Rituals and routines are important and one of mine is that as I get my 2 and ¾ year old daughter up in the morning (the ¾ is important in nursery politics) I ask her did she have any dreams. She usually – unless grumpiness is present due to the early rise – says ‘Yes.’ When then asked ‘What about?’ She replies, ‘Monkeys and crocodiles’. Never ‘Crocodiles and monkeys.’

I am one of these folks who has never been able, with the odd exception, to remember my dreams but I know that the world of dreams is a very important part of our health and wellbeing. Yet despite years of analysis and debate from Jung to Wallace, why we dream remains one of the great mysteries of psychology. Some say its to do with consolidating our memories, others that dreams provide an enactment of threats to prepare response, and yet others that they are to do with regulating our emotions. Hundreds upon hundreds of books have been written about dreaming not least around the belief that dreams are a gate to greater insight, and in some cultures that they provide insight into the future in the nature of being premonitions.

Not surprisingly I am not going to discern that mystery today – give me some more sleep and I will try.

But there is another sense in which we talk about dreaming and that is the imagining of a world or a reality which is different to the one we are currently experiencing. Perhaps this sense was best encapsulated by Martin Luther King whose immortal speech, ‘I have a dream’ led a people to struggle and gain freedom from discriminatory law and behaviour in the 1960s Civil Rights movement.

Today is the last day of the inaugural Care Home Week and it is about ‘dreaming…’ It is a day where you are invited to dream with your imagination firmly rooted in reality about a new future and about different possibilities for the shape and life of care homes in Scotland.

We know the challenges that we face with an ageing population and reducing resources. We know the need to attract more and more committed individuals to work in our care homes and to properly reward and respect those who dedicate their lives to the work of care. But we also have, in the midst of challenge, to give space to be able to dream. We have to have the power to imagine better.

What do we want care homes to be and to look like?

Might we dream of a time when the old are not just considered as recipients of care and support but are recognised as contributors and valued citizens with still much to give?

Might we dream of a time when the physical care home building was a place at the heart of our community with doors open in safety to a neighbourhood which saw it as a place of happiness and enjoyment; of value and worth; of insight and surprise?

Might we dream of care as being seen as a critical role for our society intrinsic to making us a human community, well-valued, with good status and appropriate remuneration? A role held equally by men as by women, by the young as well as those not so young.

Might we dream of care homes being sufficiently resourced that they are able to be properly staffed so as to offer excellence in the care and support of conditions as diverse as dementia or multiple sclerosis or cancer?

Might we dream of care homes as places where poets and painters, musicians and politicians, dancers and dreamers live and spend their time? Places where death sits as comfortably as life, where honesty abounds and risks are entertained?

Might we dream together and make our dreams for care homes a reality for as John Lennon once said:

A dream you dream alone is only a dream. A dream you dream together is reality.

Happy care home dreaming.

Donald Macaskill

@DrDMacaskill

Carers, families and care homes

Moving into a care home can be a big decision that brings about many changes to people’s daily lives. Some of these changes will be welcomed by people and their families because they bring more safety and security, as well as the friendship and companionship that may be found from being around peers.

Carers often say that they have conflicting feelings about making a decision with or for a person that they have to move into residential care.  Carers have told us that they experience a mixture of sadness and guilt, whilst also feeling some relief that the person they are looking after will be given a level of practical care and assistance that is now too difficult to maintain at home.

 “I know the feeling of having a huge weight lifted off your shoulders.  It’s what I felt when I made the decision that my brother had to be in a care home, and simply could not live independently any longer.  I also know the guilt that comes with that decision.”

Anon: Carers UK Carers Forum user.

For some carers, the person moving into a care home will be their spouse or partner.  In the case of older people, very often, they will have been married and living together for 50 or even 60 years. For both, the idea of living apart may be unimaginable and heart-breaking.

 “After 42 years of marriage, I miss her beyond belief.  For even when she was ill, she was a presence in the home.”[1]

It’s important that staff in care homes recognise these difficult feelings and the fact that, for many carers, caring simply continues but in a different way.  Many carers say they visit every day, help at mealtimes and in activities and take their loved one out on trips.  Involving carers and families can be crucial to the wellbeing of the person living there.

It’s important to encourage and support family life.

Care homes do and should actively work to involve carers and families and they should be encouraged to be a key part of their loved ones lives. Carers can help in bringing in personal items to decorate the person’s room, with advice on the person’s likes and dislikes, and information about what the person does as part of their normal routine.

Families, especially couples, should have time and space for private, undisturbed time together.  Where possible they should also be encouraged to take the person out to visit local places such as cafés and shops and local events… or to help them maintain interests, hobbies or clubs.

Care homes can set up a carers and families group (if there isn’t one already), where all the carers who feel like it could get together to support each other and perhaps work together for the home – fundraising or organising outings are often popular. Also they can share their concerns, and come to staff together with any issues.[2]

Useful resources for carers, families and people working in care homes:

• Video: Living in a care home: a positive outcome for a person with dementia

http://www.scie.org.uk/dementia/supporting-people-with-dementia/living-care-home-positive-outcome.asp

•  The Relatives and Residents Association has a range of resources for families, carers and workers. http://www.relres.org/

NOTES:

[1] Read more: http://www.dailymail.co.uk/femail/article-2537556/I-wife-care-home-I-bear-guilt.html#ixzz4jVqVitHk
[2] Taken from (amended) http://www.scie.org.uk/dementia/carers-of-people-with-dementia/supporting-carers/hospital-and-care-homes.asp

Since beginning my role as Workforce Development Consultant with Scottish Care in March this year I have been so impressed by the dedication and passion exhibited by the many people I have met from organisations across the country.

In particular, the enthusiasm for delivering the highest standards of care by our front line colleagues has been humbling and energising.

Scottish Care’s Workforce Groups have been very well attended by representatives of every level within services. From Directors and Managers of services, the commitment to improving the experience for every one involved (both those receiving care and their families, to their own employees) has been evident and so encouraging. The positive attitude to innovation and the extra lengths services are prepared to go to in order to ensure people receive care and support that truly addresses their needs is something that we need to be more vocal about.

We have a sector full of ideas, energy and courage. Having the bravery to attempt new things when gaps in provision are apparent and there is little or no resource to fill them shows just how caring the Independent Sector is.

There will be other blogs this week which capture this, not least the one by Alison McPherson. Alison is Home Manager at Hillview Care Home and has prepared a blog that I would insist everyone should read. I will say no more than that as I could not do it justice!

While the commitment to care of senior staff has been so refreshing, as I said at the beginning of this piece, I have been most impressed by the front line workers that I have met and heard speak at groups and events.

We live and work in a time where the number of people requiring care is increasing daily. With this comes the heightened responsibilities of providing more and more critical levels of care to individuals who are living in their own homes longer. As a result, an increasing number of individuals are moving into care homes at a point where needs are far more complex than in previous times.

Despite the amount of differing pressures that our workforce are faced with each hour of every day, the dedication to improve the lives of everyone they work with has been imprinted on our Workforce Groups like words through a stick of rock.

From workers acting as Dementia Ambassadors attending our Promoting Excellence Group and speaking with such conviction and passion about what they do, would like to do, and what needs to happen to enable it – to care at home and care home colleagues speaking with such care and compassion about the palliative and end of life care they provide so frequently and want to improve on, it is evident that our workforce have the knowledge and drive to care for us all long into old age and beyond.

At a time when care services are more embattled by challenges than ever, the voices of the workforce tell me that we are in good, caring, hands.

Personalisation, Participation and Activities

My name is Gail Melville, I am the activities co-ordinator at the Balhousie Lisden Care Home in Kirriemuir. It is a genuine pleasure to spend time with residents, assisting and entertaining them in their home. As such, I take my role here seriously, and know firsthand how important participation and activities are in a care setting to enhance a person’s well being.

What my job entails:
My job includes lots of planning, budgeting and time management. I make sure residents’ birthdays, special occasions and seasonal occasions are celebrated, with parties, concerts or events to honour them such as Burns Suppers, Halloween, Easter and Christmas Parties, Open Day Summer Fete etc. A lot of this involves effective relationship building and communication with local community groups and organisations, as social engagement and inclusion for our residents is a high priority. Sourcing and planning outings for residents to various places is also part of my role. This can be from a one-to-one visit into town to do some shopping, right up to taking residents to our local ‘Music Cafe’ for song and community singing, joining the ‘Friday Fling’ dancing and socialising group organised by Alzheimer Scotland or taking residents to visit local landmarks and organisations such as The Guide Dogs for the Blind Association and Kirriemuir Connections etc. I also plan activities and groups involving the community such as a monthly Reminiscence Group in association with Angus Alive and Kirriemuir Library, as well as intergenerational projects involving nurseries, schools and community groups such as DD8 Music and Kirriemuir Connections, and arrange and attend meetings to make these happen.

Planning activities to meet the different needs of residents can be quite challenging at times, however, working alongside residents, their friends and families to find out their likes, dislikes, past and present hobbies and interests, and by communicating with them and compiling participation care plans, all help me in getting to know everyone’s individual needs and desires and planning accordingly.

My job role includes facilitating and carrying out activities for residents, ensuring they are enjoying what they are participating in and adapting activities to meet individual needs. I regularly communicate with residents and staff to inform them of the activities going on, when and where, and I make up and distribute a weekly activity guide, along with posters and information for our display boards around the home.

I also help to guide and mentor volunteers we have working within the home, such as senior pupils from Websters High School who assist with group activities.

Activities I carry out on a regular basis include:
General Knowledge Quiz, Movement to Music and Seated Exercises, Arts & Crafts, Bingo and other group games, Hand Therapy and Manicure, Skittles and Golf, Music Therapy, Gardening Group, Cooking & Baking, Pet Therapy, Cinema Afternoon, Accessing Outdoors, Weaving & Wool Crafts, One to One Time etc.

Another important aspect of my job is logging the activities I do every day in my Residents Activities Records folder. This folder contains a participation and engagement file for each resident, where I record their engagement and participation i.e. activities they have attended, how they engaged, any positive or negative outcomes, and improvements or suggestions etc. This folder contains no medical information and I regularly encourage staff, friends and relatives to read or add any information that is of benefit to resident’s participation.

Why I enjoy my job and do what I do:
There are many reasons I enjoy my job, but the main one for me is the reward of making someone happy. I know firsthand how important participation and activities are in enhancing a person’s well being. In my experience, it is often the littlest things in life that bring the highest of rewards, and if I can play some part in contributing to making our residents day a happy and fulfilling one, contributing to their self esteem, confidence and spiritual wellbeing, then I know I have succeeded in my role.

Dementia Ambassador:
My background prior to working with Balhousie Care Group is in Mentoring and Team Management and also facilitating non medical Mental Health Care i.e. alternative therapies e.g. Art Therapy, Music Therapy, Design, Meditation, Diet, Physical and Mental Exercise, Yoga, Pilates etc.

Over the past 3 months I have taken on the additional role as Dementia Ambassador within Lisden Balhousie. I feel that the additional knowledge I am learning ties in very well with Personalisation, Participation and Activities in the Care Home setting.

A large number of our residents have dementia, varying from early onset right up to advanced stages. Taking a personalised approach regarding everyone we care for is vitally important in delivering the highest standard of care and in understanding each of our residents needs are met.

As much as the facilitation of activities is important, in my experience, it is vitally important to provide our residents with the right environment to suit their needs. This can be something as simple as making sure that furniture is arranged in the correct way; that contrasting cushions are placed on chairs; areas of access are open and visible; noise levels are appropriate etc. I am always mindful also of the changing needs of those I care for. As their dementia may progress, so too may their needs change, therefore it is necessary to update my care plans accordingly, and to always be mindful that a success one day may be unsuccessful another day, so adaptation, an open mind, understanding, patience and resourcefulness are key to everything I do.

My Daily Moto:
• “Treat others with the care, compassion and understanding as you wish to be treated yourself”
• “See the person, not the illness”