Living well through activity in care homes

This week I have been involved in filming a rough cut for a short film for people who are looking for a care home. The idea for the film rose from the publication last year of the College of Occupational Therapists’ Living well through activity in care homes toolkit.

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It is really important for people with dementia to be supported to maintain normal daily life and to live in their own home. For some there may come a point when residential or nursing care is the best option for meeting their needs. The idea for the film was born out of conversations with relatives of people with dementia and their experience of not knowing where to start in their search.

Judging a home by the feel of the place and the décor seems a common experience. Many report the rapid decline they see in their relative on entering into care and how sad it is to visit when everyone is sat around the communal areas with the television on but little conversation or activity. We recognise the truth behind the saying if you don’t use it, you lose it but we appear accepting that once someone is requiring 24 hour support they no longer need opportunities to retain their existing skills, interests and ways of doing things.

Activity: something someone does

As occupational therapists believe that human beings have an innate drive to do we recognise that taking away choice and opportunity to engage in occupation can lead to boredom, frustration, irritability and ill health. We define activity as something someone does and being active as showing involvement. Regardless of age or diagnosis we have the right to remain active throughout our life span. Recent research highlights the risk of early mortality associated with feelings of loneliness and that those who are sedentary are much more likely to be depressed than those who are active (Steptoe et al, 2012)

Living with dementia and living life

As AHPs we need to support the message to the general public that living with dementia is not just about being a recipient of care but it is about living life. We cannot expect care home staff to have the levels of skills and expertise to address the often complex needs an older person with dementia but we do need them to understand when and whom to turn to for advice be it with eating, moving or communicating. The way forward is not seeing the care home as the be all and end all of care but ensuring equality of access by care home residents to AHP services and working in partnership with care staff.

Environment, staff attitude and communication all support activity.

To start changing perceptions of the public and the understanding of care home staff, the Living well through activity in care homes toolkit touches on ideas for activities for people in the later stages of dementia, and the role the environment, staff attitude and communication has in supporting activity. All AHPs have a part to play in enabling activity and I would be keen to hear other people’s successes in working with care homes and residents with dementia.

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The toolkit can be downloaded from our website- www.cot.org.uk

 

Karin Tancock

Karin Tancock
Professional Adviser for Older People and Long Term Conditions
@karinTancock

I provide advice and information to occupational therapists to support best practice and highlight service innovation. I also maintain professional networks with key organisations and government departments and represents the College of Occupational Therapists at key influencing events related to older people and long term conditions.

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Reference:

Accessed on 14.08.2014

  • Steptoe, Demakakos & de Oliverira (2012). The psychological wellbeing and health functioning of older people in England. The Dynamics of Ageing: Evidence from the English Longitudinal Study of Ageing 2002-10

I Hope Therefore I Am

My name is Ruth Gardner.  I am an Occupational Therapist who works with people and their families who have been newly diagnosed with dementia in Forth Valley.  I run a post diagnostic group for newly diagnosed people with dementia and carers with Alzheimer Scotland and the local Carers Centre.  People who attend the group tell me that receiving a diagnosis of dementia can be really frightening and shocking.   They tell me about the stigma that surrounds the diagnosis and the unhelpful reactions friends and family can often have to their news.  They worry about losing control and being a burden on their families.  So sustaining hope in these circumstances can be a complex challenge.

What is hope?

The Oxford English Dictionary defines hope as:

“Grounds for believing that something good may happen”

It is having something good to look forward to, feeling positive and in control of our lives.

What Occupational Therapy can offer at this time is assisting the person and the family to look at skills and attitudes that can assist them in having a meaningful future despite their illness, in essence to live well with dementia.  Sounds simple enough but how do we do it?

10 ideas to facilitating Hope

  1. Reassuring the person and the family that you and other members of the team are there for them throughout their illness and helping the person and their family understand the illness, identifying areas where control can be nurtured such as power of attorney and advanced care planning.
  2. Outline what treatment is available to help manage any symptoms such as medication, cognitive stimulation therapy and compensatory strategies to manage memory loss such as telecare.
  3. Peer support, meeting with others who are going through the same thing is a powerful tool and shouldn’t be underestimated. It gives opportunities for people to share their stories, and share ideas about how to manage the condition.  They can be a constant source of encouragement.
  4. Providing information and support for the carer. Families report that this gives them more confidence to deal with issues that arise and helps prepare them for the future.  Also people with dementia have commented that it increased their trust in the carer’s ability to help them should things change
  5. Discuss and share ways of coping day to day. This can include things such as simplifying tasks or breaking them down into smaller steps to make them easier.  Other strategies can include using calendars or diaries to remember appointments, using a timer or mobile phone to set audible alarms to remember to do something such as take your medication
  6. Humour. Time after time I see people trying to see the humour in a situation.  It can defuse tension.  Also laughter releases feel good hormones
  7. Try relaxation techniques such as breathing exercises, massage or even just sitting quietly listening to music you enjoy
  8. Stay involved in life. People often speak about how they have to adjust their expectations of the future and sometimes mourn the life that they may now not have.  However through the group and individual session staff can help explore and discuss with the person with dementia and their families realistic new goals and expectations and rethink their outlook.
  9. Look after your mental health. If you experience anxiety or depression due to your diagnosis we encourage people to discuss this with their doctor or other health professionals such as Community Psychiatric Nurse
  10. Focus on your strengths. If we focus on developing and using more of our strengths it will help us to get the best from ourselves and feel happier; good enough is usually good enough.

I would love to hear your comments on my blog or for you to consider “when you integrate hope into your work what kind of things happen for you and for the person with dementia, their carer, partners and families?”

A book and weblink I have found useful on integrating ideas of hope in my work as an occupational therapist:

Lisa Snyder (2010) Living Your Best with Early Stage Alzheimer’s.  Sunrise River Press

http://www.livingwellwithdementia.org/files/2013/07/Section-8-Hope-factsheet-FINAL1.pdf

 

Ruth Gardner
Team Lead Occupational Therapist, NHS Forthvalley
@RuthOTDem

I work as an Occupational Therapy Team Lead in a Community Mental Health Team for Older Adults within the Falkirk area. As part of my role I work with people who have newly been diagnosed with dementia and their families. I work closely with my Alzheimer Scotland colleagues and do a joint post diagnostic and singing groups with them. I am also involved in dementia training for Allied Health Professional’s in NHS Forth Valley