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