Respect, Self-Determination and Choices – These words are the Dignity Alliance MA’s mantra.
In celebration of the 200th Dignity Digest, we asked readers to share their understanding of the concept of “dignity” especially as it applies to older persons, persons with disabilities, family members, and caregivers. Submissions follow!
What Is the Meaning of Dignity? By Sandy Alissa Novack
Sandy Alissa Novack is a geriatric social worker. She is the chair of the Nursing Home Committee of the National Association of Social Workers-Massachusetts chapter; Vice President of the Board of Directors of the Disability Policy Consortium; a participant in Dignity Alliance Massachusetts, and a regular contributor to The Dignity Digest.
Sometimes, you can most appreciate what something is when you are being denied it. For example, when there is conflict, you can more deeply appreciate all that defines peace.
So, too, it is with dignity. You inherently have it, but others can be quick to chip it away, as if they want to make you feel invisible, unworthy, always “less than.” I note it in health care, including my own health care, and consider it discrimination against people with disabilities as well as discrimination against older adults.
One example is from the beginning of the pandemic when I was having a non-covid health emergency and was admitted to the hospital after the Emergency Room thought something very serious was going on. Once admitted, they ruled out the issue they had thought I had, and so I thought I would be immediately discharged home, to follow up with doctors as an outpatient.
A nurse, however, came into my room and told me that though they had ruled out the issue for which I was admitted, my medical team thought I should be sent to a nursing home because of my walk. I asked what my walk had to do with what I was in the hospital for. The answer was only to repeat that they thought I should be discharged to a nursing home. I tried to point out that I walk my normal walk, and it has nothing to do with why I was admitted. I suggested they call my primary care doctor, who would confirm my normal walk.
The nurse thought for a moment, and then asked if I would be willing to walk out in the hallway for her, to show her I can walk. Of course I can walk, I said. And I took my assistive device and walked back and forth from one end of the long hallway to the other, and turned around to do another lap when the nurse told me I could stop. I said that I could keep going. No, she said, I don’t need to, that she saw me walking and she will tell the doctors that I can be discharged.
Because I am a disabled elder who uses an assistive device, without asking me to ever walk down the hallway at all, they were ready to deprive me of life living in the community because of what they assumed about me. Had I not questioned what their plan was, I would have been sent to a nursing home. No wonder so many older adults and people with disabilities end up in nursing homes. Ableism, ageism and discriminatory medical practices stifle dignity.
Another example was when my primary care office advised me to get to the Emergency Room at another point in time. I no sooner walked into the ER than I was pegged as less than others. Before I had been examined, two ER doctors already had told me they would admit me and then have me sent to a nursing home. When I pointed out they hadn’t examined me to give me a diagnosis, they told me a diagnosis I already have had for years, but that had no relevance to why I was presenting to the ER. I said I don’t need to be sent to a nursing home, I need a diagnosis and plan for treatment.
During hours and hours in the ER, they told me at least three more times that they will admit me and send me to a nursing home. I asked again what the diagnosis was and they again would only offer the same irrelevant diagnosis I have had for years that had nothing to do with why I was there.
I made it clear I was leaving to go home, and they told me they don’t think I should do that. I told them I am a geriatric social worker and they need to have a true diagnosis to admit me as a patient and then send me to a nursing home, and they have nothing other than I am an elder who uses assistive devices, and that is not a diagnosis nor a reason to admit me to the hospital nor a nursing home.
I got up from the exam table, and after seven hours in the ER out I walked, my true issue unaddressed (though let me assure you, dear readers, I got the issue diagnosed and a plan of treatment begun weeks later when I was able to get seen by a doctor in the community, but I suffered weeks more with the condition that should have been addressed in the ER).
Would a person who is not a geriatric social worker, or similarly trained, be able to push back at ageism and ableism? Probably not. That is not dignity, which is discrimination in the medical system, and we need to fight against it.
You have the right to have your medical issue taken seriously, you have the right to be examined and given a diagnosis. You have a right to stand up for yourself when your only “crime” is not a crime at all: You are an older adult and have disabilities. You have a right to equal medical care treatment that younger people and people without disabilities expect. As a human being, dignity is inherent. Push back when someone is trying to strip it away from you with medical discrimination.