Dignity and Respect
X

Dignity and Respect

Key messages

  • Dignity is a core right in aged care and includes respect for an older person’s autonomy and choices to foster a sense of self-worth, independence and participation in meaningful activities.
  • True respect in care involves personalised attention that considers each person’s history, identity, culture, and preferences.
  • Small actions such as using a preferred name, listening attentively, respecting privacy during care routines, and validating feelings, can all affirm dignity.
  • Helping people to maintain their dignity requires finding a balance between support for freedom of movement and personal safety, especially in caring for people with dementia.
  • Fostering a sense of belonging by helping people to engage in social activities involving family and community is also key to dignity.

What is meant by ‘dignity’ and ‘respect’?

Dignity is a core principle in health and aged care and a fundamental human right. [1] It refers to the inherent value and worth of the individual and the right to be treated with respect in all care interactions. Dignity is closely linked to autonomy and the freedom to make decisions about one’s own life. This includes people with cognitive decline or frailty whose sense of independence may put them at higher risk of falls or other adverse events. [2]

Affording respect means treating older people with consideration, listening to their concerns, and acknowledging their preferences, unique identity, personal history, and human rights. [3] It is expressed through the quality of interactions with staff. [4]


Why dignity and respect matter in aged care

The Aged Care Quality Standards require aged care staff to demonstrate care that is kind and respectful of older people and which fosters personal dignity and privacy (Outcome 1.2). This includes care that is free from all forms of discrimination, abuse and neglect. [5]

Respectful care that honours a person’s dignity shapes the experience and quality of life of the older person and creates a positive care environment. If care is rushed or impersonal, older people who depend on personal care workers for their intimate personal hygiene and for participating in daily activities may feel a reduced sense of self-worth and self-esteem. [6,7]

Respect and dignity are also linked to mental health and overall wellbeing in aged care settings. [8] Studies show that when dignity is compromised, older adults may experience depression, anxiety, and a loss of identity. [9] When dignity is respected and made central to care practices, individuals feel empowered, valued, involved in their own care decisions, and less isolated. [3,10]

Dignified care also enhances trust between caregivers and those receiving care. [6] It can encourage cooperation in care routines and supports a more humane and empathetic approach to ageing. [11,12]


What the evidence tells us

Dignity and respect as core values in care policies

As a person transitions from their previous home to the residential aged care setting, they will inevitably face a loss of independence in daily decisions. They will also have to adjust to new routines and environments, different social interactions, and perhaps also new experiences of loneliness, isolation, and lack of privacy. [13] Promoting dignity is therefore more than a moral obligation. It is also a practical approach to improving the overall quality of life for people in aged care settings.

A first step to creating a culture of respect is to ensure dignity is a core value within all care policies. This means emphasising the individual at the centre of care activities, seeing someone as a whole person rather than a set of tasks or as their health condition (e.g., dementia). [14] It also requires tailoring care to individual preferences and needs. [15]

Social inclusion and meaningful engagement

In residential facilities, respect for the individual extends to supporting people to engage with social activities that are personally meaningful to them. Promoting social inclusion through participation in meaningful group activities and outings may reduce isolation and foster a sense of belonging and respect. [16] Intergenerational initiatives have shown improvements in older person wellbeing by instilling a sense of value, inclusion, and appreciation. [16]

Respectful communication and staff interactions

How people are treated by staff also significantly affects their experience of respect. Positive, empathetic interactions that show attentiveness and concern for the individual boost dignity. [17]  This means speaking to care recipients respectfully, using their preferred names, actively listening, and validating feelings. [17] Aged care services might provide ongoing workforce training on the fundamental importance of respectful, person-centred care so that staff understand how actions and ways of communicating might impact on those dependent on their care. [17]

Autonomy and dignity of risk

Autonomy is deeply intertwined with dignity in aged care. Respecting autonomy means allowing people independence and the freedom to make decisions about their daily activities, including what they eat and choose to wear or when they wish to take a walk or go to sleep. [13,18] Respect for autonomy extends to balancing concerns for an individual’s safety with personal choice and control. [1] This concept of ‘dignity of risk’ allows people to make decisions, even if they involve some level of risk. [3] In many cases, risks associated with resident choices that improve their quality of life might be proactively managed rather than eliminated altogether. [19]

Privacy, personal space, and physical care

Ensuring dignity also means attending sensitively to the physical and emotional needs of aged care residents. [20] Timely assistance with toileting and proper continence care reduces the embarrassment and shame associated with dependence on others for intimate hygiene needs. [20] Ensuring residents have privacy during personal care activities, such as bathing and dressing, is also important for dignity. Staff should also knock before entering a room and wait for permission to enter. [6] There may also be gender considerations in care. Female residents, for example, may feel more comfortable discussing sensitive issues with female staff. [21]

Designing environments for dignity

Designing care facilities to feel more like homes and encouraging residents to personalise their own rooms fosters a sense of dignity. [12] Having the freedom to move within care environments is also important. For people with dementia, being able to navigate spaces within a safe, controlled environment positively impacts dignity, may reduce feelings of captivity, and increase a sense of personal autonomy. [10]

Potential challenges

Aged care services operate as busy environments. This can make it challenging for staff to prioritise individual needs and personal independence over set routines, productivity outcomes, and efficiency. [18] Understaffing leading to long wait times for support with toileting or mobility can have a detrimental impact on dignity. High staff turnover can also disrupt care continuity as new staff need time to become familiar with a person’s needs and preferences and develop a relationship of trust. [3] However, even in time limited circumstances staff can take simple actions to conserve another’s dignity. [7]

Care of people with dementia

Dependence on others for care can reduce a person’s sense of autonomy and dignity. Staff can uphold dignity by supporting people with dementia to make choices wherever possible, even as their condition progresses. [8] This might involve small decisions, such as when to bathe or what activities to participate in. [22] Personal history and identity are also important. Acknowledging the individual’s capabilities rather than focusing on limitations may promote a sense of personhood, [23] along with creating opportunities for the individual to participate in meaningful activities, even in altered ways. Families have an important role to play as they will know the individual’s values, preferences and what activities an individual derived meaning and purpose from. They can also contribute by advocating that the person retains a sense of belonging and identity, even when they are no longer able to express themselves. [18] An advance care plan put in place before a person loses the ability to make decisions can support staff in fulfilling the person’s expressed wishes. [22]

Dignity is also connected to social inclusion. Encouraging social interactions, maintaining family relationships, and creating a sense of community within residential facilities are integral to upholding resident dignity, while isolation and neglect of social engagement can lead to feelings of worthlessness. [12] Engagement with activities that are cognitively and emotionally stimulating can also help. This might be as simple as an opportunity to connect with nature through a visit to a sensory garden. [4]

Residential facilities can also adapt the built environment to minimise risks while preserving individuals' freedom of movement and right to self-determination. [22]

Cultural considerations

As dignity is often linked to the preservation of cultural identity, it is important to acknowledge, respect, and facilitate the cultural, religious, and personal beliefs of older people in providing care. This might include dietary preferences, observance of religious practices, or personal values that contribute to a person’s identity and sense of worth. [17] This recognition should also extend to an understanding of the person’s place within a family unit [1] or the wider social network or community. [11]

Staff can be trained in cultural competence to ensure that residents from diverse backgrounds feel understood and respected. This is particularly important for people with dementia who may revert to using their first language or cultural practices as dementia progresses. [24]

Considerations of family/carers

Families play a key role in advocating for and supporting the dignity of older adults in both residential and home care settings. [1] They can contribute information about a person’s history, values, and routines to help staff align care plans to the preferences of the older person. [13]

Implications for home care

Older adults in familiar home environments often have more control over their daily lives compared to those in residential care. However, care providers may find it challenging to balance respect for a person’s autonomy and freedom of movement and a professional obligation to ensure personal safety. [25] Technological innovations, such as telemonitoring, can help maintain independence but may risk the person’s privacy or lead to depersonalised care experiences. [26] Technology should complement human interaction rather than replace it.


Page updated 13 March 2025
 

  • References

  1. Kane J, de Vries K. Dignity in long-term care: An application of Nordenfelt's work. Nurs Ethics. 2017;24(6):744-751.
  2. Largent EA, Peterson A, Karlawish J. Supported decision making: Facilitating the self‐determination of persons living with Alzheimer's and related diseases. J Am Geriatr Soc. 2023;71(11):3566-3573.
  3. Gilbert AS, Garratt SM, Kosowicz L, Ostaszkiewicz J, Dow B. Aged care residents' perspectives on quality of care in care homes: A systematic review of qualitative evidence. Res Aging. 2021;43(7-8):294-310.
  4. Magnussen I-L, Alteren J, Bondas T. "Human flourishing with dignity": A meta-ethnography of the meaning of gardens for elderly in nursing homes and residential care settings. Glob Qual Nurs Res. 2021;8:1-17.
  5. Australian Government Department of Health and Aged Care. Strengthened Aged Care Quality Standards: Draft (February 2025). Canberra, ACT: DoHAC; 2025.
  6. Ostaszkiewicz J, Dickson-Swift V, Hutchinson A, Wagg A. A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings. BMC Geriatr. 2020;20(1):266.
  7. Morgan DD, Marston C, Barnard E, Farrow C. Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study. Palliat Med. 2021;35(7):1366-1377.
  8. Hasegawa N, Ota K. Concept synthesis of dignity in care for elderly facility residents. Nurs Ethics. 2019;26(7-8):2016-2034.
  9. Bradshaw EL, Anderson JR, Banday MAJ, Basarkod G, Daliri-Ngametua R, Ferber KA, et al. A quantitative meta-analysis and qualitative meta-synthesis of aged care residents' experiences of autonomy, being controlled, and optimal functioning. Gerontologist. 2024;64(5):gnad135.
  10. van Liempd S, Verbiest M, Stoop A, Luijkx K. Influence of freedom of movement on the health of people with dementia: A systematic review. Gerontologist. 2023;63(8):1351-1364.
  11. Clancy A, Simonsen N, Lind J, Liveng A, Johannessen A. The meaning of dignity for older adults: A meta-synthesis. Nurs Ethics. 2021;28(6):878-894.
  12. Davies M, Zúñiga F, Verbeek H, Simon M, Staudacher S. Exploring interrelations between person-centered care and quality of life following a transition into long-term residential care: A meta-ethnography. Gerontologist. 2023;63(4):660-673.
  13. Abbate S. Reframing holistic patient care in nursing homes through the lens of relational autonomy. Holist Nurs Pract. 2021;35(1):3-9.
  14. Sunzi K, Li Y, Lei C, Zhou X. How do the older adults in nursing homes live with dignity? A protocol for a meta-synthesis of qualitative research. BMJ Open. 2023;13(4):e067223
  15. McCormack B, Roberts T, Meyer J, Morgan D, Boscart V. Appreciating the 'person' in long-term care. Int J Older People Nurs. 2012;7(4):284-294.
  16. Ronzi S, Orton L, Pope D, Valtorta NK, Bruce NG. What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies. Syst Rev. 2018;7(1):26.
  17. van der Geugten W, Goossensen A. Dignifying and undignifying aspects of care for people with dementia: A narrative review. Scand J Caring Sci. 2020;34(4):818-838.
  18. Naden D, Rehnsfeldt A, Raholm MB, Lindwall L, Caspari S, Aasgaard T, et al. Aspects of indignity in nursing home residences as experienced by family caregivers. Nurs Ethics. 2013;20(7):748-761.
  19. Ibrahim JE, Holmes A, Young C, Bugeja L. Managing risk for aging patients in long-term care: A narrative review of practices to support communication, documentation, and safe patient care practices. Risk Manag Healthc Policy. 2019;12:31-39.
  20. Göransson C, Larsson I, Carlsson IM. Art of connectedness: Value‐creating care for older persons provided with toileting assistance and containment strategies—a critical interpretive synthesis. J Clin Nurs. 2023;32(9-10):1806-1820.
  21. Xiarchi LM, Nässén K, Palmér L, Cowdell F, Lindberg E. Gender influences on caring, dignity and well-being in older person care: A systematic literature review and thematic synthesis. Nurs Philos. 2024;25(1):e12467.
  22. Morris P, McCloskey R, Keeping-Burke L, Manley A. Nurses' provisions for self-determination in residents with cognitive impairment who live in a residential aged care facility: A scoping review. JBI Evid Synth. 2021;19(7):1583-1621.
  23. Mast BT, Molony SL, Nicholson N, Kate Keefe C, DiGasbarro D. Person-centered assessment of people living with dementia: Review of existing measures. Alzheimers Dement (N Y). 2021;7(1):e12138.
  24. Xiao LD, Chen L, Han W, Meyer C, Müller A, Low LF, et al. Optimising social conditions to improve autonomy in communication and care for ethnic minority residents in nursing homes: A meta-synthesis of qualitative research. Nurs Inq. 2022;29(3):e12469.
  25. Olsen CF, Bergland A, Debesay J, Bye A, Langaas AG. Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-a meta-synthesis of qualitative studies. Patient Educ Couns. 2019;102(11):1991-2000.
  26. Sundgren S, Stolt M, Suhonen R. Ethical issues related to the use of gerontechnology in older people care: A scoping review. Nurs Ethics. 2020;27(1):88-103.