As an occupational therapist it was interesting to observe a creative and open approach by the manager of a Swedish care home in finding out about her staff and the things that interest them, former skills and seeking to incorporate these in their job.
The first person I met was an actor and singer with a history on YOUTUBE of Tom Jones and Elvis impersonations (see link below). The contact came about through serendipity. Lars was aware of people living with dementia and others with mental health problems in his 20’s prior to doing his acting training, where he was working in mental health hospitals, working in the Social Therapy department. This is before they were shut down in the 90’s in Sweden, at a similar time to the UK, also following a ‘community care’ model in preference to an institutional model of care. He is now trained as an actor and singer and is employed to work in the home in flexibly fitting alongside his acting assignments. He carries out music and exercises, outings and trips and dance in the park in the summer. Most of these activities are centred around the exploratory, inviting the playful side of the individual to be expressed.
Love me Tender: Love me True
An example of the work is the setting up of the restaurant as a pub with themed evenings for families and their relatives with the staff as a whole community joining in together (photo from Lars/Ewa). Another example is putting on a novelty tribute day to Elvis with food, popcorn, a ‘rockers radio tribute’ for Baby Boomers! – (any pictures Lars?)
Lars works across both Homes, one provides for people with physical disability requiring nursing care, and the other for people living with dementia. These homes are physically joined and there is some sharing of staff and facilities. He visits people in their own rooms and he took me into the room of a resident who loves fishing. ‘It is wonderful to see how these conversations bring on the ‘old manners’ of another era, helping them back to where the person wants to be’ he told me. He carries out a range of other creative mediums such as ‘lifescapes’, picture collages of places, people and interests that matter most to the resident, going with the flow, in the moment, tapping into playfulness, where possible.
At lunch time Lars comes back and repeats his approach for residents in the pub style dining room. He is sometimes involved with other activities in collaboration with the activity co-ordinator
Results
‘I see people who are confident now, having the conversations that have been stimulated they may not have otherwise, tapping into the long-term memory and using the capabilities still present – it makes them feel human. It is about ‘normalising’ and enriching everyday life routines to make ‘magic moments’ from the mundane.
Lars feels that independent living has lost much wider community support and has accelerated loneliness in a society that does not have the time to notice or has no desire to get involved. Groups have become unfashionable. However, now he feels ‘the tables might be turning’ as people realise the health benefits of positive community connectivity.
‘My role here is to be sociable from 8 am and host breakfast for residents by providing a welcome and hosting to create a special moment and break the ordinary routines that so easily become ‘grey and tired’ in their ordinariness. His job is also to influence and model how to do this to other staff within the team and, at the same time match interests between people to strike up new conversations whether it be fishing, old cars or travelling. Creating friendships and developing conversational content is part of the role. Building capacity in the staff is important to instil a new culture of being.
Example of care workers using skills
One example of using the workforce smartly, is one of the staff who was formerly a tailor in his country. He is being used to develop a sewing room to include residents in related skill based activity, such as mending (Have I missed anything else Ewa??.) This creates a sense of worth, and stimulates interests, providing an opportunity for occupational meaning using former every day dormant skills such as simple sewing related familiar tasks, in a place where people can work and enjoy task-related companionship as equals. The manager is keen to identify and use the talents and non-care related skills of her staff and is creating additional roles this enriching the experience for everyone.
A high-low table is available in the room and this can be used for a computer or other activities such as using a sewing machine for both staff and residents. At the same time improving static standing tolerance and balance using purposeful activity. This is a great way to maintain an older person’s functional capacity and prevent falls.
It can also be used for stroking the managers dog!
Why is the use of the Arts so important to quality of life in a care home?
Use of the arts, particularly music, drama and dance is particularly powerful as it taps into the poetry of dementia and the spontaneity of response to the senses including movement memory, creative expression, sensory movement.
Play is an important disposition that is effective in dementia care and it forms part of the optimal experience (Perrin, May 2000). It is about natural flow when people in a childlike way are free to use their bodies , hands and brain to prove they are in control of their environment . This aspect tends to get airbrushed out by our education. Play is linked to delight and the wonder of unimpeded exploration, sometimes described as the ‘inner child within’. Playful practitioners in dementia care use their body, voice and emotions to connect with a person with dementia in non-judgemental ways. Some people have these qualities naturally and other must work on their disposition.
Music enriches the brain and nourishes the spirit. We can communicate with the power of music. Music enriches
Music is a powerful and versatile medium, which can be used in a variety of interesting and creative ways. It transcends language and taps into memories that often remain longer than verbal ability. It can be calming, motivating, stimulating, and can stir many memories, promote singing, spontaneous movement and exercise. It can be incorporated into other activities such as reminiscence, quizzes, opening and closing sessions, old and new skills with instruments or apparatus, relaxation and discussions. It can be part of a planned or spontaneous activity, passive or active entertainment.
Music can be enjoyed on various levels and can provide a powerful ‘window to the soul’. It is a wonderful medium to evoke self-expression, relaxation and enjoyment through the emotions. Sessions can be spontaneous or planned. Try to incorporate a variety of music types in your sessions, considering the range of tastes among residents.
Dancing for enjoyment, acting out the memory.
Dance offers a different way of self-expression and creativity which is emotional and aesthetic, providing both a personal or a shared experience. Dance uses music working around individuals reflecting their gesture as a dialogue. A wide range of music and rhythms can be used. A tea dance provides opportunities for expression through music, fun, enjoyment, interaction, movement, reminiscence and body awareness. It taps into movement and music-memories. Drama uses an intuitive approach, requiring a full range of communication skills to facilitate activity. These include emphasising tone of voice, touch and listening skills. Creativity is stimulated along with the senses, providing opportunities for movement expression. Drama can improve communication and interaction, stimulates imagination and memory.
It does not need to involve learning of lines or costumes.
Drama is an activity which encourages creative expression and opportunities for spontaneous interaction. It can stimulate the senses, provide a sense of fun and enjoyment and therefore raise levels of wellbeing. It is helpful to use every avenue of communication, working intuitively, emphasising the use of voice, touch and listening skills. Introduce objects where possible to validate reality, and promote interaction and contact. The benefits include increased motivation, concentration, sensory stimulation and relaxation.
Why this role is this important for staff? Job satisfaction is fundamental to creativity. The more creative the environment the more likely it is to curate and instil a spontaneous, responsive and playful workforce.
Continuity of the workforce is good for dementia and business. It requires staff feeling that their job is fulfilling, have time to deliver good care, equipped to do the job properly and feeling valued.
Research shows:
· Finding the work fulfilling also needs opportunity to collaborate with others disciplines, working as a team using opportunities for greater learning
· Staff need skill variety to include how to deliver enabling approaches for older people at the end of life
· Task identity: –seeing the contribution of staff members as an important part of a ‘whole’ care plan, with a visible outcome such as a moment of joy from a resident thus feeling their work is important to the resident’s wellbeing and therefore it has significance. Having the authority to work with residents to plan the things they enjoy doing is rewarding for staff.
· Having sufficient staffing levels and enough time to do the job properly will prevent untoward situations occurring.
· Having time to deliver good care requires managers to have sufficient administrative support to enable them to focus more time on care delivery and staff supervision, particularly where new roles are being created which need monitoring and shaping
Sufficiency of staffing levels contribute to job satisfaction and carer burden/stress in staff generally especially where ‘the way of being’ in the home for care staff is to participate in the meaningful daily living occupational experience of the residents as an essential part of their caring role rather than an ‘add-on’
· Equipping staff also includes giving them opportunities for meaningful engagement with the resident and involvement in the delivery of meaningful activities (Hurtley 2003).
The management style has a direct impact on the staff experience as the manager is leading by example and is out and about spotting good practice and encouraging staff to use their talents and take responsibilities in the wider community-building life of the Home. The manager recognising and rewarding staff in a culture of achievement where she puts a high value on staff making a difference, building relationships and using their creativity, is key to a person-centred culture. These things can also contribute to raising the wider perception of the job, particularly in cooler, northern European countries where people wear their longevity as a burden rather than a crown, where society imposes an individualistic self-maintenance model in preference to an interdependent community based alternative. This is perhaps more suited to many living with dementia, using joyful celebration, and where people are encouraged to continue living life and ‘enjoy the moment’ playfully with others, not alone.
Key learning points
1. Apply the philosophy of enabling social activity and meaningful occupation with on the job learning opportunities for practice development.
2. Demonstrate how to integrate enabling daily activities into care planning, involving the person and family carers
3. Formulate quality of life outcomes that reflect the person’s lifestyle, interests, activity preferences, enjoyment and capabilities.
4. Provide people who model this behaviour so that it becomes part of the muscle of the ‘way we do things round here’
- Adopt a playful manner and attitude in what you do and how you are using humour, joyfulness and spontaneity.
https://www.youtube.com/watch?v=2QpmbtLjPro