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Activities do not have to be costly, but are priceless
July 2014 | Activities do not have to be costly, but are priceless
Introduction 
The College of Occupational Therapy and the National Activity Providers Association have been working hard for many years now to raise the profile of the importance of person-centred activity provision in care-homes.  
They evidence through a whole body of work that activities are beneficial to people, and now, finally the topic is gaining the recognition and attention it deserves.  
The Alzheimer's Society?s 'Home from Home' report states 'Availability of activity is a major determinant of quality of life and affects mortality rates, depression, physical function and behavioural symptoms.' (2007, p5).  
The National Institute for Health and Care Excellence states 'A lack of activity and limited access to essential healthcare services can have a detrimental impact on a person's mental wellbeing.' (2013,p1).  
The COT, NAPA and Skills for Care have been collaborating and working really hard together to provide extra resources and training to promote activity provision in Social Care.  
They have been working with training companies to promote the vocational (QCF Levels 2 and 3) qualifications in 'Supporting Activity Provision in Social Care' and recruiting occupational therapists to deliver, assess and mentor, carers and activity organisers through the courses. NAPA also offers these vocational qualifications and is committed to ensuring that 'Activity is at the heart of care for older people.' (NAPA, 2014).  
The COT has compiled an excellent resource 'Living Well Through Activity in Care Homes: the Toolkit' which gives ideas to provide an activity service focused on residents' needs, preferences and activity choices.  
It is available to download free from their website (College of Occupational Therapists, 2014). 
CQC inspectors already look for evidence that individuals' needs are being promoted including physical, mental, social, personal relationships, emotional and daytime activity (CQC, 2010).  
They presently feel that there is room for improvement on finding out how people like to spend their time, provision of choices of activities and options for people to support their independence - particularly for people with dementia (CQC, 2013, p.6).  
The Care Quality Commission Strategy 2013 - 2016 'Raising Standards - Putting People First' proposes a number of changes to raise standards in health care. It pledges to improve inspections, ensuring that services provide a safe, effective, caring environment, are well-led and responsive to peoples' needs.  
It states 'We will work closely with our partners and the National Institute for Health and Care Excellence (NICE) so we are clear about the measures we use in our assessments' (Section 1, p.9).  
CQC has also been collaborating with NAPA on ideas for improvements of inspections of meaningful activity. NAPA have suggested that carers should be asked to explain to inspectors why residents sit where they do in a care-home, and how residents spend their day. 
By working collaboratively all these organisations are now far more influential, and finally NICE has recognised the importance of their work; in December 2013 it issued a new Quality Standard (QS50) titled 'Mental Wellbeing of Older People in Care Homes'.  
This calls on care homes to provide spontaneous and planned opportunities by trained staff during the day allowing residents to engage in meaningful activities of their choice, involving family and friends if the resident wishes, helping residents to express themselves and maintain their personal identity.  
This means that for the first time, activities in care homes will be regulated and this must be a catalyst for change.  
Are commissioning agencies, owners and managers of care homes really taking it on board'  
There is little doubt that some care homes are working very hard to offer person-centred activities to their residents.  
Since these homes believe in the importance of activity provision to keep their residents active and healthy, which ultimately promotes their independence; they employ an occupational therapist or activity organiser and allocate a specialised budget for activity provision. 
There are some excellent examples of practice. In particular, David Sheard from Dementia Care Matters is helping to change culture in dementia care homes and there are currently 56 homes in the United Kingdom known as Butterfly Service Homes adopting the Feelings Matter Most model of care: 
?Feeling you matter is at the core of being a person. Knowing you matter is at the heart of being alive. Seeing you matter is at the centre of carrying on in life' (Sheard, 2013 p.2) 
However there is another side to the coin; in comparison, the Alzheimer's Society's 'Home from Home' report found that the typical person in a care home spent only two minutes interacting with staff or other residents over a six-hour period of observation, excluding time spent on care tasks.  
Also that some people with severe dementia had been left alone in their room for hours with no attempt from staff to engage with them (Alzheimer's Society, 2007).  
These statistics are horrifying, but the recent policy changes will affect the way activities are inspected in care homes which will drive up standards.  
Training along with a whole-team approach will help raise standards of activity provision in care homes. 
The heart of Occupational Therapy philosophy is that all people share an innate occupational nature which exists in the framework of environment and time.  
Time reveals itself as a vacuum, inviting us to fill it with 'doing'. Without activity time weighs heavily on us.  
Therapy enables people to engage in activities and occupations that provide meaning and satisfaction and that support their physical and emotional well-being (Kielhofner, 2007).  
If people are bored and have no or little opportunity to engage in activities it affects their whole being: they may become depressed, give up on life, and ultimately may retreat inside themselves, withdrawing from their social network and environment. If people become depressed it affects their motivation to engage in activities, which can impact upon activities of daily living (getting washed, toileted, dressed and feeding themselves). 
When residents become less able through lack of motivation, it means that carers do more and more for the resident which can have an effect of de-skilling and reducing independence. Carers and other staff must use skills to motivate and encourage residents to continue to do as much for themselves for as long as possible. 
With the right approach from staff, even activities of daily living can be made into pleasurable activities rather than tasks.  
If carers are bright and cheerful, and promote the sensory aspects, any task can be a meaningful and pleasurable 'activity'.  
For example encouraging the resident to notice and smell the lovely coconut aroma of the soap, singing to and with the resident, bringing some fun into it, taking the resident to the window and discussing the weather and what can be seen, encouraging them to feel the fabrics and choose what they want to wear.  
If residents have cognitive failings, the Pool Activity Level (PAL) Instrument is very helpful in assessment and guiding carer support at the appropriate level for each individual (Pool, 2012).  
 
Assessment and planning 
Activity assessment and planning needs to be done in discussion with the resident, involving the family and intermittently reviewed. Every resident must have an activity plan. It should include: 
. Personal history. 
. Interest checklist. 
. Medical conditions and any sensory, physical or cognitive difficulties. 
. Risk assessment. 
. Outcome measures. 
 
Putting it into practice 
There are many aspects of therapy, the complexities of which are not always appreciated by the lay-person and the team may require training to appreciate the aims, objectives and risk assessment of activities that they deliver, and to help residents reach their full potential and well-being. 
Research shows that when staff are given such training from an OT it raised their understanding and interest in the importance of graded activities that are appropriate to each resident's ability and interests (Boyd et al, 2014).  
Occupational therapy promotes balance, motor, sensory, perceptual, cognitive, intrapersonal and interpersonal skills, spirituality, self-confidence, self-esteem, mood, and independence to name a few. 
Through engagement in graded activity, it helps to keep residents mobile and flexible, thereby promoting independence and control. For example, ball games keep arms flexible which helps a resident retain the ability to raise an arm to brush their own hair.  
Residents who want to, should be included as much as possible in daily routines for example folding paper napkins, laying tables, sweeping up, clearing plates away, washing up etc. 
Meaningful activity is all about correct activity care-planning and finding the 'right fit' for individuals; not everyone will want to help with domestic chores, but for a lot of ladies, this was their life role - and is still enjoyable and meaningful to them. Generally residents of all ages like to be active and feel that they are helping-out.  
Participation in activities needs careful observation and documentation in the individuals' care plans. During activity sessions carers should be helping the OT or activity organiser' by staff losing their inhibitions and getting enthusiastically involved in activities, it encourages the residents to do the same 'nobody wants to be the only one dancing on the dance floor!  
Carers in care homes have a difficult job and most of their time is taken up being involved in direct care tasks and observing people to ensure safety, but if everyone in the staff team makes even a small change in the way they work, it can make a large change overall. 
A skilled activity facilitator makes activity provision look easy but it can be draining, especially when giving so much of themselves to encourage and motivate residents to engage in activity.  
With hard work, good communication skills, determination and correct activity planning to explore graded activities that are meaningful to each individual, the most reluctant of residents can be supported to enjoy activities even if in their own discrete way.  
This also applies to residents who cannot verbally communicate and therefore who some inexperienced people may perceive can't 'do' activities, for example in later-stage dementia or stroke. Some residents just need more patience and skill than others who readily join in.  
When people can no longer join in with the more complex activities on offer, sensory stimulation/therapy can still be enjoyed by all so it is a very important aspect to bring into activity planning.  
Some examples are aromatherapy hand massage, music, singing, rhythm, movement, taste, touch, stroking animals and use of bright colour.  
The environment should also contribute towards interest and sensory stimulation, providing opportunities for hands-on engagement for example 'rummage boxes' of items for people to explore. Some homes also incorporate rooms or -stations for reminiscence? such as a pub, cafe music room or book library. 
 
Giving your activity organiser support 
OTs and activity organisers in care homes sometimes find themselves to be disregarded by the care home team which can be very de-motivating and de-moralising.  
This attitude needs to be changed in care homes, and to be cascaded down from the owners and managers. They must make clear at job interviews, in job descriptions, at staff meetings and supervisions that everyone is an activity facilitator, and must work as a team to support the O.T or activity organiser (if there is one).  
Activity organisers should receive ongoing training and supervision sessions to help them to define aims, objectives and outcomes of activities and to give them the underpinning knowledge and skills for their role. 
Those who deliver activities in care homes should be appreciated, respected and supported because they contribute so much to health, well-being, spirituality and quality of life for the residents. They need to be supported to avoid possible 'burn-out'. 
 
When you get it right 
The following two quotes help to evidence the benefits of activities. 
At a mental health and dementia nursing home in Devon the residents chose that they wanted to remember stories from the Bible.  
They were supported by the occupational therapist to re-create the story of Adam and Eve. Residents helped to make the props and took parts in the play-let, and the local priest was involved.  
A resident's comments demonstrate what he got out of the activity: 
'Fabulous. The best bit was the way people smiled and laughed - it set people free. If you are able to smile and laugh it frees you from your troubles. People have been taught religious stories in a light-hearted way before and it works'. I'm sure Jesus laughed.  
'Singing the hymns also set me free. I have troubles, I guess everyone has but whilst I watched the show I forgot about them. It's nice to remember the stories from the bible' 
At the same nursing home, a comment from the daughter of a resident demonstrates the difference that personalised activities can make to a person's life: 
"I think activities in a home can be very under-valued by management, other members of staff and visitors. 
"Too many people have the attitude that those with dementia aren't worth bothering with or that -where's the point they won't remember in a couple of minutes".  
"Some people don't seem to realise that when a person is made to feel 'happy' even if they can't remember why they feel 'happy' the wonderful feel good factor can stay with that person for a long time.  
"When you are just sat in a home and there is almost nothing going on around you, you switch off into a world that is a very sad and lonely place. Therefore being part of an activity is so important. 
"I think my dad benefits from your visits because you bring life into his life. You treat him as an individual who has needs, and who needs to know he matters. Your activities make him 'happy'.  
"They make him feel that he is alive and that someone cares.  
"Being part of an activity also allows him to be part of a bigger picture giving him a sense of belonging. You found out what his likes and dislikes are and provide him with stimulation to suit his needs. Besides football dad loves music, singing and dancing. You found that out. Dad has lost the ability to have a conversation but you found that you can communicate with him and make him happy by singing with him. You always make him smile. Thank you so much." 
 
Conclusion 
This article has explored some of the benefits, complexities and barriers to person-centred activity provision in care homes using a 'whole-team' approach, and has given some sign-posting to resources promoting good practice.  
As previously mentioned, activity is at the heart of the occupational therapy profession. Presently, there are few occupational therapists employed in care homes, but it is an emerging role for occupational therapists and it makes total sense that occupational therapists - specialists in activities, should be playing a larger part in training, guidance and leading the way to 'getting it right'.  
Every individual in every care home deserves to be given opportunities to engage in meaningful activities of their choice as a right not a privilege.  
Why not print this article for a care home staff room that you know, and help to make a change?
More News From Caring UK
Gloria visits Isleworth care home
July 2014 | Gloria visits Isleworth care home
GLORIA Hunniford, ambassador of National Care Home Open Day, visited Barchester's Atfield House in Isleworth to get the day's celebrations in full swing. 
Gloria signed the visitors' book before heading to the World Cup themed lounge where a football quiz was underway. 
As part of National Care Home Open Day, care homes around the country took part in a Mexican care wave. As the BBQ was lit and everyone headed out to enjoy the summer sunshine, Gloria kicked off the garden party with a care wave.
Hyndburn care home welcomes Mayor
July 2014 | Hyndburn care home welcomes Mayor
AMORE Care's Addison Court care home welcomed the Mayor of Hyndburn, Judith Addison to join in with a 'Dementia Friends' session. 
During her visit the Mayor viewed the new Namaste care room, a worldwide programme that provides compassionate, holistic and person centred care.  
She took the opportunity to chat with residents and was presented with flowers by Alice Wallwork, a resident who was previously Mayoress of Accrington when husband Wilf was Mayor.
Employees give up their time to help local community
July 2014 | Employees give up their time to help local community
A NUMBER of employees from large corporate companies give up a day in the office to give their time to helping in the local community. 
Brunelcare had over 80 volunteers overall from both Lloyds Banking Group and Pricewaterhouse Coopers to help out with various projects, from boat trips in the sun to gardening and shed painting. 
Robinson House in Stockwood, Bristol welcomed 30 volunteers from PwC to help give the care home garden a makeover. The residents enjoyed watching and in some cases joining in, followed by a fish and chip and wine lunch in the garden. 
Glastonbury Care Home also welcomed 15 volunteers from Lloyds Banking Group to help with a garden makeover. 
Lloyds also hosted two day trips for clients from the operator's day centres in Bristol, Clevedon and Portishead that help and support those living with dementia and their carers and families. Twelve volunteers took a group to the Brean Down tropical bird garden, with a further 24 taking over 50 clients and relatives on a boat trip around Bristol. 
Lloyds Banking Group volunteers are pictured with the day centre clients before boarding the boats
Mayor opens new homecare branch in Poole
July 2014 | Mayor opens new homecare branch in Poole
THE new Mayor of Poole has officially opened Eleanor Care's new homecare branch in the town. 
Councillor Peter Adams, and his wife Brenda were on hand to cut the ribbon at an open day to mark the official opening of the branch. 
Eleanor Care, which operates throughout London and Poole, Dorset, provides a range of care services including home care, live-in support and specialist care. 
Attendees at the open day included Eleanor Care staff and service users, local authority staff and individuals from the local community who were looking for jobs. The open day gave people a chance to meet Eleanor care workers and services users and learn more about the company, the services it provides and career opportunities within the company.
Property News From Caring UK
Bondcare invests in North East care homes
July 2014 | Bondcare invests in North East care homes
BONDCARE is investing more than £1m in major refurbishments at four of its North East care homes. 
Allan Court in Benwell, Newcastle; Debaliol Care Home in Newbiggin-by-the-Sea, Northumberland; Donwell House Care Home & Day Centre in Washington and Redworth House in Shildon, Co. Durham, will all benefit from the investment. 
Allan Court will undergo a full refurbishment of its lower ground floor to create a seven-bed learning disability unit. The refurbishment will include a new heating system, new lounge, kitchen and diner and a full re-fit and redecoration of the home's bedrooms.  
Debaliol will also have a new heating system installed and its public areas and some bedrooms refurbished.  
Donwell House will have a new heating system fitted, some of its bedrooms refurbished and improvements made to the car park and the home's gardens. And Redworth House will benefit from general improvements to the public areas in the homes, including new carpets throughout.  
Chris Denton, manager at Allan Court, is pictured with resident Annie Hunter and Steve Massey, north east regional manager of Bondcare, choosing materials.
Loan facilitates home's £1.1m expansion
July 2014 | Loan facilitates home's £1.1m expansion
Barclays has provided funding to support Peverel Court Ltd's expansion plans at Bartlett's Residential Care Home The loan has helped facilitate a £1.1m expansion project and complete the first phase of a new 14-bed extension at the facility in the Buckinghamshire village of Stone, a short distance from Thame. Bartlett's Residential Care Home, which is owned and traded by Peverel Court Limited, is a Victorian country house built in 1856 and offers residents around the clock personal care including those with the early onset of dementia. The newly completed extension will allow the care home to increase the number of residents to 38 and will create eight new jobs to take the staff teams to 38. 
Barclays relationship director Neil Chandler is pictured with Peverel Court managing director Anil Dhanani.
Residents and supporters celebrate the opening of new retirement development
July 2014 | Residents and supporters celebrate the opening of new retirement development
A NEW retirement living development has been officially opened in Market Harborough by Methodist Homes. 
Rev Alison Tomlin, who lives in the town, cut the ribbon of Welland Place, one of the newest services from MHA. 
Welland Place has 100 one and two bedroom apartments for people over 60, with individualised care and on site support available 24 hours a day and options for sale, rent or shared ownership. Facilities for residents include a gym, spa, swimming pool and landscaped gardens. 
Residents and local supporters were welcomed by MHA Board Member Norman Mann, followed by a thanksgiving service with contributions from residents and the local Methodist Church.  
Manager Richard Haddon said: "We offer privacy and independence with total peace of mind, the best of both worlds, in a community of like-minded friends and neighbours. Several people have already become firm friends and the new community is growing and evolving all the time." 
MHA also offers residential and dementia care at Aigburth care home in Oadby, Leicester.
July 2014 | Home approved despite residents' opposition
PLANS for a new 44-bed care home in a Suffolk town have been approved despite vociferous opposition from local residents. 
Tanner & Tilley Town Planning and Development Consultants were successful in obtaining planning consent for Angel Care to construct the facility after a more ambitious scheme was rejected on appeal in January 2012. 
Angel Care's Sandip Ruparelia said: 'This approval means this scheme can now go ahead, enabling much needed extra care accommodation to be provided for the residents of Woodbridge.' 
Tanner & Tilley operations director John Montgomery told the Development Control Sub-Committee the new application fully addressed the appeal inspector's concerns regarding effect on the amenities of surrounding properties and, in particular, those in Godfreys Wood to the rear.   
The committee heard from local residents who opposed the scheme before granting planning permission, but only on the chairperson's casting vote.
July 2014 | Karim adds Valley Lodge to his portfolio
HEALTHCARE operator Karim Rajan has completed the acquisition of Valley Lodge care home in Chandlers Ford thanks to loan facilities from The Royal Bank of Scotland 
He plans to increase the facilities at the 30-bed specialist dementia facility by extending the existing property as well as undertaking a full refurbishment which will provide a better living environment for its current residents.  
The work on the extension, which will take the registration up to 43, is expected to commence in September and will be carried out sensitively to ensure there is as little disruption as possible. 
Other homes in Karim's portfolio include Grasmere Nursing Home in Worthing, West Sussex and Shangria-la Care Home in Lee-on-the-Solent, Hampshire.
Current & Upcoming Events
09/09/2014 | Care Providers Conference - Elderly Care&Positive Choices in conjunction with West Midland Care Association, Black Country Living Museum
10/09/2014 | Care Providers Conference -Elderly Care/Positive Choices, Leeds United Football Club