The hand that stopped trembling

Creative activities in UK care homes work wonders.

16.12.2013

Jack lives in a home for retired people. At meal times Jack causes problems because he has some element of tremors in his hand coordination.  As a consequence the home care staff take extra precautions by laying out protective sheets on the floor around Jack as he eats and drinks. It has not been thought necessary for him to be fed by someone else and it is possible that he would refuse anyway.

Despite all this extra work for the staff any observer would see that meal times were not seen as a problem with all parties being very friendly and supportive.  This is fortunate because it is possible that in other similar situations staff perceptions of Jack may be limited to observations made at meal times and the extra ‘nuisance’ work required.

A few years ago I was able to fund a small arts based initiative in Jack’s home.  The idea was to train the residents AND the staff in some form of creativity.  The aim was to show that creativity had no upper age limit, that to succeed in locations such as this there had to be full collaboration and cooperation between staff and resident.  The arts organisation which was to provide the training researched an appropriate home and Jack’s was chosen.

Care roles reversed

The art forms chosen were paper craft and glass painting. The paper craft did not prove popular and was soon dropped but the glass painting became a huge success, with staff supporting resident and resident supporting staff thus completely reversing usual dependency roles.  Normally in care settings the older resident is dependent upon the caring staff for many or most of their needs. This creates complex relationship issues of guilt or resentment at needing the help of others and annoyance at or even power over the older resident felt by the carer. So to create a situation where the older resident can support and encourage the carer is quite rare. Roles are reversed, the person cared for feels of value; and the care staff discover a new dimension in their charges. Also, when very personal tasks are being performed – often in embarrassing silence, the shared experience provides a safe source of conversation.

Normally when a care home puts on any activity it is not usual procedure for care staff to be involved.  In some homes a dedicated activity organiser is employed.  In other instances outside organisations are invited in to ‘stimulate’ or at least ‘occupy’ the residents.  During these times the care staff can ‘escape’ to do other things or take a break.  So to undertake an activity which involved care staff alongside residents was quite unusual.

This particular opportunity arose not long after I had written a short report about the dearth of educational, creative and stimulating opportunities for older people in care settings. (Fourth Age Learning Report. Department for Education & Employment (DfEE), 2000).  It was an ideal opportunity to test out some of the suggestions and recommendations made in the report.

Creative activities ignored in care homes

For over 25 years my work in various locations has been about the creation and maintenance of educational opportunities for older people – for whatever purposes and in whatever location. The educational participation statistics in the United Kingdom (NIACE) and across Europe (Eurostat) indicate that educational participation reduces with age.  Similarly in the UK old age has become synonymous with the need for care – although the reality does not accord with the myths and perceptions – only 15% of people in the UK over age 65 receive social care and only 3% of people over age 65, 18% of those over age 80 and 28% of those over age 90 live in residential care.

So, for many years I have attempted to focus on the educational needs of older people in care settings either in residential or nursing homes or in their own homes. In that time I have noticed that the records kept of residents’ behaviours, health, demeanour and day to day social interaction tend to ignore creative activities.  With a wide range of different professions in the UK engaged in ‘care for elderly people’ – health, housing, social care and welfare, there has been a tendency for services to be disjointed and individual care plans restricted to medication issues rather than present a ‘whole life’ perspective.

Therefore “activities” are usually viewed simply as an opportunity for the care staff to ‘escape’ and as a short time where the residents are occupied or amused.  What this activity proved was how wrong this limited perception is.

In the United Kingdom care home staff are not well trained and because of the low pay and low perceived status of the work there can be very high turnover of staff which creates instability and a less than harmonious working and living ambience.  The arts organisation however chose this location wisely.  The local authority and management were quite supportive of such work with the assistant manager being particularly enthusiastic. Her enthusiasm was an important factor in the success of the programme.

My observations were limited to just two visits but I received regular reports from the artists.

Steady hand

The stand out achievement and ‘change’ was in Jack.  When he was holding a paint brush in his hand there were no tremors – none at all.  Now if the activity had excluded the staff this fact may well have gone unreported: the artists, on the other hand, would not have known about Jack and mealtimes.  Perceptions among staff and other residents about Jack changed. He was seen differently and more positively.  His care records would note this behavioural change and it could be built upon. He would no longer be seen as a burden and source of work but as an individual with an artistic flair which seemed to overcome his disability. Could this improvement be built upon?  What other dimensions of Jack were unknown to those around him?

In addition it was commented that in several instances it was the residents supporting and encouraging the diffident and lowly confident staff to be ‘creative’.

Benefits for staff

During a review meeting at the end of this stage of the programme one care worker who acknowledged her own poor educational background and low self esteem acknowledged that creativity and learning were central to care and not luxuries.  It gave her confidence to look at her own personal development; it gave her other things to talk about with the residents – particularly when undertaking very personal tasks. It enhanced job satisfaction and had the potential to reduce staff turnover.

The local authority – owners of the home – observed the activity and supported the Deputy Manager as she attempted to get other homes in the town to do something similar – and of course the biggest barrier was staff and managers’ attitudes – reluctance and suspicion bred from ignorance and fear.

In 2009 the Department for Business Innovation and Skills (the successor to DfEE) with NIACE revisited this work through its Enhancing informal learning for older people in care settings. (Aldridge F.). Aldridge’s consultation document and interim report drew on ten case studies looking at learning in care settings which included the use of making music, looking at and appreciating museum items and fine art collections, and educational arts workshops –  thus highlighting not only the importance of creativity in later life among older people dependent upon others for some aspect of their care or daily living but what is possible.

Whilst the activities are often negotiated and created for groups of older people – mainly for financial reasons – it is the individual development which is important. According to Aldridge the individual benefits can include:

• improved confidence, self esteem and sense of well being
• better physical and mental health
• increased mobility
• improvements in motor skills
• lower levels of depression
• lessening of incontinence
• less dependency on medication
• faster recovery rates
• better ability to manage pain and illness
• increased levels of resilience and ability to cope
• changes in behaviour
• maintenance, and for some, improvement of attention, communication and memory skills
• reduced dependency on others
• reduced isolation
• development of stronger relationships between carers and those being cared for
• increased sociability with other older people being cared for
• greater levels of engagement, by providing opinion, speaking up and communicating with others
• development of new skills
• improved levels of motivation to participate in day-to-day activities, and
• greater enjoyment of life – something to look forward and to talk to others about.

Why does it work?

This is an impressive list – what it does for the individual is that it indicates that they still have potential, a role to play and to be of value rather than being perceived as a burden. It encourages reflection about life’s experiences and future fears and dreams. It creates opportunities for self expression in very broad ways, not just through writing and perhaps speaking but through creative expression.  For some people this may be the first time in their lives that they have had the opportunity and been given the encouragement to be creative.

For Jack there will be scientific reasons for the change in his actions, the desire to be engaged transcended the normal messages to his hands; feeding the mind was more important than feeding the body; the visual impact on others immensely strong and emotive. Initially Jack himself was probably unaware of his actions.

These are powerful forces.  For society as a whole the potential cost benefits are enormous, the research evidence on the social and personal benefits of engagement in learning is accumulating and fully supports and affirms the actions of those practitioners who have believed that there is no limit based on age or care location to our potential to be creative.

Not only should we all be affirming creativity at all stages and ages of life, it seems we should also be looking at creativity in our social care, health, housing, welfare, and educational policies to ensure that the opportunities described above are made more accessible to others and the ‘gate keepers’ to such developments are better trained, supported and encouraged to be creative themselves.

This article is produced in cooperation with the InfoNet adult education correspondents’ network.

 

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References

Soulsby J. (2000). Learning in the Fourth Age 2000. NIACE and DFEE.

Aldridge F. (2009). Enhancing informal learning for older people in care settings. Interim Report and consultation document 2009 NIACE and BIS.

Audit Commission (2008). Don’t stop me now.

Jenkins A & Mostafa T. (2012). Learning and Wellbeing Trajectories Among Older Adults in England. BIS Research Paper Number 92. November 2012. Department for Business, Innovation and Skills.

McNair S. (2012). Older people’s learning in 2012. A survey. NIACE 2012.
Active ageing and solidarity between generations. A statistical portrait of the European Union 2012. Eurostat statistical booklet 2011.

Schuller T. & Watson D (Eds.)(2009).  Learning through Life. Inquiry into the Future for Lifelong Learning. NIACE 2009.