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.