Sarah, Fife, Scotland, gives an in-depth view of the Care Home from the perspective of an Activities Organiser
Every home is different, but I can give you my experiences of a small care home in Fife. I worked as a part-time Activities Organiser, providing activities to residents with dementia. The staff there were all local and many of them seemed to be related to one another. I never did quite get the relationships between them, but the stories were choice. They were all lovely people, and worked together well as a team – with the odd flare-ups now and again, granted.
As is the Scottish way, the morning would start with who had done what on the last shift. As I was never good at work politics, I tended to keep busy with what I was doing, and feign deafness to all that was being said around me. On the outside looking in, it often ran like an episode of Eastenders, and I found that staff rarely minded what they were saying in front of residents, which was a little off. But then, care staff work incredibly hard for their money, and the chat greases the wheels, I guess.
Minutes are a precious commodity in a care home. For residents, the hours probably go by rather slowly from late morning on, but every second is counted by employees. So every morning, the old grandfather clock struck the beginning of a long shift and everyone would take up positions, and the nattering would stop.
The first job of the day was to get everyone up. There were around 17 residents there and it was an old house which had been converted, so the able-bodied residents had bedrooms upstairs. I was at first quite upset by the cold way in which people were hoisted up out of their beds and taken for a bath – I had imagined that out of respect, it would be a soft awakening for every resident, perhaps a wee cup of tea by their bed, etc. But then, this was the dementia unit, and care staff spent much of their morning calming those who were confused about someone 'coming into their house' and invading their privacy. With the same rigmarole every morning, it can't be easy to keep a human touch on these rituals. Still, some of them managed. There was a consistent element to this – those who had a kindness to them, always had it; those who didn't, never did. I would say the ratio was about 50/50.
Once everyone was up, breakfast was served in the dining area of the home. It was a small line of tables along a south-facing conservatory wall and was lovely in the Summer. Residents were asked what they would like for breakfast, choosing between porridge, cereal, scrambled egg and toast. As dementia can affect appetite as the disease progresses, this was a trying time for staff and residents alike. I saw this as an important part of my day, although I was not due to start until well after breakfast. Several of the residents would typically not eat, saying either that they were not hungry or had just eaten. However, by chatting to them about their likes and their past, etc, there was enough distraction that they would start to eat in between talking. I preferred this to the way in which many of the care staff would either 'feed' those unwilling (simply holding the fork for them, not force-feeding I must stress!) or leave them with a full plate of food, only to throw it in the bucket once breakfast was over.
After this, residents were placed at various areas around the home. There were those who generally spent the day walking, and would walk from one room to another. There were also those who were not mobile and would sit for long periods of time in the same place, until either moved or taken for a walk. The doors to the home were always locked due to the risk of residents wandering out, so there was nowhere to go but around the ground floor of this 180 year old house. So before, long, tellies in each area were switched on, marking the beginning of a long day of GMTV, followed by the afternoon delights of a variety of the same Scottish music videos, day in, day out.
Staff were now busy administering medication, tidying bedrooms and writing reports and so very little would happen with the residents, with the exception of whatever activities I had in store that day. Even then, because I always tried to fit it a good deal of time on one-to-ones (activities spent only with the one resident, rotated so that by the end of the week everyone had spent some quality time with me – lucky them :) there would be some who did not become involved in the day's activities. Also, just depending on what kind of mood many of them were in, (Mood swings are very common in Dementia) my 'party' of 6 or 7 could go down to 2 in a matter of minutes. On good days, we got a lot done and I could see that the residents were really enjoying themselves, whether this was baking, gardening or arts and crafts. On bad days, I felt rather useless, trying to distract these lovely people momentarily from the confusion and frustration caused by not knowing who they were or why they were there.
One gentleman, a sweet man in his early seventies, was visited by his long-suffering wife most days. I felt for her, deeply – she had effectively watched the man she'd spent fifty years of her life with, deteriorate in front of her eyes. He often didn't recognise her, or would introduce me to her as his daughter. Yet, despite this obvious difficulty, noone ever seemed to offer her advice, or support during this difficult time. Also, no 'snug' was available – a room where couples could go and, maybe, listen to music, watch telly, or just relax and spend time together away from the prying eyes of care staff and residents. She would come for a couple of hours, and then whisked off with a 'We're going to give him his lunch now' cue. Her husband had stopped being able to reciprocate the affection she showed him, and he didn't take in the sadness on her face every time she said good bye. I always thought it was such a shame that Care Manager responsibilities did not seem to extend beyond the wellbeing of the resident – after all, it's often the family who are paying for the service. But that's only in this case – I'm sure it's different in other care homes.
Lunchtime was very much like breakfast – those who would eat, did, and those who wouldn't simply left a full plate in front of them until it was taken away. Again, I would sit which each person and have a natter with them – those residents in the progressive stages of the disease often fixated on a particular memory or song or topic, and so it was easy to get them talking. Those who could not be helped would eventually be given supplements to keep them going. It would be a downwards spiral from there – I never saw anytime regain their eating patterns once turned over to supplements. However, care staff are between a rock and a hard place, here, as they have to ensure that they get sufficient nutrients into their bodies, and cannot 'force' someone to eat. I never envied care staff for the difficult decisions they have to make on a daily basis.
If the weather was good, I'd take some of the residents out on a walk. As the body does not retain heat so well in advanced years, the residents were swaddled in hats and scarves (and if in a wheelchair, blankets) and taken out for half-an-hour. It was just pot luck what kind of mood some of the residents were in. Occasionally, I would take them out and they would talk about woodland walks as a child, spotting flowers and sheep in nearby fields. Other times, they would just be screaming at me 'where the hell are you taking me?!! I'm calling the police you wee b****r”. One of the saddest things about dementia is how it can take an ordinarily sweet-natured person who may have been the most wonderful wife/father/grandparent and turn their personality into something quite unrecognisable.
A little word on the care staff at this point – they have been busy, dealing with wounds and ailments, outbursts and incontinence, in addition to ensuring that residents are well and happy. It's a difficult situation, I'm sure, as care staff are limited in what they can do for residents who are in the latter stages of dementia, other than ensuring their general well being. However, I always felt that could be more done than was. Late in the afternoons, we would often put on music or I would hold a light exercise class, but it sometimes felt that any activities which may require more input from care staff were frowned upon by the majority – the same ones who would, I confess, ordinarily have less patience with the residents.
I think this is one important aspect of employing care staff that should not be overlooked during the selection process. There seemed to be a clear demarcation between staff who's input was purely physical and those who used their hearts in providing care to these lovely people. It begged the question, I felt; “Why not only employ the latter as a rule?” I supposed at the time that this was because such people were in short supply, and it was probably idealistic to expect a happy caring home (with roses round the door and bluebirds tweaking tablecloths). However, having seen many other care homes, I realised that it's not so much about those employed, as how willing a care home is to train their staff accordingly. It's about creating a paradigm shift in the way care staff perceive and value their roles. However, I'm wandering from the point..
Evenings begin typically at 5pm. This is the same across many care homes, and is often little more than a desire to have all residents medicated, bathed and in bed before the end of the shift. As a result, residents can find themselves in bed for 14 hours – another thing I had very little understanding for, but again, realise that this varies across care homes.
Although I appreciate that unfamiliarity can cause great upset for residents in the mid-to-latter stages of dementia, it is also known that mental and physical activity can help slow the degenerative process. Providing stimulating conversation, increased participation, providing choice and facilitating independent thought can all help to keep the mental processes ticking over. These are things that need not be taken out of a resident's day just because they have lesser reasoning power or communicative skills than other residents. I wished very much that those care staff who obviously took great care in their work should be recognised and 'championed' by care managers to lead the way for others – I'm sure it happens – but as a rule it seemed that those who were loudest were heard, and the good ones just humbly went about their day, making their residents comfortable.