way.

Other important information

The guidance is not structured around the key human rights identified above and does not explain in detail how they might be put into practice in a community or hospital setting. For example, it gives examples of what constitutes abuse of an older person, but does not connect this expressly to the right not to be subject to inhuman or degrading treatment.

Readers may wish to read this authoritative statement of principles alongside other guidance that offers detailed advice and practical case studies about how to make human rights real in day-to-day nursing, and the 'added value' of such an approach.

Date of review

April 2011

• This website links to the guidance reviewed above and related materials e.g. FAQs about the guidance and facts and figures about older people in healthcare:
  http://www.nmc-uk.org/General-public/Older-people-and-their-carers/Care-and-respect-every-time-new-guidance-for-the-care-of-older-people/
• Equality and Human Rights Group, Department of Health (2008) Human Rights in Healthcare - a framework for local action (2nd edition)
  http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
  documents/digitalasset/dh_088972.pdf
  

We hope that you found the resource helpful and easy to use. Please let us know about other guidance or references that you think we should include. Send us your feedback.