‘Are You Experienced’ first appeared in Mental Health Today inJune 2011. To subscribe to the magazine click here.
Experiential training can help carers to give more empatheticcare 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 increasinglypopular in residential care homes and day centres for people withdementia for some time.
This is a more creative and adaptable ‘doing with’ rather than’doing to’ approach to care. Each resident is supported toundertake a range of daily tasks, often reflecting their own lifehistory or work experiences, from maintaining a flower garden tohelping with jobs they would have done in their own home.
While results of this approach have been good, it needed to beadapted and developed, because the increase in timelyidentification of early onset dementia means that more people intheir 50s are attending day centres and bringing along their iPadsand iPhones.
These people are more interested in Dire Straits than a VeraLynn sing-a-long and so the care given needs to reflect thisdiversity. The way forward is to take individual person-centredcare to a new level – and the only way to accomplish that isthrough staff.
This required a new type of training for everyone working in aresidential care home – not just the carers and nurses. In orderfor every resident genuinely to be treated as an individual,everyone they deal with in the home must understand how they arefeeling – 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 aretoo 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 thiscan look like they are hallucinating.
I remember one lady becoming very distressed because she couldsee an old lady outside in the garden at night. She kept trying toget out into the garden to help the woman but in reality it was herown reflection. In her mind she was in her 30s and so herreflection looked like a stranger. Understanding the cause of theproblem meant it could be solved with window blinds, notmedication.
Stop making sense
The training I devised encapsulates this principle. Staff areinvited to take part in a one-day course that gives them directexperience of the effect that dementia and frailty can have on thesenses.
They are taken through a whole day where nothing seems to makesense. For example, special glasses blur their vision, headphonesdeliver white noise, and bandages or gloves restrict the movementof fingers. Trainees can find themselves being fed food that theycannot see, drinking tea from a plastic training cup and beingasked several questions in quick succession without enough time tothink of replies.
They are moved in hoists, taken to the toilet and have even beenleft outside the training room for three quarters of an hour with anote on the door saying ‘I’ll be back soon. Do not enter – the dooris alarmed.’ They get angry and frustrated. I ask them how theyfeel, and then ask how someone with dementia would feel in anequally strange and confusing situation, especially as they mayalso be in pain.
Is it any wonder that sometimes they behave in what is seen asan inappropriate way? They are having a normal reaction to anabnormal situation.
If carers are not empathetic, the therapeutic relationshipbreaks 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 isan easy trap to fall into and it causes real problems. Not using aresident’s own name is confusing for them, removes theirindividuality, lowers their self-esteem and damages the therapeuticrelationship.
When I start training I use the kind of high voice so manypeople use when talking to older people; colleagues last about 30minutes before they ask me to stop. Another powerful lesson!
Tailored approach
The aim is to help individuals live their life as they want. Theidea is that staff leave the course with a much better idea of howfrustrating and confusing the world can be to someone with dementiaand realise how they can tailor their approach to make the carethey deliver more sensitive.
For instance, if people can drink out of a normal cup, why notoffer them their own individual mug? If they like gardening, whynot get them the help and equipment to do it? These are all peoplewho have led full lives, so why should that stop now? Staff find itempowering – they can find solutions and the residents thrive onbeing offered choice and normality. Staff are also taught tolisten. People with dementia often speak in metaphors or use thewrong words. Our job is to listen so that we hear the truemeaning.
Trainees are also taught ‘active watching’ – to watch and seewhat the person sees, and this has also been successful. A lady hadcome to us and we were told she could not feed herself. I spentseveral meal times observing her and what I began to see was thather visual impairment was the issue, not her cognitive function ormotor skills. Her clothes guard was heavily patterned and herplate-guard obstructed her view. By taking these away and bychanging the way her food was presented, she could clearly see whatwas on her plate and is now feeding herself again.
I have delivered this training to more than 400 staff as part ofa pilot study in Care UK’s residential care homes and day centre inSurrey. As well as the training, fireplaces are being introducedinto lounges so that they more closely resemble a family home. Theusual symbols for toilet or bathroom are being replaced with signsthat show a photograph of what is behind the door – this stops anyconfusion about what the room is for. Also, dining rooms arebeing made smaller and entirely separate from the lounge areas, sothat people have a sense that it is time for a meal.
Care UK is also introducing ‘retro’ fittings such as old-styletelephones or ornaments from the 1940s to 1960s and, in the daycentre where people may be younger, items from the 1970s thatresidents would recognise from earlier days in their ownhomes.
Conclusion
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 majorconclusion that can be drawn already is that in an environment thatwill see more and more people in their 50s diagnosed with dementiaand people in their 80s and 90s living longer with it,person-centred care that genuinely listens to the wishes andconcerns of the individual is the only way forward for the caringprofessions. And that can only be delivered by recruiting andtraining staff so that they get real satisfaction from deliveringthat person-centred care.
Post uploaded May 2011. By Maizie Mears-Owens (Care UK)
