'Are You Experienced' first appeared in Mental Health Today in June 2011. To subscribe to the magazine click here.
Experiential training can help carers to give more empathetic care to people with dementia, says Maizie Mears-Owens from Care UK, who has devised such a scheme for staff at the service provider
Theories such as activity-based care have been increasingly popular in residential care homes and day centres for people with dementia for some time.
This is a more creative and adaptable 'doing with' rather than 'doing to' approach to care. Each resident is supported to undertake a range of daily tasks, often reflecting their own life history or work experiences, from maintaining a flower garden to helping with jobs they would have done in their own home.
While results of this approach have been good, it needed to be adapted and developed, because the increase in timely identification of early onset dementia means that more people in their 50s are attending day centres and bringing along their iPads and iPhones.
These people are more interested in Dire Straits than a Vera Lynn sing-a-long and so the care given needs to reflect this diversity. The way forward is to take individual person-centred care to a new level - and the only way to accomplish that is through staff.
This required a new type of training for everyone working in a
residential care home - not just the carers and nurses. In order
for every resident genuinely to be treated as an individual,
everyone they deal with in the home must understand how they are
feeling - including kitchen staff, cleaners and the admin team,
because everyone can make a difference.
New way of thinking
My background is as a mental health nurse and drama therapist. It has been my concern for many years that, as a society, we are too quick to medicalise problems.
But to change this philosophy involves news ways of thinking, including developing empathy with the individual. For example, people with dementia often mistake their own reflections and this can look like they are hallucinating.
I remember one lady becoming very distressed because she could
see an old lady outside in the garden at night. She kept trying to
get out into the garden to help the woman but in reality it was her
own reflection. In her mind she was in her 30s and so her
reflection looked like a stranger. Understanding the cause of the
problem meant it could be solved with window blinds, not
Stop making sense
The training I devised encapsulates this principle. Staff are invited to take part in a one-day course that gives them direct experience of the effect that dementia and frailty can have on the senses.
They are taken through a whole day where nothing seems to make sense. For example, special glasses blur their vision, headphones deliver white noise, and bandages or gloves restrict the movement of fingers. Trainees can find themselves being fed food that they cannot see, drinking tea from a plastic training cup and being asked several questions in quick succession without enough time to think of replies.
They are moved in hoists, taken to the toilet and have even been left outside the training room for three quarters of an hour with a note on the door saying 'I'll be back soon. Do not enter - the door is alarmed.' They get angry and frustrated. I ask them how they feel, and then ask how someone with dementia would feel in an equally strange and confusing situation, especially as they may also be in pain.
Is it any wonder that sometimes they behave in what is seen as an inappropriate way? They are having a normal reaction to an abnormal situation.
If carers are not empathetic, the therapeutic relationship breaks down. I also often get trainees to wear badges with 'love', 'sweetheart', 'darling' and 'dearest' written on them - they are then called those names in the training session. This is an easy trap to fall into and it causes real problems. Not using a resident's own name is confusing for them, removes their individuality, lowers their self-esteem and damages the therapeutic relationship.
When I start training I use the kind of high voice so many
people use when talking to older people; colleagues last about 30
minutes before they ask me to stop. Another powerful lesson!
The aim is to help individuals live their life as they want. The idea is that staff leave the course with a much better idea of how frustrating and confusing the world can be to someone with dementia and realise how they can tailor their approach to make the care they deliver more sensitive.
For instance, if people can drink out of a normal cup, why not offer them their own individual mug? If they like gardening, why not get them the help and equipment to do it? These are all people who have led full lives, so why should that stop now? Staff find it empowering - they can find solutions and the residents thrive on being offered choice and normality. Staff are also taught to listen. People with dementia often speak in metaphors or use the wrong words. Our job is to listen so that we hear the true meaning.
Trainees are also taught 'active watching' - to watch and see what the person sees, and this has also been successful. A lady had come to us and we were told she could not feed herself. I spent several meal times observing her and what I began to see was that her visual impairment was the issue, not her cognitive function or motor skills. Her clothes guard was heavily patterned and her plate-guard obstructed her view. By taking these away and by changing the way her food was presented, she could clearly see what was on her plate and is now feeding herself again.
I have delivered this training to more than 400 staff as part of a pilot study in Care UK's residential care homes and day centre in Surrey. As well as the training, fireplaces are being introduced into lounges so that they more closely resemble a family home. The usual symbols for toilet or bathroom are being replaced with signs that show a photograph of what is behind the door - this stops any confusion about what the room is for. Also, dining rooms are being made smaller and entirely separate from the lounge areas, so that people have a sense that it is time for a meal.
Care UK is also introducing 'retro' fittings such as old-style
telephones or ornaments from the 1940s to 1960s and, in the day
centre where people may be younger, items from the 1970s that
residents would recognise from earlier days in their own
The pilot has now ended, but feedback from staff, residents, relatives and healthcare professionals has been positive.
The final report has yet to be completed, but one major
conclusion that can be drawn already is that in an environment that
will see more and more people in their 50s diagnosed with dementia
and people in their 80s and 90s living longer with it,
person-centred care that genuinely listens to the wishes and
concerns of the individual is the only way forward for the caring
professions. And that can only be delivered by recruiting and
training staff so that they get real satisfaction from delivering
that person-centred care.
Post uploaded May 2011. By Maizie Mears-Owens (Care UK)