Dignified Language for the older person

Lorraine Morgan 24/01/12 Dignity Champions forum

Hi,

I have just sent an email to my local Network (Care in South Wales) as it is about the language that we all use to address an older person which is user preferred.

I undertook research in care homes in the nineties and part of this was about the actual Choice older people have in care homes. One aspect was about whether they were consulted on how they would like to be addressed. Even all those years ago I was concerned about the use of familiar terms and stereotypical language as being disrespectful and undignified.
I have challenged in the past and continue to do so whenever I can but when I discuss with some health professionals I just get the feeling that they think that it is not important - or at least it is not top of their priorities when there are other awful practices occurring which they need to address.
My thoughts have always been that if you can't get such a simple thing right as addressing someone appropriately and how they would prefer, then the attitude etc.. that follows will automatically be affected.

I have just spent the last two weeks supporting both parents who are in their nineties and are both in hospital following falls within 3 days of one another.
I have spent time observing in two A&E departments and 4 different wards and without exception every area is using the terms 'Darling, Lovely, lovey and love, Sweetheart, Chicken, Dear and Babe.' for every patient and most of the visitors including me.
I taken this to a meeting with the Nurse Executive who disappointingly did not seem overly concerned, felt that it was a 'cultural thing' and felt that there were far more important things to address first.
This is despite clear direction from the Strategy for Older People in Wales which discusses stereotypical language and requests use of the term 'older person' or 'older people'; and also the NSF for Older People of which there is a 'Person-Centred Care' Standard.
I have also raised use of appropriate language as a major issue at a recent Older People Commissioner conference on Safeguarding and Elder Abuse and had my concerns recognised in this public arena as very relevant to the Dignity and Human Rights of Older People. I used the example that there are still 'Care of the Elderly Units' in hospitals - why is this term still used when the government asks for different. Policy into practice is just not working.

So - seeing the latest Dignity poem written by S Saunders, which is absolutely brilliant, I hope that he/she will forgive me for having added my own two final sections.

Here it is :-
Dignity Awareness by S Saunders (last two sections added by Lorraine Morgan (Wales)

Can we swap for an hour or two?
You be me and I'll be you,
Someone's daughter, someone's son
Busy with life getting things done.
Doing the things I want to do
Dependant on no one, not having a clue.
What was in store in the future for me?
That the person I was, could anyone see?
Remember please that I was young too
I held down a job, could have looked after you!
Live life to the full, that's what they say
I haven't always been this way
So as I sit in my chair or lie in my bed
Think of the life I may have once led.

Remember these words as you care for me
Remember those words that dignify me
Those words that you use that respect me too
The ones that I've chosen - not just for you.

So 'Darling, Sweetheart, Babe, love and dear'
Is not what I'd choose or even want to hear,
Please remember my words as you listen to me
Always treat me with kindness and dignity. END.

I would like to know what you all think. Sorry for such a long email but hope that some people think that it is worth writing about.

With best wishes,

Lorraine
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Paul Kellard 25/01/12

You are right to say that we should use a person's name, when we address them especially if we don't personally know them.
However I work in a residential care home and the residents enjoy me using names like 'sweetheart' etc.. But I would never do this until we both know each other well & I would not do this if introducing them to another healthcare professional.

Healthcare professionals should think of their own feelings, when they're referred to by these names

Best wishes

Paul

Engelina Mafirakurewa 27/01/12

In any care setting, it is more appropriate to address service users in the way they would like to be addressed.

Lorraine Morgan 27/01/12

Thank you Angelina,

I absolutely agree but the problem is when in more acute settings (and I have recent evidence of how both my parents were labelled as well as myself) the default is not - Sir or Madam until there is time to find out their name and what they would like to be called - the Default is 'Darling, deary, love, lovely - for Wales!, and other terms". I was called Darling several times too.

However, none of the doctors in either the A&E departments or indeed in the various wards used these awful terms. They said Sir or Madam until they were handed the notes or asked Mum and Dad.
if the doctors can do it why not everyone else. Please don't give me any reasons as to why not as there is enough written in nursing, social work and healthcare professionals' text books to say otherwise.
I am an educationalist and I despair why research and principles and human rights just does not get into practice sometime.

It is taught but may not monitored or recognised enough in practice. Any ideas??

Regards,

Lorraine

Lorraine Morgan
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CAROL MUNT 30/01/12

I agree completly with the personal name issue but what would you call the elderly care unit?
Carol

Lorraine Morgan 30/01/12

If there has to be a Unit then use the language that older people have said that they prefer (Horrocks 1995 researcher based at City University, Baseline Journal). So 'the older person', 'Senior', 'older people'.
However, if you read the latest large UK research project from Dr Win TADD on Dignity in Hospital on the PANICOA website then care of the older person is everyone's business as over 70% of patients in hospital are older (>60) so why have a Unit at all.
By all means there need to be specialists for specific issues to do with ageing or diseases that affect older people in a different way.
But how can we sustain equality of treatment, with just some units, when the older person is now the typical, average NHS patient.

Do read recommendations from this research - all of these are absolutely crucial.

Best wishes
Lorraine

Old forum user 02/02/12

On 30 Jan 2012, at 10:56, CAROL MUNT <[log in to view email address]> wrote:

> I agree completly with the personal name issue but what would you call the elderly care unit?
> Carol
>
>
>
>

How about, Specialist Care Unit for the Elderly, then only the older people that needs this sort of care need be in this unit. Everyone else regardless of what adult age they are can go to whatever ward or unit most suitable for them and their treatment needs.
I must say the only thing my 96 Auntie complained of was that when she was in hospital last they put her in a bed next to a man. My Aunt was most disgusted and put out about this. She said they demanded they got her to the toilette as they expected her to use a bed pan. My Aunt said no way was she going to be using a bedpan with a man next to her, even with the curtain pulled. She want's to know where is the dignity in that?

Sally

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Disgusted

Lorraine Morgan 02/02/12

Hi Sally

I actually meant - not to use the term 'the elderly' at all.
It is despised by many older people (see the research I mentioned) and is a stereotypical term which makes older people a homogenous group.

A Gerontology Unit would be better - just like a term used for wards that look after people with endocrine system diseases - the Endocrine ward, or another - the Cardiology Unit.
This then denotes the speciality rather than using a people term.
Hope I have made this clear.

How awful about your Aunt. I would say that her experience was abusive as it denied her any dignity.
Hope you complained formally.

Regards

Lorraine

Old forum user 02/02/12

How about, Specialist Care Unit for the Elderly, then only the older people that needs this sort of care need be in this unit. Everyone else regardless of what adult age they are can go to whatever ward or unit is specifically for them and their treatment needs.
I must say the only thing my 96 Auntie complained of was that when she was in hospital last they put her in a bed next to a man. My Aunt was most disgusted and put out about this. She said they demanded they got her to the toilette as they expected her to use a bed pan. My Aunt said no way was she going to be using a bedpan with a man next to her, even with the curtain pulled. She wants to know, where the dignity in that is.

Sally

Old forum user 06/03/12

I really like the poem - it made me think about a number of issues relating to the elderly. While I understand that terms such as "love etc" are not meant in a malicious way, I too, find it very irritating and demeaning in much the same way when somebody calls me "hun" or "dear" unless I know them well and/ or have given permission to do so. This will take time I believe... time to make a change in much the same way as some terms are now considered racist and discriminatory that were not considered inappropriate years ago. I believe we all have to make a positive effort to contribute to this change at local level and beyond.
I also feel checking out with somebody how they like to be addressed is a good way forward - it is not ok to call a senior person by their first name without doing so. My father was a professor of physics in his life and while he would not have complained - he sure would have considered "love" somewhat patronising.

Lets try and make a change wherever we can, eh?
Corinne Rover-Parkes

Old forum user 29/03/12

I agree with you both completely. Although it's not usually done with any malicious intent, negative language and terminology has an impact on the way that we think and feel about a person and in turn, the way we treat them.

I think 'dear, lovey' etc belong with terminology such as 'feeding, toileting, nappies' etc - it just shouldn't happen and it's not that hard to stop doing it, we just need to keep reminding ourselves until positive, person centred language is embedded.

mike stone 05/04/12

Lorraine,

I tried to send you a Nursing Times discussion of this issue to your listed e-mail addresses - did you get it ?

I think the simple answer, is just for staff to ask 'What would you like to be called ?' on first contact. Personally, I go for first names both ways, or titles both ways.

The one which would get a very sharp response from me, whatever form of address was being used, is 'How are we today ?' I would reply with 'I'm not sure - you tell me your part of how we are, first !'.

Best wishes, Mike Stone

By the way, like a lot of issues with behaviour in the NHS, there are a lot of 'perception issues' here. Some patients prefer to be called 'Jim' instead of Mr Jones, some don't, some like to be asked 'How are you, dear ?' etc. Nurses also seem to get annoyed that they don't get called Nurse Jackson, and get called 'Jane', but doctors always seem to be called Doctor Jones by patients, never 'Fred' - they see this as 'a professional issue', to an extent, I think.

I am trying to discuss some End-of-Life issues with various clinicians by e-mail, and actually getting answers to tricky questions is the problem I have: I don't really care if a return e-mail starts with 'Dear Mike', 'Dear Mr Stone', 'Dr Stone', 'Mike', 'Idiot' or even 'Pillock !' - what categorises the usefulness of the e-mail, is if it engages with the question I raised ! But in hospital, Dr Stone could cause confusion - I have a doctorate in chemistry, and English usage of titles for people with doctorates is complicated.

Lorraine Morgan 05/04/12

I am unable to reply to your email at the moment.

Lorraine Morgan 05/04/12

I am unable to reply to your email at the moment.