A Duty of Care

The Alzheimer's Society's Home from Home report says that "people with dementia spend an average of two minutes in every six hours interacting with other people." The solution's simple, says care instructor Gill Kearsley.

Every day, throughout Britain, elderly residents in care homes are waking, or being woken, to face a day of boredom and loneliness. If they, as is common in care homes, are suffering from a dementia, then their day may also be full of confusion, anxiety, fear and an overwhelming sense of failure. They may be kept clean and well fed, their rooms may be tidied and their beds made. They may be physically cared for, but the truth is that emotional and mental neglect in care homes is all too common. The BBC recently published an article about a survey they carried out - they found that, on average, the time care staff spent in conversation with elderly residents was only six minutes a day. Six minutes a day. Every day. Throughout Britain.

Today, when 'person-centred care' and 'therapeutic activity' are buzz phrases continually bandied about within the elderly-care environment, that six-minute statistic is nothing short of chilling. There clearly isn't much person-centred care going on… But what exactly is it? And how can we change things?

Person-centred care means exactly what it says - caring for the resident as a person. Therapeutic activities are what is done to achieve it.
Person-centred care does not mean keeping a resident engaged 16 hours a day - rest should follow all activities, after all. But it does mean spending time with the resident, talking to them, learning what makes them tick, and tailoring what therapeutic activities you employ to meet their needs as an individual. It's too easy for a carer's working day to cement into a tickbox routine (wake, feed, wash, move to TV room), until the residents stop being seen as people, and become little more than a living list of chores.

During my time as a physio working in residential homes, I have seen carers walk through a room of communication-hungry people to chat with other carers across the corridor. I have seen residents asleep in their chairs, or shouting out in distress, while the television drones on, unwatched, in front of them - a 'babysitter' to keep them amused. But they are not babies. And they are not amused.

It should go without saying, but it's immeasurably more beneficial for a carer to chat to a resident while helping them to dress, than to hurry through making the bed, pulling on their clothes, and wheeling them off to the dining room. Does it matter if Mrs Robinson's room is untidy if the carer spent time talking to her about her past life or sharing details of her own? If Mrs Robinson is happy and responding, that should be considered a triumph - not the neatness of the sheets.

The regular litany of care home activities - bingo, crafts, seaside outings - may be the kind of things that relatives like to see on the notice board, but they can only be considered therapeutic if the resident is fully engaged in them. Any activity can be considered therapeutic if that is the case. If the care home has someone to come in and play the piano and sing, and a resident sleeps throughout the performance, the entertainment is not therapeutic for them. If another resident is singing along with the piano and obviously enjoying herself, then, for her, it is.

One resident I knew, Elizabeth, would have loved the piano. She came in every six weeks for respite care.
She had early dementia. Often, she would appear at the top of the stairs stark naked, throw her arms up in the air and announce 'Darlings - I'm here!'

Many of the carers were baffled by her behaviour, but a quick glance at her notes would have explained everything. She'd been an actress in her youth, and still enjoyed being centre stage. If that had been taken into account, a whole host of effective therapeutic activities could have been planned for her. She would have enjoyed having help putting make-up on; she would probably enjoy watching DVDs of old musicals, perhaps a dance in the afternoon, maybe poetry reading. The list of effective care opportunities grows and grows the moment background and biography are taken into consideration.

I once worked on the geriatric ward of a local hospital. There was a gentleman who, every night would drive the sisters to distraction by picking up all the chairs in the ward and piling them on the tables. It didn't take much detective work to discover that he'd been a pub landlord, and would naturally clear the pub floor for the cleaners each night. In hospital, however, he was considered a nuisance. Today, in a more enlightened care home, the staff would help him, praise him for clearing the floor for the domestic staff. He would achieve satisfaction from helping. His self esteem would rise. He would feel worthwhile again.

The work ethic often remains strong in dementia sufferers, and can often be utilised to help staff rather than hinder. A retired office worker could shred paper, stick down envelopes for posting, put papers into boxes. It might sound patronising, but making residents feel that they are doing something to help, that they have a contribution to make, is the single most effective therapeutic activity there is.

Person-centred care means being person-orientated, not task-orientated.
Mr Smith didn't finish his dinner then later complain he was hungry just to be awkward - reading his care plan might tell the carer that his eyesight was compromised and he could only see half his plate. Turning his plate around when he'd eaten half would allow him to finish the meal.

If a resident is refusing to eat breakfast and shouting aloud, there will be a reason for it. Perhaps a few quick questions to her relatives would reveal that she is used to having an egg, and not cereal. If the kitchen staff are informed and prepare her an egg every morning, the problem will be solved. And it's not just relatives and case notes that provide such invaluable information, often the residents themselves are able to explain what's wrong - if only the carers were listening.
Passing this knowledge on to all staff who come into contact with the resident would allow effective plan of therapeutic activities to be made.

It's not only the residents who benefit from person-centred care, either. Understanding their background, their quirks and foibles, their humanity, the carer can begin to see the resident as an individual - getting a glimpse of the person they once were, and how that has shaped the person they are today. If all carers, every day, throughout the UK, take just a few minutes to learn about the history of one resident of their care home (Monday's Mr Simmons, Tuesday's Ms Lennox and so on), then we can make that six minutes into 600. Gill Kearsley is the co-founder of ExQoL, a provider of care-guidance seminars and therapeutic activities advice throughout the UK.