A Duty of Care Part 1

The Alzheimer's Society's Home from Home report says that "people with dementia spend an average of two minutes in every six hours interacting with other people." The solution's simple, says care instructor Gill Kearsley.

Every day, throughout Britain, elderly residents in care homes are waking, or being woken, to face a day of boredom and loneliness. If they, as is common in care homes, are suffering from a dementia, then their day may also be full of confusion, anxiety, fear and an overwhelming sense of failure. They may be kept clean and well fed, their rooms may be tidied and their beds made. They may be physically cared for, but the truth is that emotional and mental neglect in care homes is all too common. The BBC recently published an article about a survey they carried out - they found that, on average, the time care staff spent in conversation with elderly residents was only six minutes a day. Six minutes a day. Every day. Throughout Britain.

Today, when 'person-centred care' and 'therapeutic activity' are buzz phrases continually bandied about within the elderly-care environment, that six-minute statistic is nothing short of chilling. There clearly isn't much person-centred care going on... But what exactly is it? And how can we change things?

Person-centred care means exactly what it says - caring for the resident as a person. Therapeutic activities are what is done to achieve it.
Person-centred care does not mean keeping a resident engaged 16 hours a day - rest should follow all activities, after all. But it does mean spending time with the resident, talking to them, learning what makes them tick, and tailoring what therapeutic activities you employ to meet their needs as an individual. It's too easy for a carer's working day to cement into a tickbox routine (wake, feed, wash, move to TV room), until the residents stop being seen as people, and become little more than a living list of chores.

During my time as a physio working in residential homes, I have seen carers walk through a room of communication-hungry people to chat with other carers across the corridor. I have seen residents asleep in their chairs, or shouting out in distress, while the television drones on, unwatched, in front of them - a 'babysitter' to keep them amused. But they are not babies. And they are not amused.

It should go without saying, but it's immeasurably more beneficial for a carer to chat to a resident while helping them to dress, than to hurry through making the bed, pulling on their clothes, and wheeling them off to the dining room. Does it matter if Mrs Robinson's room is untidy if the carer spent time talking to her about her past life or sharing details of her own? If Mrs Robinson is happy and responding, that should be considered a triumph - not the neatness of the sheets.

The regular litany of care home activities - bingo, crafts, seaside outings - may be the kind of things that relatives like to see on the notice board, but they can only be considered therapeutic if the resident is fully engaged in them. Any activity can be considered therapeutic if that is the case. If the care home has someone to come in and play the piano and sing, and a resident sleeps throughout the performance, the entertainment is not therapeutic for them. If another resident is singing along with the piano and obviously enjoying herself, then, for her, it is.

- -Steve Whateley

Come back tomorrow to read the rest of the story...