From greyhounds to boa constrictors, a menagerie of creatures is now finding its way into RMBI care homes. Sarah Holmes discovers the therapeutic effects that animals can have on those in need
Bella the greyhound is proving popular at Cadogan Court in Exeter as she meanders through the crowds at the annual summer fete. With her hazelnut fur and her pink tongue lolling lazily out of the side of her mouth, she’s a big hit with the residents.
‘She loves it,’ laughs owner Sue Bescinizza. ‘She could stand here for hours being stroked.’
Meanwhile, across the grounds, Elsie and Walter Nicholls watch in delight as Audrey the schnauzer leaps enthusiastically around their bench. The couple have been living in Cadogan Court for nine months, and are ardent dog lovers. ‘I’m so glad they bring the animals into the home,’ says Elsie. ‘It brings back all the memories of our own pets.’
With more than a million older people suffering from loneliness in the UK, visits from animals such as Bella and Audrey are vital in tackling the effects of social isolation. This is particularly true for people in residential care homes, where there often aren’t the facilities – or the manpower – to look after pets.
‘Pets bring a sense of comfort and well-being, so we encourage many different animals into our homes,’ says Debra Keeling, Deputy Director of Care Operations at the RMBI. ‘We want residents to enjoy the benefits animals provide, even if they don’t have their own pets.’
At Cadogan Court, an RMBI care home that looks after older masons and their families, residents like Elsie and Walter get to see Bella every week. Just one of 4,500 dogs registered with the charity Pets As Therapy (PAT), Bella regularly visits hospitals, special-needs schools and care homes around her local area to provide therapeutic comfort and companionship to the residents. Her docile nature makes her the perfect candidate for the charity.
‘She’s always a welcome guest,’ says Helen Mitchell, Manager at Cadogan Court. ‘The residents’ faces light up when she walks through the door.’ With nearly half of residents aged over 65 relying primarily on their TVs for company, Bella’s visits give them a chance to engage in something a little different.
‘The best thing about the PAT visits is that everyone can get involved,’ says Helen. ‘If a resident is immobile, we’ll take Bella to their bedside so they can reach out to stroke her.’
For residents who are battling with dementia, Bella has proven to be a particularly calming influence. ‘A lot of our nursing residents had pets before moving in, and they have fond memories attached to dogs. It’s a good way of helping them to remember. Sometimes, I think they remember the animals better than the people.’
‘I’ll always remember when Echo the Eurasian eagle owl tried to take off right here in the living room.’ Norman Wilkins
Creating a sanctuary
But it’s not just domestic animals that visit. The home has established links with animal sanctuaries throughout Devon, so that every year donkeys, ponies and even owls come to see the residents.
‘I’ll always remember when Echo the Eurasian eagle owl fanned out its wings and tried to take off right here in the living room,’ remembers Norman Wilkins, a resident at Cadogan Court, with delight. ‘It created this incredible draft of air that pushed down on us like a gale. I’ve never felt anything like it before.’
In an effort to broaden the animal activities, Helen also got a local pet shop to showcase its collection of exotic snakes, lizards and tarantulas. ‘It’s not every day you see a three-foot-long lizard running loose in the living room,’ laughs Helen. She brought her own boa constrictor along for the visit. ‘Luckily, she was a lot smaller then, only about four-and-a-half foot,’ she says. ‘She’s double that size now.’
Despite some initial apprehension, it wasn’t long before many of the residents let the boa constrictor hang around their necks, and fork through their fingers with its head. ‘They were all asking for photographs to send home to their sons and daughters to prove they’d actually held a snake,’ remembers Helen. ‘The energy and excitement of the day really brought people out of their shells.’
Taking the idea one step further, staff at Prince Edward Duke of Kent Court in Essex decided to introduce a live-in dog to the home to bring the community together and give residents a renewed sense of purpose from having to walk and feed her.
Named Meg, the black labrador was originally owned by a gentleman who refused to move into the home unless she could come with him. ‘Life changed the moment she arrived,’ explains Audrey Brown, Activities Coordinator at the RMBI care home. ‘The whole place felt more homely.’
‘A lot of residents had pets before moving in, and have fond memories attached to dogs. Sometimes, I think they remember the animals better than the people.’ Helen Mitchell
A positive presence
While PAT visits have always been a key form of therapy in the care home, Meg’s constant presence allows her to build up relationships with the residents and become attuned to their particular behaviours. If Meg senses that a resident is feeling down, for example, she’ll seek them out to sit by them or lie on their bed.
For Kathleen, who lives in Mauchline House, the home’s dementia support house, companionship has proved particularly beneficial. ‘I think simply stroking Meg’s head is very calming for Kathleen, as it gives her something to think about other than herself and her condition,’ says Audrey. ‘Meg is one of the few companions who won’t force herself on you. She won’t insist you get up to take your medication, or expect you to make conversation.
In dementia, your relationship with others can become difficult, but with Meg it’s a simple bond.’
The home has now been given Butterfly Service Status – a nationally recognised award that identifies care homes that deliver an exceptional standard of support for their residents living with dementia. Meg is another example of the way in which the RMBI provides individualised care for its residents. ‘Care homes are constantly changing, and what works changes with it,’ says Audrey. ‘But for us, Meg has been a seamless fit. It’s like having another member of staff.’
One in eight older people rely on their animals as a source of companionship, but it seems dog owners are the ones reaping most benefits. Not only do four-legged friends keep people 12 per cent more active than those who don’t own pets, they also raise our self-esteem and make us more conscientious and extroverted, as well as less fearful, according to the American Psychological Association.
Bella the greyhound passed away shortly before publication. Cadogan Court would like to thank her owner for all the happiness Bella brought to residents
A life in stories
Whether it’s memories of D-Day landings or receiving a slice of the Queen’s wedding cake, telling life stories can both reassure care home residents and help personalise the type of support they receive. Imogen Beecroft reports
Tuesday, 6 June 1944 was Doris Taylor’s day off. She was taking a break from the Women’s Royal Naval Service but had been called in to help re-kit survivors who had not reached the shores of France during the D-Day landings. ‘You don’t say no when you’re asked to help,’ she remarks.
Doris recalls being asked to tie a tiddly bow on the side of a cap band by a soldier: ‘I said I wasn’t very good at it, but he said he’d talk me through it. So, with his instruction, I did.’
When Doris went to put the soldier’s cap on, she noticed that his hands were red-raw and bleeding. ‘I said he needed to get that seen to, but he told me not to say anything. He’d been waiting to be taken on board the rescue boat, and the only things he could hold on to were wires. He’d been in the sea for hours, waiting, and they’d cut right through his hands. That day has remained with me all my life. I can still see those men. I can still hear them. I’ve never forgotten it.’
This is the story Doris chose to share with her fellow residents at the RMBI care home Prince Edward Duke of Kent Court in Essex on National Tell a Story Day, 27 October 2014. Residents from all the RMBI care homes told stories of key moments in their lives that day, which the RMBI then collated into a book and distributed among care home staff, residents and their families.
The day was part of a wider RMBI initiative centred on life story work. Debra Keeling, Deputy Director of Care Operations at the RMBI, explains this process: ‘Life story work involves a biographical approach, which gives people the opportunity to talk about their life experiences. It involves recording relevant aspects of a person’s past and present life with the aim of using this life story to benefit them in their present situation.’
Big or small, pivotal or trivial, these memories help bring elderly people out of themselves, bonding with other residents and carers as they share their stories.
With more than 820,000 people in the UK diagnosed with dementia, the RMBI estimates that 650 of its residents have the condition. Life story work can be particularly beneficial for those with dementia as it promotes individualised care and builds relationships between staff and residents.
‘The potential benefits of life story work as an intervention for people with dementia and their families have been recognised for some time,’ explains Debra. ‘Medical and social research is continually evolving in the field of dementia, and the adoption of new best practices is a fundamental philosophy of the RMBI. A key objective in dementia care is to reduce the use of anti-psychotic medication, replacing it with activities and environments that both reduce potentially threatening situations and create a reassuring ambience.’
‘A key objective in dementia care is to reduce the use of medication, replacing it with activities and environments that create a reassuring ambience.’ Debra Keeling
Becky Timms, Business Administrator at RMBI care home Albert Edward Prince of Wales Court in Mid Glamorgan, has been at the forefront of life story work, and has seen some significant transformations among her residents. ‘One lady in particular used to be part of a drama group for elderly people. Since her husband passed away she hasn’t been able to go to it, but she took a lead role in the storytelling programme and has done lots of different readings. She’s really come into her own and you can see the confidence in her storytelling improve over the weeks.’
For Becky’s team, National Tell a Story Day was the culmination of more than a year’s life story work. They had been running successful fortnightly storytelling sessions, at which a member of staff or visitor read the residents a story. The effect on some of the residents was overwhelming: ‘Our carers were very surprised how well our dementia residents responded to the storytelling and the kind of conversations it stimulated afterwards.’
Some of the residents at Albert Edward Prince of Wales Court have such severe dementia that they cannot perform daily life tasks. ‘But then a poem will be spoken and they’ll mouth along to the words because they remember them,’ says Becky. ‘The memory is there because it’s something they learnt so long ago. Hopefully, for those couple of minutes they can just enjoy themselves, and enjoy taking part.’
In life story work, residents’ recollections can range from historic occasions to something from their youth. John Wadia, who was an RAF flight engineer, flew US President Franklin D Roosevelt on several occasions. John recalls, ‘He was down to earth and a very nice person.’
One of the most popular stories to come out of this initiative was that of Alan Baker, who set up a Father Christmas call line for charity. Parents would give a donation to charity, and then either Alan or one of his friends would ring their children at an appointed time, pretending to be Father Christmas:
I spoke to Emma and she wanted new dolls. At the other end she said, ‘Would you like to speak to Fiona?’
I said, ‘Yes, if she wants to speak to me.’ So then Fiona came on the phone.
I said, ‘Where would you like me to leave your presents?’
She said, ‘If you leave me some surprises at the end of my bed that would be lovely.’
I said, ‘Do you clean your teeth twice a day?’
She said, ‘Yes.’
I said, ‘Do you wash your hands after you’ve been to the toilet?’
She said, ‘Yes.’ And then she said, ‘By the way, I’m nineteen and I’m the babysitter.’
Life story work is just one of many initiatives run by the RMBI to help those with dementia. Another is building sensory gardens, and Debra says, ‘We try to recreate spaces where people with dementia are able to experience a high level of wellbeing and independence while still feeling safe. The RMBI has created small domestic-style gardens where people with dementia can enjoy many different sensory experiences, as well as having a quiet place to sit and enjoy the garden.’
The RMBI has opened a number of dementia support units in its homes. Given the success of National Tell a Story Day and the life story work in general, it’s no surprise that the charity is also planning to maintain the initiative.
Becky’s storytelling sessions will continue, and she hopes to receive funding to print a monthly leaflet with a changing selection of poems and readings. ‘These would be distributed to residents, but also available in reception for visitors to pick up and read to them.’
Audrey Brown, Activities Coordinator at Prince Edward Duke of Kent Court, says, ‘I want to do our own little booklet. Having seen the success of the last one, I think it would be really nice to make a booklet of experiences from our own residents, so they can read each other’s stories.’
Doris is already looking forward to telling more of her stories. ‘I’ve got lots,’ she laughs, ‘but some I couldn’t put into print!’
‘Big or small, pivotal or trivial, these memories help bring elderly people out of themselves, bonding with other residents and carers.’
JULIUS PACHTER, ninety-six, reflected on life as a Jew in Nazi Germany, and told the story of his escape. ‘The only way I could escape was by speaking German, raising my arm and saying “Heil Hitler”.’
BERYL HUME, ninety-three, remembered receiving a slice of Queen Elizabeth and Prince Philip’s wedding cake as a thanks to her husband who was a Guard of Honour at the ceremony. ‘I have not had a taste and would have never dreamed of it! I have kept the cake safe for all these years; it is very special to me.’
MARGARET HASELL GOULDBOURN, ninety-six, shared her experiences as a volunteer for the Merchant Navy, writing letters to the loved ones of merchant seamen. ‘I think the voluntary work during the war kept the country going and kept everyone’s morale up. Everyone felt they wanted to do their duty, me included.’
Investing in the future
RMBI care homes Queen Elizabeth Court in Llandudno and Prince Michael of Kent Court in Watford have been recognised with a prestigious award for their care of people living with dementia
The Butterfly Service status is a nationally recognised ‘kitemark’ awarded by Dementia Care Matters to identify care homes that are committed to delivering excellent dementia care and providing residents with a high quality of life.
Only a handful of care homes in the UK have been awarded the status, and Queen Elizabeth Court and Prince Michael of Kent Court now join four other RMBI care homes around the country to have received the award.
RMBI care homes Devonshire Court in Leicester, Shannon Court in Surrey, Barford Court in Hove and Prince Edward Duke of Kent Court in Essex have also received the Butterfly Service status.
Debra Keeling, RMBI Deputy Director of Care Operations, said, ‘To have been awarded the Butterfly Service status is testament to the dedication of our care home staff providing exceptional care. We have made a substantial investment in dementia care training for staff and hold regular events and initiatives for our residents as part of our drive to support their welfare and wellbeing.’
Debra believes that the award demonstrates the RMBI’s commitment to delivering innovative care techniques to maintain the highest quality of life for its residents, as well as putting solid foundations in place to continue to provide excellent care as the number of those with dementia increases over the next few years.
‘As a charity we have been working closely with Dementia Care Matters since 2009, and with a number of other specialist dementia providers to deliver our dementia care strategy,’ said Debra. ‘Dementia Care Matters works with care providers with the aim of improving the quality of life for residents of care homes – not only for those with dementia, but also for the other residents living in the same home.’
GREAT BRITISH CARE
The RMBI was delighted to be recognised for a second time at the Great British Care Awards last year with seven shortlisted nominations, and for the first time in the Third Sector Care Awards with one nomination
The Great British Care Awards celebrate excellence across the care sector and pay tribute to those who have demonstrated outstanding excellence in their field of work.
Congratulations go to Joanne Pinkney at Prince Edward Duke of Kent Court, Essex, who was shortlisted for the Ancillary Care Worker award. The home also made the shortlist for the Care Innovator award – an achievement likewise enjoyed by the first RMBI Day Service at Barford Court in Hove – as well as the Creative Arts accolade in the Third Sector Care Awards.
In addition, Jane Baldwin, Learning and Development Officer for the South, made the shortlist for the Great British Care Awards Care Trainer accolade; Erisilia Antohe from Prince Michael of Kent Court in Watford for Frontline Leaders; Sandra Robson from Scarbrough Court in Northumberland for Putting People First; and Sue Goodrich from Prince George Duke of Kent Court in Kent for Care Home Activity Organiser.
To add to these achievements, Jane Geraghty, Care Support Worker at RMBI care home Queen Elizabeth Court in Llandudno, was announced as the winner of the Excellence in Dementia Care Award at the Wales Care Awards 2014.
Putting the pieces back together
A new way of treating dementia recommends that you concentrate on creating the best possible quality of life for people. Andrew Gimson finds out how RMBI homes are pioneering groundbreaking techniques in dementia care
Helen Walton speaks with some emotion as she discusses providing good quality care for people living with dementia. As operations director at Dementia Care Matters, an organisation that has become closely involved in the provision of dementia care in the homes run by the Royal Masonic Benevolent Institution (RMBI), Walton draws a sharp distinction between the right and wrong approach.
Care has traditionally been very institutionalised; huge importance is attached to routine and the atmosphere in some homes is sterile. People with dementia are treated as passive recipients from whom no initiative is expected.
Walton is deeply concerned that this kind of care still exists today, which can leave people sitting in their chairs staring into space. She believes strongly that it can be different, that instead of being run with the greatest possible efficiency, homes can concentrate on creating the best possible quality of life. She emphasises that although people living with dementia may have lost their capacity for logical thought, ‘their feelings are enhanced – feelings are what they have left, and are stronger than before’.
For Walton, staff must encourage rather than repress the natural inclinations of those they look after. The first step is to relax any barriers between staff and residents. In a home where Dementia Care Matters is called in to advise, the staff will get rid of their uniforms and the main meal of the day will be eaten together. Once this happens, it will not necessarily be apparent who is a member of staff and who is a resident. The two groups will be running the home together as friends.
Debra Keeling joined the RMBI four and a half years ago. In her role as deputy director of care she has a brief to bring in exactly this approach. She is ‘hugely encouraged’ by the progress that has been made: ‘The people who live in our homes are now becoming much more involved. We’re really developing communities.’
Joining their reality
The RMBI has seventeen homes in England and Wales, accommodating more than one thousand residents. Louise Baxter is home manager at an RMBI home, Prince Edward Duke of Kent Court in Essex. She tells the story of Nina Wainwright, who arrived in the dementia support unit in 2008. Mrs Wainwright, who was suffering from early to mid-stage dementia, had great difficulty settling in. Like many people, she felt disorientated by leaving her own home. She would ask: ‘What is this place? Why am I here?’
The staff became increasingly worried about her happiness and welfare, so they arranged with the catering contractor for Mrs Wainwright to start working in the kitchen. Each morning, she comes downstairs, goes to the kitchen and starts to wash up and make herself useful. She believes she lives upstairs in her flat and is employed to undertake washing up as well as some waitressing duties. This has given her a sense of purpose and allowed her to feel once more in control of her life. Staff ‘join Mrs Wainwright in her reality’ – they do not seek to disabuse her of her beliefs.
Baxter believes that her diploma course with Dementia Care Matters has certainly given her the confidence to join people in their reality without being accused of infantilising them. ‘It allowed me to work in the way I’d always wanted to.’
‘If a resident asks for her mother, you could say: “Tell me about her. She sounds very special”’ Debra Keeling
Conventional methods for treating dementia would confront the person with reality. When they asked for their mother, for example, they would be stood in front of a mirror and shown they were clearly far too old for their mother to still be alive.
Nowadays, there is a different approach. When a resident with dementia says they want to go home, the best thing to do is open the door and let them go outside. ‘Once they’re outside, the urgency to get out is gone,’ says Baxter. ‘You can then go and rescue them by saying something like: “Oh hello, Mrs Jones. I live next to you. Would you like to come and have a cup of tea with me?”’
There are parallels between the care of children and those with dementia. If a child is playing a game that depends on imagining that a toy is real, you do not ruin things by telling them to stop being so stupid, the model car is not real. Rather, you enter into the child’s world in the same way that you should with a person with dementia.
Keeling agrees: ‘While you should never lie to people with dementia, if a resident asks for her mother, you could say: “Tell me about your mother. She sounds very special. Do you have a photograph of her?”’ The RMBI has sent one or two people from each of its homes to take the diploma run by Dementia Care Matters, while everyone else – from gardeners to trustees – have attended courses run by the Alzheimer’s Society.
Dementia Care Matters has awarded Prince Edward Duke of Kent Court its Butterfly Services kite mark. Launched in 2010, the kite mark is conferred after unannounced visits by auditors who ‘observe the quality of interaction between staff and people’ in a home. Six of the RMBI’s homes have received the award and this work is of the greatest value. By showing that there is a better way to look after people with dementia, the RMBI and Dementia Care Matters are performing a public service of inestimable value.
Flying high – the butterfly kite mark
In recognition of their excellent care for people with dementia, five RMBI homes have been awarded the Butterfly Service status kite mark
The RMBI is committed to making its dementia care service exceptional, and substantial investment in training for staff over the past three years is now benefitting the ever-increasing number of people with the condition who are living in RMBI care homes.
A number of the homes, including the dementia support units at Cornwallis Court in Suffolk, Prince Edward Duke of Kent Court in Essex, Devonshire Court in Leicester, Shannon Court in Hindhead and Albert Edward Prince of Wales Court in Mid Glamorgan, have received the acclaimed Butterfly Service status kite mark, which is nationally recognised and awarded by Dementia Care Matters.
Dementia Care Matters works with care providers to improve the quality of life for those residents living with dementia. They believe that care should focus on people, rather than policies, and this is tested through unannounced visits by trained impartial auditors. The audits are carried out using a qualitative observational tool, and homes that demonstrate exceptional dementia care achieve the Butterfly Service status. The goal is to make sure that all RMBI homes with a specialist dementia support unit work to obtain the award.
George Manley, resident at Prince Edward Duke of Kent Court, Essex, and the RMBI's oldest resident, celebrated his 105th birthday in style
The day commenced with a presentation from Alan Garner, President of the Association of Friends in which he highlighted some of George’s achievements and wished him a happy birthday from the Province of Essex. This was then followed with George receiving his gifts and cards including his all important card from The Queen.
The Colchester Town Crier, Mr Robert Needham, then announced Mr Manley’s birthday in the traditional manner and gave the captive audience a brief history of town criers and how communication has developed over the years. This was very apt in that Mr Manley has seen vast developments in technology to improve communication and in the way we live.
The day continued with a lunch for 20 of George’s friends and entertainment was provided by a singer in the afternoon with birthday cake and wine. George said “it was one of his best days ever”.
George has been a resident at the Home since it opened 14 years ago and says that he “wouldn’t get it much better than this”.
During his time at the Home he has visited 200 lodges across the UK and is also heavily involved in charity work, which he takes great pride in.
George has had many achievements in Provincial Freemasonry which have included being Master of two lodges at the same time, promoted to the rank of Past Provincial Grand Senior Warden and awarded the jewel Distinguished Service Medal to Essex Freemasonry. Mr Manley will also be celebrating 50 years in Freemasonry next year, having joined in 1963.