Personal care and communication

Also called Intimate care and consent, Dignity in personal care

Washing, dressing and the toilet are done to a person unless the person can say how, and stop. Dignity is a communication task.

What it is

Personal care is help with washing, dressing, the toilet, periods, shaving, teeth and hair. It is the most intimate thing one person does for another, and for someone who cannot speak it is the moment when they are most likely to be handled rather than helped. Communication during personal care means the person can say what is about to happen, choose how, say it hurts, and say stop.

A care task done in silence, at the carer's pace, with no way to object, is not neutral. It teaches the person that their body is not theirs.

Who it can help

Anyone who needs help with personal care and does not speak or cannot be understood by the person helping: people with physical disabilities, learning disabilities, dementia, and children in nappies past the age when their peers are not. Their family carers, and paid staff, who mostly want to do this well and were never shown how.

It also matters for safeguarding. A person who can say stop, and who is used to stop being honoured, is a person who can report when something is wrong.

How it works

Tell before touching. Every step is named before it happens, in words, signs or an object of reference: "I'm going to wash your face now". Then a pause, so the person can object. This is the single habit that changes everything and it costs nothing.

Give choices inside the task: this flannel or that one, sleeve first or head first, now or after breakfast. See offering choices. Keep a way to say stop, hurt and no within reach: a card on the wall, a sign the person makes, a single button, and honour it every time; see saying no.

The bathroom vocabulary belongs on the person's system: toilet, wee, poo, wipe, wet, dry, pad, period, cold, private, finished. Some people prefer a paper board in the bathroom because a device does not like steam. And the person's preferences, who helps, how, what they hate, go in the care plan and the communication passport so that a new carer on a Saturday night does not have to guess. See consent and communication for the law behind this.

Getting started

This week, start telling before touching, every time, and pausing. That is the whole first step.

Put a stop sign where the person can reach it during care: a red card, a button, an agreed gesture. Practise it when nothing is happening, then honour it when it is.

Write the person's preferences for personal care on one page, in their words if they can give them, and ask everyone who helps to read it. If the person is in a service, ask to see the personal care section of the care plan and check that it says how the person says stop.

Where to get help

Care Quality Commission sets the standards for dignity in care and takes concerns. SCIE publishes guidance for care staff on dignity and personal care. Mencap and BILD cover consent and personal care for people with a learning disability. Carers UK supports family carers doing this at home. A safeguarding concern goes to the local authority's adult or children's safeguarding team.