A radical change in culture and practice is needed to achieve dignified care for older people, says an editorial in this weeks BMJ.

The welfare of older people who live in care homes has raised concern for decades in many countries, write Marion McMurdo and Miles Witham at the University of Dundee.

Of course, both illness and dependency pose threats to dignity, but people of all ages have a fundamental right to be respected. So why is dignified respectful care for older people still lacking, and what might restore it, they ask?

Legislation, regulation and standard setting are widespread in the health and care home sectors, and more of the same seems unlikely to alter attitudes and prejudices. There is a current vogue to appoint champions and commissioners for older people, but what is needed, they say, are not just individual advocates but rather a long overdue and major change in culture and practice to reflect the central position of older people in systems of care.

How might this be achieved in care homes?

Firstly, we need to stop blaming individual practitioners and care homes, they say. A whole systems approach is much more likely to succeed; for example, changing infrastructure, procedures, management techniques, and staff training. Frontline care staff should not be made scapegoats; instead, their dignity should also be assured, they write.

Secondly, access to good quality medical care should be readily available. They believe that primary care teams need to be supported by secondary care specialists and should be given time, money, incentives, and training in comprehensive geriatric assessment.

Older people have an important part to play too. When older people become politically organised they are a large and formidable force that has real power to campaign for change. They suggest that older people need to demand that carers are paid a decent wage and ar
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