The Age Page

Ger'ring it...

 

“Can Gerry Robinson Fix Dementia Care Homes?” (BBC2)

In two gripping programmes, Gerry Robinson’s conclusion was that it is profit propels many private companies, rather than high standards of care and even when help is at hand, if you don’t get it, there is little point as nothing can succeed.

With an average 30 per cent return in the £6.5 billion-a-year industry, there’s plenty of money to be made from a home that passes CSCIE’s approval as merely “adequate”. “We ought,” said Robinson, “to be ashamed of ourselves.” I would add that CSCIE should be ashamed of themselves too.

So what does “adequate” actually mean? He visited Woodlands House in Torbay. Who was left to sit around the lounge walls endlessly staring into the middle-distance, their brains and bodies in a state of slow but inevitable atrophy? The staff certainly didn’t know.

Mr Robinson did his best to find out. We were introduced to three of the residents. There was Les, a former Spitfire pilot who spoke of shooting down enemy planes during the second world war, “I shot six down; it was exhilarating” and pleaded with Mr Robinson to help. There was Thelma, who, one carer believed, “used to cook” and had mysterious temper tantrums (mysterious at least to the home). One resident, Daisy, was “miserable”, but at least she had the comfort of her devoted husband Don who visited daily, spending long hours with her, talking and cuddling because he recognised that their relationship meant more than anything else. “I love the girl”, he said with deep fondness.

There were many other aspects of care that the programme investigated but for the sake of this blog, it is people’s relationships I want to highlight.

Dementia care consultant and fellow evangelical David Sheard said to me recently in his inimitable northern accent, “the thing is, Sarah, you ger'rit”. I do indeed.

The reminiscence coaching and life history projects that I specialise in and have been doing with residents, their families and carers in care homes this year have been revealing some interesting results.

As expected, they have demonstrated with crystal clarity how rich, engaged, meaningful relationships sit at the very heart of care in care homes; at the heart of the well-being and self-esteem of residents and at the heart of staff motivation and job satisfaction. 

I urge any readers who are from the industry to talk to me about what a huge difference these can make. Here is but one small but significant example. As a result of one of our life history projects, we discovered that L, a woman with moderate dementia and a resident of one care home for four years, had been one of the country’s top dog breeders for twenty years.

Yet there was no sign of this passion anywhere in her room. By using the techniques from our Many Happy Returns workshops, her Philippino carer was able to spend time while doing things for her, in conversation, gently finding out about her past – something her care plan could not reveal. L’s family have now brought in rosettes, certificates and newspaper cuttings for her to enjoy when she is alone and have created a collage of photographs of her with her dogs for her room that will remind her of these rich experiences.

The result for L is that she is more alert, more engaged with her carers and more likely to join in activities within the home. The process has restored some of her sense of self – and in valuing her and her experiences, has improved her life in the home.

And there have been major changes for her carer, too. Before this project, R. found it difficult to talk with residents, thinking it was rude and intrusive to ask questions, but as she gained confidence she also grew to enjoy L’s company and noticed how L began to respond to her. By the time the album was complete, she described responding to L “as though she is my own grandmother” and noted how the bond between them had grown to be one of genuine affection.

L’s daughters also described how their relationship with both L and R had changed for the better and how the album helps them to talk with L about the things she is interested in when they visit. They have commended the home and Many Happy Returns for the project and say that now they feel more re-assured that L is in a place of great care.

Now that’s what living in a care home should be like.

Image: Jeff Koons Puppy 

 

 

 

Mucking about in the street in the 1950s

 As children, if we ever complained of being bored, my mother would always say the same thing, regardless of the season, "...then go outdoors and play". And we did, however reluctantly. And in the summer months we would be out until all hours. My daily journey to primary school with my younger sister involved crossing wheat fields, and passing by gravel pits and cherry orchards, using the back lanes for speed, with all their opportunities for games and harmless mischief. I do remember worrying whether someone might jump out at me while I trod the footpath when the wheat was high, but by then, I had read Great Expectations...

Here's an interesting article and readers' comments about the loss of children's freedom to play in these risk-averse times  from the BBC magazine... 

They blame "stranger danger" and the likes of Myra Hindley and Ian Brady.  But I believe our whole culture has changed and this is as much to do with things like negative media, computers, working mothers, the break up of communities, petty crime, over-caring and car ownership to name but a few.

That said, in the mid-eighties I was making a marketing film about Royal Victoria Docks in the far East End of the City of London for a commercial property developer. The client and I spent a summer's day there, travelling from our offices in busy-busy Soho to look for locations to shoot in. 

My enduring memory of the excursion was that wherever we drove, up and down the many streets of terraced houses out of which had once poured the dockers in response to the siren at the start of the working day, we saw nothing – and nobody. Front doors were shut, curtains were drawn across, there was hardly a sign of life and certainly no children. But there were no cars, either.

Whatever the reasons, it's a shame that children have so little personal freedom and choice now – perhaps we are secretly preparing them to be elderly...

 If you were young then, what are your memories of these times? I welcome your comments.

Respect your elders - who could argue?

 Image: Ari Seth Cohen

Serial Sevens

Serial sevens – that is, counting down from one hundred in sevens – is a clinical test used to test mental function in suspected cases of dementia and forms part of the MMSE – the Mini Mental State Examination, wherein people are asked to count backwards from one hundred in sevens.

On its own, the inability to perform 'serial sevens' is not diagnostic of any particular disorder or impairment, but is generally used as a quick and easy test of concentration and memory in any number of situations where clinicians suspect that these cognitive functions might be affected.

Similar tests include serial threes, where counting downwards is done by threes; reciting the months of the year in reverse order or spelling 'world' backwards.

Seven is an interesting number in all sorts of ways, but my personal favourite is that it is the maximum amount of times that you can fold a sheet of paper in half.

 

 

Having a laugh: more than the best medicine

Using rich reminiscing conversations to improve care relationships is what it's all about. When they are connected and meaningful, they have proven benefits for the older person and rather more surprising ones for carers.
People sometimes look aghast when I say it's about having fun as well – apparently no one's really supposed to enjoy themselves if they're inter-relating with someone who is older – especially if they have dementia or other mental or physical disabilities.
We really need to change this.
Would you like to be able to enjoy yourself whatever your age, whatever your physical or mental health?
Who would answer N0? These create really good conversations instantly...

Collected Short Stories in Harrogate...

I spent the earlier part of this week at the UK Dementia Congress where I had the privilege of presenting the results of a family project: "Collected Short Stories" which I completed recently, with Shaaron Caratella, the exemplary home manager of a Barchester home in south west London, Queens Court.

We did something quite simple in concept: buddied carers with the home's residents and their families to have conversations about the residents' life and times during their 'reminiscence bump' years (age 5 - 25). These exchanges led to their building autobiographical albums for the residents together. 

At the end we formally evaluated the project. All the carers come from different cultures and they have learnt some social and cultural British history and a little geography along the way and this has also helped to improve their relationships with those in their care – and one another. 

Earlier this year, the staff had participated in my REAL Communication workshops which explore reminiscence, empathising, enquiry and active listening in conversation, using the Many Happy Returns 1940s cards as the basis. This recent project has allowed them to practice what they learnt.

The outcomes from Collected Short Stories have been manifold. The residents' sense of value, well being and self-esteem rose and their alertness and sociability has increased. The families' appreciation of their loved ones, the carers and the home has been strengthened. The carers' work enjoyment, motivation and commitment has increased both individually and as a team. 

We also made a number of surprising discoveries about the residents, all of whom have moderate to advanced dementia. One such was a top dog breeder – despite there being no evidence of this either in her room or among her possessions. The family had a large archive of rosettes, certificates, newspaper cuttings from over thirty years of her work stored away, some of which can now be found in her room, as well as in her album that celebrates her achievements and helps her remember. 

The family had simply not understood that their mother's past is possibly more important to her now as her dementia advances. Why should they? People's understanding of dementia and old age is often predicated on the belief of many, articulated by someone to me recently as "oh that's just wrinklies losing their marbles, isn't it?". 

As this normally reticent resident commented to the carer, "you have done really well for me". The carer, who earlier in the project had been worried that asking questions was 'prying' and held that her relationship with residents should be more formal, now describes her relationship with the resident as "... more like being a grand-daughter". And as her confidence in her abilities has grown, so she has become more engaged with the rest of the residents and the staff team as well. 

The resident's daughter commented, "we are never short of conversation now. I really commend the home and Many Happy Returns for doing this – all residents and their families should have one of these books."

In the building of another album, one resident, whose family live some way away and who is intensely private, has been able to clarify earlier confusions in her memory of events in her life, using the pictures and words as triggers. 

As her carer said, to begin with, she was disappointed to be buddied with this resident, who had few pictures of her life and was very withdrawn. But the album has become the source of richer conversations, with illustrations of her life, from images of places and things about which she has spoken. These have also prompted other and deeper memories she had forgotten or had unintentionally misrepresented as a result of her dementia. 

This additional remembering has raised her self-esteem, saying "I really like to look at the book and can remember much better with it". Her relationship with her Caribbean carer has improved to the point where she has invited her to lunch.

Pain can complicate relationships as well as depress, but one team leader reports that when he encouraged one resident with chronic arthritis to reminisce about her life as a younger person, the palliative effects were immediate and she said her pain"just seems to melt away".

Another pairing has delivered benefits to the family, who realised that they knew very little about their mother's life, growing up in a pub in the East end during the war. For the first time, they went to explore the area, photographed the house and brought it back for her to enjoy. 

"We always talked about our father's life" they said, "it was he who seemed to be the more interesting. But now we have become intrigued by our mother's experiences and this research has changed our relationship with her for the better." This altered dynamic is most evident in the family's interaction when they are gathered together, which is now more connected and meaningful.

As Shaaron commented on the project, "my residents are happier, their families are happier and my staff are happier, so it's win, win!" 

The senior carer said of the training and project, "I am grateful to Many Happy Returns for what you have given to me – tools for life both inside and outside the home – which I will never forget and which no one can ever take away from me."

Finally, let one resident express a most moving outcome, "I feel I am important to people again". More importantly, she is also more important to herself.

Image: paraorkut.com

Active listening is a dog's life

Listening is one of the most important skills any of us have. How well we listen has a major impact on on the quality of all our relationships with others.

We listen to obtain information, to understand, 
for enjoyment and to learn. Given all the listening we do, you might reasonably expect that we’d be good at it. But in fact, we’re not.

Depending on the study being quoted, we remember a dismal 25-50% of what we hear. That means that when colleagues, customers or friends talk to us for, say, 10 minutes, we’re only likely to hear between 2½-5 minutes of what they say.

It takes both concentration and determination to be an active listener and old habits are hard to break, but it is possible. Since the beginning of the year, I’ve been running workshops that help carers to listen better to residents, as part of my work with Many Happy Returns.

It might be better to call it “deliberate listening without passing judgement”. It means reminding yourself constantly that your aim is to truly hear what the other person is saying. This means setting aside all other thoughts and behaviours that might be distracting you and not thinking about your reply, so really concentrating on the message.

The results have been fantastic – one carer reported that not only his work, but also his marriage had improved as a result; another carer was able to build a care plan for someone with dementia who had no friends or family left alive. As one of residents who spoke about feeling more valued so aptly put it , "being listened to makes you feel that what you have to say is worth something". If you want to know more you can contact us through the Many Happy Returns website. 

It’s such a pity that politicians don’t get any training in this. If they did, there’d probably be fewer wars.

When remembering makes people forget pain

Over the last two months I've been working with residents, families and carers on a personal stories project we called 'Collected Short Stories' at a care home in south-west London. The home's manager and I will report the findings of this experience at the UK Dementia Congress in a couple of weeks. 

It started earlier this year, when I ran three, half day REAL Communication workshops for staff at the home where they honed their empathising, listening and conversational skills, using Many Happy Returns 1940s cards as the key driver.

For this project, we assigned carers to a resident each, to find out about their early lives during their 'reminiscence bump' (ages 5 - 25/30, where people's most powerful memories reside). 

The results were even better than we expected. 

When staff who don't have English as their first language and have limited knowledge of British history speak with people some two or even three generations older, conversation can be very challenging and the resulting poor communication may be exacerbated by the older person's diminishing hearing, eyesight and sometimes speech or other physical or mental issues. But give the carers techniques for enquiring and listening and encourage them to find out about people's childhood and teen experiences and suddenly, other wonderful things start to happen.

Amongst an array of good outcomes was this: one resident lives in almost constant pain with her knees which are deeply arthritic. All walking is a struggle for her, between her sense of independence and continual gnawing pain. However, her assigned carer noted that when he encouraged her to talk about her happy memories from her youth and engaged with her better using the listening techniques  he had learned, she told him unprompted that the otherwise ever-present pain "just went away". This knowledge encouraged him to continue to get to know her through the retelling of her life history and help provide some respite from the pain. 

In building an autobiographical album of her life together, they have developed a more meaningful and connected bond that extends far beyond expected standards of care, right to the very centre of her – and his – well-being; physical and spiritual and emotional. Now that's what I call relationship-centred care.

'This is My Life' Album Workshops; REAL Communication Workshops and GREAT Workshops for children; are all part of what Many Happy Returns is doing to help care homes get better at what they do. If you would like to know more, please look here.

Image: Age Concern Cardiff

The importance of Austerlitz, and remembering

"Austerlitz" is widely considered to be W G Sebald's best attempt to explore the meaning of memory and history ­– and I can’t recommend it highly enough.

The text positively exudes melancholy loneliness, and the forced separation from the past, that so often pervades the recent European cultural past. And yet it is never depressing or downbeat. Memory and language are central to the book, yet even though language is so important to memory, it can never fully capture entirely the way we experience the past, because we all remember in our own private images and senses.

Curiously, there are occasional illustrative photographs throughout the book at various points in the narrative. The book is as much about the making of memories as about re-finding ones that are lost.

The central character, Austerlitz, endlessly uneasy with his life without knowing why, uncovers a painful personal past, which motivates other aspects of his life.

As with his other books, I suspect that this is as much about Sebald’s search for personal understanding as that of his eponymous character. Without doubt, we ignore our histories at our peril, condemning them to a myopic future – so let’s reminisce and rejoice in our memories.

Image:  ohbara.com 

Love bouncing back

I have long been passionate about how we care about and for our older people. Never has the time been better to reconsider their place in society and their treatment by the various care services they encounter. Part of this is reconnecting the generations for mutual benefit.

We all know, or know of someone over 75 who lives alone and may be lonely. Why not send them a nice card to say hello, or phone them up to let them know you are thinking about them, or better still, pop round to see them or take them out for a cup of tea and a chat.

Best of all, think about volunteering for Contact the Elderly – such small input, such big results. The only effort required is a few hours once a month on a Sunday; the result is a lifetime of connection and pleasure for everyone involved – the love you give bounces back. Simple really.