A Duty of Care Part II


One resident I knew, Elizabeth, would have loved the piano. She came in every six weeks for respite care.

She had early dementia. Often, she would appear at the top of the stairs stark naked, throw her arms up in the air and announce 'Darlings - I'm here!'

Many of the carers were baffled by her behaviour, but a quick glance at her notes would have explained everything. She'd been an actress in her youth, and still enjoyed being centre stage. If that had been taken into account, a whole host of effective therapeutic activities could have been planned for her. She would have enjoyed having help putting make-up on; she would probably enjoy watching DVDs of old musicals, perhaps a dance in the afternoon, maybe poetry reading. The list of effective care opportunities grows and grows the moment background and biography are taken into consideration.

I once worked on the geriatric ward of a local hospital. There was a gentleman who, every night would drive the sisters to distraction by picking up all the chairs in the ward and piling them on the tables. It didn't take much detective work to discover that he'd been a pub landlord, and would naturally clear the pub floor for the cleaners each night. In hospital, however, he was considered a nuisance. Today, in a more enlightened care home, the staff would help him, praise him for clearing the floor for the domestic staff. He would achieve satisfaction from helping. His self esteem would rise. He would feel worthwhile again.

The work ethic often remains strong in dementia sufferers, and can often be utilised to help staff rather than hinder. A retired office worker could shred paper, stick down envelopes for posting, put papers into boxes. It might sound patronising, but making residents feel that they are doing something to help, that they have a contribution to make, is the single most effective therapeutic activity there is.

Person-centred care means being person-orientated, not task-orientated.
Mr Smith didn't finish his dinner then later complain he was hungry just to be awkward - reading his care plan might tell the carer that his eyesight was compromised and he could only see half his plate. Turning his plate around when he'd eaten half would allow him to finish the meal.

If a resident is refusing to eat breakfast and shouting aloud, there will be a reason for it. Perhaps a few quick questions to her relatives would reveal that she is used to having an egg, and not cereal. If the kitchen staff are informed and prepare her an egg every morning, the problem will be solved. And it's not just relatives and case notes that provide such invaluable information, often the residents themselves are able to explain what's wrong - if only the carers were listening.
Passing this knowledge on to all staff who come into contact with the resident would allow effective plan of therapeutic activities to be made.

It's not only the residents who benefit from person-centred care, either. Understanding their background, their quirks and foibles, their humanity, the carer can begin to see the resident as an individual - getting a glimpse of the person they once were, and how that has shaped the person they are today. If all carers, every day, throughout the UK, take just a few minutes to learn about the history of one resident of their care home (Monday's Mr Simmons, Tuesday's Ms Lennox and so on), then we can make that six minutes into 600. Gill Kearsley is the co-founder of ExQoL, a provider of care-guidance seminars and therapeutic activities advice throughout the UK.

For further information visit http://www.exqol.com.

Steven Whateley

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