Monday 21 March 2016

Why activity is everyone's business

Go into most care homes and you will see a familiar array of staff, from carers to chefs, housekeepers to maintenance personnel. A role you will also often encounter is that of an 'activity coordinator'. All of my dad's three care homes had activity coordinators, all of whom were women and some clearly more suited to the role than others.

In essence an activity coordinator is charged with ensuring that everyone living in the care home gets to do activities that they want to do and enjoy doing. The scope for those activities is largely dictated to by budget, with some care homes having extensive 'activity' programmes that include trips out and even holidays, while others literally scrape around to find pens and paper for residents who want to draw.

Whilst I am the first person to advocate that people living in care homes should have opportunities to engage in 'activity', I am not a fan of the 'activity coordinator' role. Why? Because in my view activity is everyone's business.

By creating a role in a care home that is centred around activity, everyone else working in the care home automatically defaults to that individual for anything related to activity. This is seen with other roles, where everyone goes to the chef for matters relating to food, and everyone goes to the maintenance person if something needs fixing.

The other reason I'm not a fan of this role is that activity is about everything that happens in the day, from the moment you get up to the moment you go to bed. Given that people living in a care home spend most of their day with care staff, it is vital that care staff recognise that everything they do to support that person is, in itself, an activity.

By taking this approach, it is then much easier for care staff to appreciate the need to support the person to do as much as possible, thus retaining maximum independence, rather than just automatically doing everything for them and effectively de-skilling them and taking over their life.

Making a cup of tea, having a shower, getting dressed - these are all activities, just as much as bingo and singing groups. And they can all be expanded upon to go beyond the purely functional. So, for example, making a cup of tea could be about doing it 'the old fashioned way' with loose leaf tea and a tea pot, sparking a reminiscence session. Having a shower could become a full on pampering session, with some gentle exfoliation of hard skin, a massage with body lotion afterwards or a full-on salon-style blow dry. Getting dressed could be about coordinating colours and outfits, dressing up or dressing down, and might even lead onto a mending session if clothing needs some TLC.

Throughout any of these 'activities' songs could be sung, conversation could flow, laughter could be triggered and memories could be drawn upon and mulled over. The problem is, if your care home has an activity coordinator, he or she is unlikely to be involved in these 'care' related activities, and thus these daily occurrences just become bland tasks for the care workforce to 'get through'.

In my consultancy work with care providers, I look at the structure of the workforce in a care home, who is responsible for what, how those responsibilities are carried out, and whether there is, in fact, a better way of approaching how the care home operates. A huge focus for me is how holistic a care home can become, which in practice means frontline staff taking on a more fluid role that responds to the individual needs of the people living in the care home and treats every interaction as an opportunity to create a special moment with that person.

It is irrelevant if those moments will be remembered, and the fact that they might not is no reason not to create them. There is often a belief that group 'activity' sessions are more memorable, but actually as a person's dementia advances, it is often the one-to-one time spent doing something very simple and very familiar, like eating, drinking, folding laundry or making the bed that enhances wellbeing and quality of life more.

Persuading staff to be creative and expressive whilst providing this type of essential support is often very challenging; many would much rather just default to the activity coordinator when conversation and interaction is needed. But care staff who approach their work with an emphasis on both supporting the person and creating an activity out of everything they do generally have much more job satisfaction.

So what would I suggest care providers do with their activity coordinators? By all means turn them into event managers, charged with creating those important community experiences in the care home, and indeed helping people living in the care home to get out and about. If they are great communicators and creative types (which they certainly should be!), then utilise that to show other staff how to communicate more effectively and be creative in their support.

Encourage all of your staff to show off their talents - you may have some real gems who can play instruments or sing beautifully, people who are good at needlework, crafts, gardening, cooking or DIY. Support them to bring those talents into their job, whatever their 'official' role is meant to be. And likewise with your residents and relatives - find out what talents they have and how they might express those for individual benefit or the greater good.

The best care homes do this seamlessly, because they appreciate that activity is everyone's business and they facilitate that way of working. It may mean staff allocations need to change or rotas need to be adjusted. It may mean that someone in one role is actually much more suited to something else. It will almost certainly need training, mentoring and monitoring, but ultimately you will have created a care home far closer to what a home truly is, and what living a life in a care home and working in one should represent.

Until next time...
Beth x

You can follow me on Twitter: @bethyb1886

Monday 7 March 2016

Doll therapy - Disrespectful or comforting?

One of the most controversial non-drug therapies for people with dementia is doll therapy.

Before the work I do now, I knew this not as a 'therapy' but as the lady in my dad's care home who occupied the room opposite him having dolls she would cradle, talk to, dress, put to bed and at times cuddle as if her life depended upon it. To a lesser extent my dad also found comfort within the principles of this therapy - not with dolls but with life-like soft toy farmyard animals that he would stroke and cuddle.

Back then I thought nothing of the ethical arguments around introducing items most closely associated with childhood into the world of people at the other end of life's spectrum. All I knew was that my dad had extremely restless hands that needed something to hold onto, and he seemed to draw a lot of comfort from stroking these animals and looking at them.

Likewise the lady in the room opposite had her dolls brought in by her daughter who would talk to her about them, and leave her to hold them and 'care' for them when it was time for the daughter to go home. From what I observed, the lady found a great deal of pleasure in these dolls, and seemed to have a far more creative interaction with them than she did with the daytime TV programmes that would often blare out from the corner of her room.

Looking at the use of these dolls and toys now with my more objective hat on poses an interesting dilemma for me. In my work I am a staunch advocate of ensuring that we never infantilise people with dementia. A dementia diagnosis doesn't mean you stop being an adult. Everything about dementia care should be dignified and respectful, and never treat people in any way whatsoever that belittles or demeans them.

On the flip side, do I really have any right to deprive someone who is living with dementia from finding comfort, enjoyment or familiarity from participating, of their own volition, in doll therapy? I saw first-hand how my dad's soft toys benefited him - they were our idea as a family, we bought them, we gave them to him, and we facilitated his use of them (at the time dad had these soft toys he was immobile, so he couldn't walk across the room to pick them up himself). He didn't ask for them, but he actively participated in handling them.

I didn't see his affiliation with these items as something that made him less of an adult, but arguably someone walking into his room seeing a grown man in a chair with a soft toy lamb on his lap might have thought very differently, and then treated dad as less of an adult as a result. Whilst I wouldn't have wanted to be responsible for anything that stripped away dad's status as an adult, I would have done anything that gave him comfort and pleasure.

In essence, this sums ups the complexities of the arguments around doll therapy. Such arguments polarise opinions and leave people like me - who pride themselves on offering balanced views, thoughtful commentary and helpful advice - with a real dilemma. I've never openly advocated for the use of dolls in dementia care in the way that fans of this therapy have, but equally I could never go into a care home, see dolls being used and honestly object, provided it was clearly in the best interests of the person with the dolls and something they were participating in willingly.

That last point gets to the heart of the arguments around doll therapy. The willingness of the person with the dolls is, for me, the deciding factor. If the person with dementia really takes to a doll in the way that someone else might find comfort in any other object, then that is their choice. We may present items other than a doll in the hope that they might prove more appealing, but if the doll remains the item of choice then that must be respected.

The argument about infantilisation in relation to dolls has much merit, but I think infantilisation can be avoided if the attitudes of those around the person remain respectful and adult. For most people with dementia who find comfort in having a doll, the doll is merely the physical manifestation of the person's need to care for something, and for that something to be familiar.

We know that as dementia advances a person often retreats to memories of their early life, which may involve childhood or early adulthood, marriage and starting a family. In the present day, a doll could easily be a reminder of childhood or of starting a family. Dogs and cats could also remind a person of those landmark childhood and early adulthood years, but many care homes (not all) won’t allow animals to live within their homes unless they are of the soft toy variety.

If dolls, and indeed soft toys, are seen as props to facilitate reminiscence then they take on a different significance. The ability to reminisce is considered the mark of a life lived with all the memories and events along the way that come with adulthood. Reminiscence also draws on the wisdom and experience that is the landmark of ageing. Therefore in that context dolls could be the spark to unlock knowledge, for example about parenting, for some people.

Ultimately, whatever your views on doll therapy - and incidentally I remain largely on the fence -  I suspect that being judgmental does more harm than the therapy itself. Yes, it has the potential to be disrespectful. It also has the potential to be comforting. The key to unlocking both the value of this therapy and combatting the negatives associated with it seems to be more about how those supporting the person with dementia facilitate it and react to it.

Until next time...
Beth x

You can follow me on Twitter: @bethyb1886