The resident DJ
Whether it’s writing a book, having a go at volleyball or playing music at a local radio station, RMBI care home residents are discovering new skills in later life. Amy Lewin explores the activities on offer
There’s a new DJ at Tudno FM and he’s spinning some old tracks from Duke Ellington, Benny Goodman and Glenn Miller. Back in the 1940s and 1950s, Ken George played trombone and saxophone in a band. Nowadays, he plays music at Llandudno’s community radio station, just across the road from his home, Queen Elizabeth Court.
‘Ken’s unbelievable,’ says Gary Carr, Activities Coordinator at the RMBI care home. ‘He’s 87, and so knowledgeable and enthusiastic.’ Gary does some drive-time DJ’ing himself, and one day suggested that the music enthusiast came along to see what they do at the station. And so DJ Ken was born. ‘Older people tend to get stereotyped. Here, we don’t assume that our residents can’t do something – we find out what they can do.’
The media may be awash with gloomy headlines about the problems facing the UK’s ageing population, but an increasing number of over-65s are still in employment, and many learn new skills every day.
‘Everything we do is geared to maximising people’s strengths, in all different areas, while giving residents the opportunity to try new things,’ says Debra Keeling, RMBI Deputy Director of Care Operations. ‘We need to remember that someone living in a care home has a huge amount to offer, and can still keep learning. So as far as possible we just continue with normal life, while developing self-esteem, supporting each other and creating a sense of community.’
Ken’s swing session isn’t his only appointment for the day. After lunch, he will be building with Lego and cardboard boxes, keeping his hands dexterous. More importantly, he will also be swapping stories with a group of fellow residents.
‘It’s all about reminiscence,’ says Gary. ‘I tend to tap into memories of things people did as a child, or when they were younger.’ It could be a creative activity that sparks conversation, or hearing an old song or taking a day trip. ‘That’s what we do here – we unlock memories.’
One of the most recent donations to Gary’s club, inspired by Age UK’s hugely successful Men in Sheds initiative, was an old Singer sewing machine. And it just so happens that he is a trained sewing machine mechanic, so he stripped it down and fixed it up like new. ‘You should have seen the looks on their faces when I opened the box and showed it to the group,’ he chuckles. ‘They were so excited, because they’d all had one once.’
At Cornwallis Court in Suffolk, the residents also have plenty of tales to share. When 26 uniformed RAF officers visited earlier this year, they found themselves staying well beyond teatime. ‘A lot of the residents fetched their medals from their rooms,’ says the home’s Activities Coordinator Alexander Winter. ‘They swapped stories with the officers for the whole evening.’
It’s not just the people actively taking part who benefit from these sessions. Some residents might have lost the ability to speak, yet sometimes simply being surrounded by other people communicating, laughing and using positive body language can have a huge, positive impact on their sense of wellbeing.
Leading by example
Later in the week, back in Llandudno, Ken has another activity in the diary. But this time, he will be leading it. ‘Ken loves to help out when I’m not around,’ says Gary. ‘On Saturdays, he runs “Music with Ken George” in the home’s Silver Jubilee Lounge. He’s made a lot of friends here.’
Like everything else going on at Queen Elizabeth Court, the music session is advertised in the home’s monthly Court Tales magazine, so residents can pop along if they like the sound of whatever’s going to be playing on the day.
Ken is not the only one sharing his skills and interests. In another home, a lady who had been a florist hosted a flower-arranging club to share her skills with other residents. ‘It boosted her self-esteem immeasurably,’ says Debra. ‘It was really important for her to show other people who she was. And everyone walking around the home commented on how lovely the displays looked.’
Carers and activities leaders work hard to arrange events and to encourage hobbies – whether carried out in a group or as an individual – that are relevant to each person living in their home, based primarily on their personal care plan.
‘We focus heavily on life history and get to know people really well – right from where residents were born to what subjects they did at school, what jobs they had and what their interests were,’ says Debra. ‘We mould all that information together and develop a plan that’s meaningful to them.’
‘Older people tend to get stereotyped. Here, we don’t assume that our residents can’t do something – we find out what they can do.’ Gary Carr, Activities Coordinator
The RMBI’s tailored approach to care helps its residents to maintain their independence, and to tot up plenty of personal achievements along the way. Among the 1,000-plus people living in RMBI homes in England and Wales, there is a 100-year-old playing the occasional game of volleyball, someone over 80 who has learned to play the piano and an autobiographer who has written a book of personal wartime experiences.
Not that it is always possible for all residents to achieve everything that they’d like to. One resident wanted to fly on Concorde which, short of time travel, was beyond the means of the care home.
So it was decided to look for the next best thing – going on a flight simulator.
‘We also used to have somebody who really loved horses, but was no longer able to ride,’ remembers Debra. ‘Yet she could still enjoy going to see the horses and stroking them, so we set up trips to a stable. You name it and we’ll try to arrange it, as much as we possibly can.’
Creating a community
At Cornwallis Court, basket weaving is a favourite activity. ‘It doesn’t always end up involving basket weaving, though,’ says Alexander, explaining that the session sometimes morphs into embroidery and crafting, depending on what the residents fancy. ‘Lots of the residents keep things like toiletries in the baskets they’ve made. Sometimes they make them for those residents who can’t, or they bake a cake for the less mobile, take it round and have a chat.’
Alexander thinks this community spirit is not only part and parcel of the activities programme but also a key feature in all RMBI care homes. ‘It’s a window of opportunity to socialise and make friends in their own time. It reawakens a social environment, which continues when there’s nothing going on. Even when there are no activities coordinators around, they will visit each other’s rooms, or bring some board games to the lounge to play together. That’s what I call a butterfly-effect moment.’
For many residents, living in an RMBI home is a sociable kind of independence. ‘After all,’ says Alexander, ‘everybody here has a degree in life.’
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
Easy as pie
RMBI residents across the UK took part in a variety of activities to mark British Pie Week, with tasting, baking and recipe-sharing sessions among the events. The RMBI places great importance on providing its residents with food that they grew up with and enjoy – as well as new dishes they have come to love – and its balanced, nutritious menus include classic pie dishes.
Recipes and Reminiscences, the RMBI cookbook, contains 50 favourite recipes from residents and staff. Many in the book were national staples in their era, including Woolton Pie, named after one of Churchill’s Cabinet.
A classic wartime dish, it encouraged people to use whatever vegetables were available to them during the rationing period to create family meals.
Debra Keeling, RMBI Deputy Director of Care Operations, said: ‘We strive to deliver a high quality of life for our residents, and providing enjoyable food and drink is essential to this. Our residents are encouraged to put their menu ideas forward to ensure we cater to their individual tastes. British Pie Week is a great way of bringing residents together through their mutual love of food.’
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.’
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.
Dementia is one of the most challenging issues society faces: in the UK, there are around 750,000 people with a form of the syndrome, and this figure is set to rise in the next 20 years. A recent report from the Alzheimer’s Society showed that two-thirds of people living in care homes have some form of dementia. Debra Keeling, deputy director of Care Operations at the Royal Masonic Benevolent Institution (RMBI), said: ‘We found that people with dementia, of varying types and stages, live throughout our care homes. Therefore, as an organisation, we needed to think about how we could adapt, improve and expand our services to meet the needs of the people who live in our homes, in a way that enhances their wellbeing and quality of life.’
A NEW CARE STRATEGY
As a result of the RMBI’s research on the type of care needed by the people using its services, a five-year strategy was approved by the board of trustees in 2009. The RMBI Care Strategy – currently being rolled out in a phased approach to its 17 care homes – focuses on person-centred care, and how quality of life can be improved for individuals using its services. New and improved care-planning documentation has been introduced. This focuses on the individual’s care needs and how this information could be used to infl uence the way care is delivered to ensure that it is meaningful to the individual. Relatives are also encouraged to be involved in the process throughout.
Many homes hold regular relative-support groups for families of people living with dementia that offer both emotional support and advice about all aspects of dementia, with an emphasis on sharing experiences. The RMBI Care Strategy is integral to the working of all departments within the organisation. Closer working relationships have been developed between departments, ensuring that the key goals of the strategy are met, and that any changes required within the care-home environment are implemented in a manner that is appropriate to the people living there. A comprehensive training programme to support staff has also been implemented. Through this investment in training and development, the RMBI aims to equip staff to review the care regime in their local care setting, in order for them to seek ways of removing barriers that hinder relationship-based care. On completion of the strategy, the RMBI will be able to deliver a more person-centred approach to its care provision throughout the organisation.