1. Promoting Excellence in All Care Homes (PEACH) Dr Martin O’Neill Cardiff University

2. Investigators Dr Win Tadd; Senior Research Fellow: Cardiff University School of Social Sciences Dr Martin O’Neill: Research Associate oneillm2@cf.ac.uk Bangor Team Dementia Service Development Centre

3. Research Sample: Eight Care Homes All based in England. From small family based home to large chains. Rural, Semi Rural and Urban locations

4. PEACH Project Data Collection Methodology I Focus Groups: Home Managers/owners: Training managers. Care Home Associations. (ECCA, ) Residents and Relatives Postal Questionnaires: Managers/ Care Home Workers

5. PEACH Project Methodology II In situ attitudinal questionnaires with 96 care home workers. Observational study in all eight care homes consisting of between 60- 90 hours of observation covering all times of the day and all days of the week.

6. Dignity All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. (UNIVERSAL DECLARATION OF HUMAN RIGHTS Adopted by UN General Assembly Resolution 217A (III) of 10 December 1948. Article 1)

7. Dignity Human dignity is inviolable. It must be respected and protected. (European Charter of Human Rights, Chapter 1, Dignity, Article 1, Human Dignity (2003))

8. Self Respect Dignity of Merit Dignity of Moral Status Dignity of Identity Human Dignity Respect for Persons A Model of Dignity (Tadd et al 2005) What is dignity? What does it mean?

9. Dignity of Identity One experiences indignity if one's adult competencies are compromised:  Physical control  Language use  Social competence A loss of physical control or a disfigurement are not inherently humiliating – Stephen Hawkins. Such physical phenomena are interpreted within a culture.

10. Dignity of Identity* A person’s sense of self often depends on the stories he or she can tell about themselves, their communities or people like themselves. Ageism can have a destructive impact on these stories. This sense of dignity (or indignity) was widely referred to by older people.

11. Why dignity matters Loss of health, wealth, personhood even life. Loss of dignity NeglectAbuse

12. The Wheel Chair Incident Care Assistant: “Stan where are you going again without your frame?” Stan: (Jokingly with mock innocence) “What, I don’t know nothing me.” Care Assistant: “Come on get in this wheel chair and I’ll give you a ride back to your chair in the lounge.” Stan pretends to get in the chair the wrong way round (head first). Care Assistant: “What are you doing you dopey old git, you can’t sit in it like that. Come on if you sit in it properly I’ll give you a ride round the unit.” Stan sits in the chair properly and they both go for a running tour of the lounge and corridors. The foot rests are not down and she is pushing the wheel chair quite quickly and I am concerned that an accident might happen but both the Care Assistant and Stan are really enjoying themselves. When they get back to the lounge the Care Assistant flops in the chair feigning exhaustion and says “I wish my own grand dad was as much fun as you.”

13. Thank you Any questions?